Childfree Lifestyle Research Articles

Voluntary Sterilization for Childfree Women

Approximately 47 percent of women ages fifteen to forty-four are currently without children, and slightly more than 20 percent of white women in America will never bear children, the highest percentage in modern history. Many fertile women who are childless are voluntarily so. Although any competent person twenty-one years or older is legally eligible for voluntary sterilization, many doctors refuse to sterilize childfree women. This essay explores various reasons a woman would want to continue in her childfree lifestyle, evaluates the accessibility of sterilization for women who are childfree by examining the reported reasons for denial of sterilization-both from the woman's and the physician's perspective-and assesses the legal status of voluntary sterilization for nonparous women. The essay also urges physicians to follow recommended guidelines for counseling women who, regardless of parity, desire sterilization and to provide this contraception if, after careful consideration, there are no outstanding health or other reasons that the procedure should not be performed.

Resilience in infertile couples acts as a protective factor against infertility-specific distress and impaired quality of life

Our hypothesis was that resilience (=psychosocial stress-resistance) reduces infertility-specific distress and maintains quality of life of infertile couples. Questionnaire data of WHO Quality of Life assessment (WHOQOL; domains: 'physical', 'psychological', 'social relationships' and 'environment'), Fertility Problem Inventory (FPI; scales: 'social concern', 'sexual concern', 'relationship concern', 'rejection of childfree lifestyle' and 'need for parenthood'), Resilience Scale (RS), as well as sociographic and medical data were available for 199 infertile couples. Age, medical diagnosis and 'intensity of desire for a child' had no influence on quality of life. High scores on 'suffering from childlessness' went along with less satisfaction on 'physical' and 'psychological' domains for the women only. For both partners, high scores on 'suffering from childlessness' went along with higher scores on all FPI scales. High resilience was associated with high scores on all WHOQOL domains for both partners, also with low scores on all FPI scales except for 'need for parenthood' for the women and with a low score only on 'relationship concern' for the men. For infertile couples, resilience can be considered as an unspecific protective factor against infertility-specific distress and impaired quality of life. When offering counselling to involuntarily childless couples, awareness should be raised for resilience as a couple's resource and a "generic" factor of coping.

Direct and indirect effects of perceived social support on women's infertility-related stress

Social support can be a critical component of how a woman adjusts to infertility, yet few studies have investigated its impact on infertility-related coping and stress. We examined relationships between social support contexts and infertility stress domains, and tested if they were mediated by infertility-related coping strategies in a sample of infertile women. The Multidimensional Scale of Perceived Social Support, the Copenhagen Multi-centre Psychosocial Infertility coping scales and the Fertility Problem Inventory were completed by 252 women seeking treatment. Structural equation modeling analysis was used to test the hypothesized multiple mediation model. The final model revealed negative effects from perceived partner support to relationship concern (β = -0.47), sexual concern (β = -0.20) and rejection of childfree lifestyle through meaning-based coping (β = -0.04). Perceived friend support had a negative effect on social concern through active-confronting coping (β = -0.04). Finally, besides a direct negative association with social concern (β = -0.30), perceived family support was indirectly and negatively related with all infertility stress domains (β from -0.04 to -0.13) through a positive effect of active-avoidance coping. The model explained between 12 and 66% of the variance of outcomes. Despite being limited by a convenience sampling and cross-sectional design, results highlight the importance of social support contexts in helping women deal with infertility treatment. Health professionals should explore the quality of social networks and encourage seeking positive support from family and partners. Findings suggest it might prove useful for counselors to use coping skills training interventions, by retraining active-avoidance coping into meaning-based and active-confronting strategies.

Invasive prenatal testing decisions in pregnancy after infertility

This study assessed decisional conflict about invasive prenatal testing among women pregnant after infertility. We surveyed 180 pregnant women with a history of infertility using a mixed methods cross-sectional design. Difficulty in deciding whether to have prenatal testing was measured using the Decisional Conflict Scale. A minority of women (31%) chose to have invasive prenatal testing. Most participants (72%) reported low decisional conflict (score < 25; mean = 22.1; standard deviation = 23.2; range: 0-100). Half (53%) of the participants said that infertility made the testing decision easier. Qualitative data suggest that infertility makes the decision easier by clarifying relevant values and priorities. Most infertility characteristics studied were not significantly associated with decisional conflict. Variables associated with higher decisional conflict included infertility distress due to rejection of a childfree lifestyle, disagreement with others about testing, and choosing to have invasive testing after having had treatment for infertility. For some women, infertility may make the invasive prenatal testing decision easier. Women with the greatest need for decisional support were those who have had treatment and choose invasive testing, who disagree with others about their testing choice, or who are particularly distressed about being childless.

Psychometric properties and factor structure of the Fertility Problem Inventory in a sample of infertile women undergoing fertility treatment

Objective to examine the psychometric properties of the Fertility Problem Inventory (FPI) originally developed by Newton et al. (1999); as there are no data concerning the factorial structure of the FPI, a special focus is placed on construct validity through factor analysis. Setting public hospital in Athens, Greece. Design a cross-sectional study. Participants 108 women undergoing fertility treatment with in-vitro fertilisation. Methods the FPI was ‘forward–backward’ translated from English to Greek. The translated instrument was then administered to a set of infertile women for pilot testing. Principal axis factoring with promax rotation was used to test the factor structure of the FPI. Measures of anxiety State Trait Anxiety Inventory, depression (Center for Epidemiologic Studies—Depression Scale) and mood states Profile of Mood States were used to assess the convergent validity of the FPI. Cronbach’s α was used to measure internal consistency of the FPI scales. Findings exploratory factor analysis suggested four factors. The majority of relationship and sexual concern items grouped into one solid factor, named ‘spousal concern’. The original scales of social concern, need for parenthood and rejection of childfree lifestyle were reproduced after rearranging nine cross-loading items. Construct validity was confirmed by computing correlations between the derived FPI scales and conceptually similar constructions of anxiety, depression and mood states. Internal consistency reliability was satisfactory. Conclusion the FPI was found to have a relatively stable factor structure and satisfactory reliability, and convergent and discriminant validity. The FPI may enable researchers and clinicians to apply a reliable measure that focuses on various/many dimensions of infertility-related stress.

Investigating the Effect of Socio-Economic Status on Perceived Infertility-Related Stress in Women

Background: Infertility, the inability to conceive a child after 12 consecutive months of unprotected sexual intercourse, is a medical concern for 10-15% of Canadians. For some females, the ability to bear children defines them as a woman and the inability to do so bears a certain stigma. While advancements in medicine have led to assisted reproductive techniques, such as in vitro fertilization, infertility is still a source of significant chronic stress, marital discord and sexual dysfunction. Some studies have shown that social position can moderate the effect of this infertility-related stress. While there is evidence of a relation between socio-economic status and perceived infertility-related stress, no such studies have been conducted on Canadian women seeking infertility treatment. Purpose: This study aimed to define the relationship between socio-economic status and perceived infertility-related stress. Method: A questionnaire was administered to a population of English speaking females (n=64) seeking infertility treatment at the CReATe In/Fertility Clinic and the In/Fertility Support and Education Program at Women’s College Hospital. Patients completed a 56 statement questionnaire composed of quantitative questions, including Likert-like scales, from the Family Quality of Life Survey and the Fertility Problem Inventory. Financial well-being and five different infertility-related stresses (Social Stress, Sexual Stress, Relationship Stress, Rejection of Childfree Lifestyle and Need for Parenthood) were assessed using this instrument. Results: One way ANOVA analysis revealed statistically significant increases in sexual stress (p=0.02) for those with a university education compared to those with a college education. Those with a higher income reported less stress associated with a child-free lifestyle (p=0.03) and a need for parenthood (p=0.02). Conclusions: The findings suggest that for those with lower incomes, more resources should be dedicated to reduce stress related to having a child-free lifestyle and their need for parenthood.

Perceived infertility-related stress correlates with in vitro fertilization outcome

To determine the effect of perceived infertility-related stress on IVF outcome, all couples undergoing their first cycle of IVF were administered the Fertility Problem Inventory from May 2002 and April 2005 at our institution. Couples who conceived during their first cycle of IVF had significantly higher measures of need for parenthood and loss of sexual enjoyment, compared with couples who did not conceive. Couples who achieved ongoing pregnancies had higher scores on measures of a negative view of a child-free lifestyle, need for parenthood, and total stress than those who did not.

O-130: A randomized-controlled study of an online infertility psychoeducational program

This study sought to develop an evidence-based, online psycho-educational program grounded in cognitive behavioral and social learning theories to provide a comprehensive educational experience for infertility patients. The study goal was to determine if an online psycho-educational program could positively influence problematic fertility beliefs and attitudes, decisional conflict, and self-efficacy in the management of fertility treatment. A randomized-control study with 297 fertility patients (188 females and 109 males) from 3 major US treatment centers. Female patients were the primary study participants; >50% of their partners were recruited for an exploratory study. Patients seeking fertility treatment were recruited via flyers posted at fertility clinics to participate in an online study about how patients cope with fertility treatment. Using a rigorous research design that controls for assessment affects, patients were randomized into one for four groups, two of which received the online psycho-educational program and two groups which did not. The assessment battery, which was delivered online at a secure web portal, included measures of perceived distress, attitudes and beliefs about fertility problems, decisional conflict, ways of coping, and infertility self-efficacy. Participants exposed to the online psycho-educational program were asked to spend two 45-minute sessions using the program, which included 4 media-rich modules on basic fertility facts, coping skills, partner and provider communication. An online follow-up assessment battery was administered at one-month after baseline. The Solomon 4 analysis revealed several important findings. Overall, participants in the intervention group decreased their “sexual concern” score on the Fertility Problem Inventory (p=.03), and improved their self-efficacy on the “body integrity” subscale of the Infertility Self-Efficacy Scale (p=.04). In spite of pre-assessment reactivity to “planful problem solving”, participants further increased their use of this coping style after viewing the intervention (p<.01). An effect was also observed for decisional conflict whereby decisions for which participants felt “uninformed” (p=.02) and “unclear” (p=.06) improved at post-test. By gender, the intervention resulted in less distress for women in the areas of sexual concerns (p=.04) and rejection of childfree lifestyle (p=.06), and improvements in infertility self-efficacy around body integrity and decisional conflicts initially perceived “uninformed” (p=.02). For the men in the intervention group, improvements were observed in the area of relationship concern (p<.05) and decisional conflict where “clarity” was perceived as needed (p=.07). An online psycho-educational support program may offer a viable adjunct service for fertility clinics to offer patients seeking a fertility evaluation or treatment, and may be particularly effective in teaching skills for problem solving and decision making. The confidential nature of an online program may also serve as an important approach in helping patients grapple with intimate matters related to one’s relationship and sexual concerns, especially for patients who do not have access to counseling services or do not feel comfortable raising these issues with medical staff.

Perceived Infertility-Related Stress Correlates With In Vitro Fertilization Outcome

Stress can have significant effects on patient wellbeing and the success of treatment regimens. The goal of this study was to determine the effect of perceived infertility-related stress as measured by the Fertility Problem Inventory (FPI) on pregnancy rates for an in vitro fertilization (IVF) program. Retrospective analysis. Couples who underwent their first IVF cycle between May 2002 and April 2005 and had FPI testing were studied. The FPI is a validated questionnaire which tests five scales of perceived infertility-related stress: social concern, sexual concern, relationship concern, negative view of a childfree lifestyle and need for parenthood as well as a composite or global stress score. Patient charts were retrospectively analyzed for age, gravidity, parity, serum HCG, total number of oocytes retrieved and number of embryos transferred. The primary outcome was total pregnancy rate. One hundred twenty-nine couples underwent their first IVF cycle, with both partners completing the FPI prior to treatment, between May 2002 and April 2005. Sixty-nine patients (53%) had a positive serum HCG compared to 60 (47%) with a negative serum HCG or a cancelled cycle. There were no significant differences between the group with a positive serum pregnancy test compared to the group with a negative serum pregnancy test with regard to age of the female partner (34±1 vs. 35±1, p=0.06), age of the male partner (35±1 vs. 36±1, p=0.29), gravidity (1.0±0.2 vs. 1.2±0.2, p=0.23), parity (0.4±0.1 vs. 0.4±0.1, p=0.80), total number of oocytes retrieved (10±1 vs. 10±1, p=0.98), total gonadotropins used (39.5±1.8 amps vs. 43.2±2.4, p=0.20) or the number of embryos transferred (2.4±0.1 vs. 2.3±0.1, p=0.36). When both partners are analyzed together, couples who conceived had significantly higher scores for sexual concern (31.4±1.2 vs. 28.1±1.1, p=0.05) and need for parenthood (72.5±1.5 vs. 66.6±1.6, p=0.01) but no differences in social concern, relationship concern, negative view of a childfree lifestyle or global stress. Independent analysis of female partners who became pregnant demonstrated significantly higher scores in the need for parenthood scale (37.7±1.0 vs. 34.0±1.1. p=0.01) with a trend toward higher scores for sexual concern (16.9±0.9 vs. 14.7±0.8, p=0.06), negative view of a childfree lifestyle (26.9±1.0 vs. 24.8±0.8, p=0.11) and global stress (123.3±3.1 vs. 115.4±3.7, p=0.10). There were no significant differences between pregnant and nonpregnant female partners with regard to social concern or relationship concern. There were no significant differences between the male partners of couples that did or did not become pregnant for any of the parameters measured. Couples who conceived in this study exhibited statistically higher scores on measures of need for parenthood and loss of sexual enjoyment. These results suggest that patients who experience more infertility-related stress as measured by the FPI may be more emotionally invested in IVF and thus more likely to conceive.

Childfree And Feminine

The roles of women and of feminine identity have been historically and traditionally constructed around motherhood. However, recent years have seen a growing trend among women to remain childless/ childfree. Drawing on interviews with 25 voluntarily childless women, this article considers the extent to which this trend results from the appeal or pull of the perceived advantages of a childfree lifestyle as well as the ways childfree women might represent a more fundamental and radical rejection of motherhood and the activities associated with it. The article concludes by considering how to recast understandings of feminine identity away from a mother-centered focus.

The Relationship between Information Search in the Childbearing Decision and Life Satisfaction for Parents and Nonparents

The relationship of information search in the childbearing decision to life satisfaction was investigated. In Women over age 30 residing in the San Francisco Bay area; 62 women who were mothers who had their 1st child near the age of 30 and 23 voluntarily childless women in their 30s responded to a questionnaire concerning their childbearing decision. The study investigated kinds of information search reported by subjects in making the childbearing decision and the relationship of information search to measures of present life satisfaction. Decision strategies included whether there was a conscious process whether the search was a active one and questions asked (about goal attainment future life satisfaction or impact on others). Difficulty in reaching the decision and certainty of rightness of decision were also measured. Life satisfaction measures consisted of general marital and work satisfaction measures. For mothers parenting satisfaction and performance were also examined. Results indicated that information search is related to positive outcomes for women who become mothers. For voluntarily childless women information search was negatively related to life satisfaction. The implications of the results for the decision process in parents and nonparents are discussed. A satisfying career may be related to nonmotivation for having children. In order for women to perceive that parenting and a career are not exclusive society needs to provide flexible career development models childcare facilities and changes in the workplace. More attention to parenting in educational institutions would aid individuals in making better decisions and facilitate effective parenting. Greater acceptance by society of a childfree lifestyle or a dual career option would enable greater freedom of choice.

Male pressure in the decision to remain childfree

To examine the negotiations and resolutions of disagreement over childlessness (the childfree lifestyle), questionnaires were sent to 100 married couples drawn randomly from membership lists of the National Organization for Non-Parents (NON). Responses of 40 couples were analyzed, in a synthesized theoretical framework drawn from Thibaut and Kelley (1959) and sex role socialization theory. The pattern that emerged was: if it was the husband's decision to remain childfree and not the wife's at first, she was likely to come into agreement with him; if it was the wife's decision to remain childfree, only very rarely would the husband consent. The more likely result, if she remained adamant, was divorce. Because marital power was so much greater for the husbands, the childfree life-style as an alterntive marital form may not differ greatly from traditional marital patterns.

Decision-making patterns and postdecision adjustment of childfree husbands and wives

The processes by which married couples come to the decision to have no children and the mechanisms they employ in reaction to pronatalist pressures were explored in interviews with 44 childfree husbands and wives. Two characteristic paths of decision-making were identified, Independent and Negotiated, and further categorization on the basis of degree of influence exerted by each spouse was proposed. Several mechanisms employed to counter pronatalist pressures were identified, including defense of the childfree lifestyle, devaluation of the parenthood status and denigration of parents, and avoidance of pronatalist company. Implications of these findings for the study of childfree marriages are discussed.

The Psychosocial Implications of Voluntary Childlessness

With the changes in marriage patterns, new family structures are emerging; one of which is an intentionally childfree lifestyle