Women’s reproductive health and economic activity: A narrative review

Abstract

• Income per capita moderates the effect of fertility on female labor force participation across LICs, MICs and HICs. • In LICs, fertility is high, and women work in the informal sector. Household income sharing is not always practiced, and women must work. • In LICs, women devise strategies of birth spacing, informal childcare, and switching job-type to enable childrearing and work. • In HICs, women work in the formal sector, but career advancement and gender wage gaps persist despite supportive policies. • For all women around the world, attaining the combination of reproductive empowerment, along with decent work, is a challenge. This paper provides a narrative review of the literature that addresses the connection between women’s reproductive health and women’s economic activity. Women’s reproductive health, gender equality and decent work, are all part of the Sustainable Development Goals and this review highlights how these Goals are interconnected. The review focuses on the relationship between fertility and women’s work and provides a detailed discussion of the academic literature that identifies the causal effect of fertility on changes in female labor force participation. Fertility is captured by timing, spacing and number of children, and career advancement, job quality, and hours worked are addressed on the work side. The review contrasts the fertility-work nexus for low-, middle- and high-income countries separately, recognizing national income per capita as a moderator of the effect of fertility on female labor force participation. In low-income countries, where labor force participation is for the most part in the informal sector, women must adopt their own strategies for balancing child rearing and labor force participation, such as selection of job type, relying on other women in the household for childcare, and birth spacing to limit infants in their care. In middle-income countries, women juggle child rearing and labor force participation with the overarching issue of income inequality, and early childbearing and lone motherhood perpetuate poverty. For women in high-income countries, social protection policies can assist women in managing the balance of childrearing and work, but these policies do not address underlying issues of gender inequality. Despite these policies, career advancement is interrupted by childbearing. As the relationship between fertility and women’s work varies by income per capita across countries, polices that support women in achieving balance in their desired family size and accessing decent work varies across countries.