National Survey Of Fertility Barriers Research Articles

Confidence in Pregnancy Among U.S. Women

Researchers often ask women about pregnancy intentions but seldom ask how confident women are that they will be able to become pregnant when they desire. We argue that beliefs about fertility and infertility may function as justifications for behaviors to which one is already committed. Thus, women who have delayed childbearing but who intend to become pregnant may express confidence in their ability to become pregnant, even in the face of diminished odds of conception. Using data from the National Survey of Fertility Barriers, we demonstrate that over 75 percent of women who intend a first or subsequent pregnancy express confidence that they will be able to become pregnant when they wish, even if they perceive themselves as having a fertility problem or meet medical criteria for infertility. Our results are consistent with the motivated reasoning perspective. Our findings suggest that confidence in pregnancy may be a response to social‐structural pressures to delay childbearing among women who intend to become pregnant, but not necessarily the reason for delay.

Prospective Attitude about the Importance of Planning Pregnancies Is Associated with Retrospective Attitude toward a Specific Pregnancy

Several theories of fertility behavior assume that planning is important to women. Is this a reasonable assumption? To answer this question, the authors used the National Survey of Fertility Barriers. Among women with unsure or positive fertility intentions at wave 1, most (75 percent) agreed with the statement “It is important to plan my pregnancies.” Logistic regression, adjusted for control variables, indicated that fertility intentions are a distinct construct from pregnancy planning attitudes. Multinomial regression of retrospective pregnancy attitude three years later among a subsample of women who had pregnancies during that period indicated that women who felt that it was more important to plan pregnancies had higher odds of describing their intentions at the time of a subsequent pregnancy as “trying to” become pregnant compared with “okay either way.” Therefore, it is useful to measure and include pregnancy planning attitude, in addition to intentions, in fertility research.

Reproductive Regrets among a Population-Based Sample of U.S. Women

Women have many reproductive options, but little is known about their regrets regarding prior reproductive choices and outcomes. Guided by the life-course and stratified reproduction perspectives, this study draws on an open-ended question about reproductive regrets from wave I of the National Survey of Fertility Barriers, a representative telephone survey of reproductive aged U.S. women conducted from 2004 to 2006. The authors classified regrets into five broad categories: (1) none, (2) problematic fertility, (3) unfulfilled fertility desires, (4) family, and (5) pregnancy experiences. The authors conducted the analyses separately by motherhood status. Logistic regression analysis revealed that regardless of parental status, those who were older, had infertility, or were experiencing economic hardship were more likely to report reproductive regrets. The authors also investigated factors associated with the likelihood of expressing specific reproductive regrets. In general, the present findings confirm expectations based on the life-course and stratified reproduction perspectives.

The Infertility-Abortion Nexus: Does Having Had an Abortion Influence Distress and Help-Seeking for Infertility?

To determine whether a history of abortion is associated with the experience of infertility among women, 2,199 women who ever met medical criteria for infertility were studied. Data for the study come from the National Survey of Fertility Barriers (NSFB), a nationally representative telephone survey of US women aged 25–45. Linear and logistic regression analysis revealed that a history of induced abortion was not statistically associated with fertility-specific distress, talking to a doctor about fertility, or seeking medical treatment for infertility. Having had an induced abortion may increase women’s confidence in their ability to get pregnant in the future.

Is Reproductive Orientation Associated with Sexual Satisfaction Among Partnered U.S. Women?

Little is known about how "reproductive orientation" (i.e., trying to get pregnant, ambivalent about pregnancy, trying to avoid pregnancy, or having had a sterilization surgery) is associated with sexual satisfaction among women of childbearing age. Using data from the National Survey of Fertility Barriers (N = 2811), we examined the association of reproductive orientation with sexual satisfaction, adjusting for relationship characteristics including union type (cohabitation versus marriage), quality, and length; infertility history; and demographic characteristics including age, parity, and race/ethnicity. Results indicated that women who were ambivalent or trying to get pregnant reported significantly higher levels of sexual satisfaction than women who were sterile in the unadjusted model, but not in the models that included relationship quality. The association of reproductive orientation and sexual satisfaction depended upon relationship quality; among women with lower relationship quality, "trying" was associated with higher, and among those with higher relationship quality, with lower sexual satisfaction.

Changes in Importance of Motherhood Following Pregnancy Loss

Pregnancy loss (i.e., miscarriage, stillbirth) is a relatively common and often traumatic experience. Although prior research has examined mental health consequences of pregnancy loss, to our knowledge, none have examined how the experience of pregnancy loss affects how women perceive or value the importance of motherhood. Using longitudinal data from the National Survey of Fertility Barriers, we applied change-score regression analysis to examine how a pregnancy loss that occurred between survey waves was associated with a change in importance of motherhood scores, controlling for sociodemographic and pregnancy-specific characteristics. We found that women who experienced a pregnancy loss reported an increase in importance of motherhood compared to women without a pregnancy loss. The findings suggest that an increase in the importance of motherhood following a pregnancy loss could be a grief response. Health care professionals should consider validating maternal identity following a pregnancy loss, as women highly associate with this role.

Does Self-Identifying as Having a Health Problem Precede Medical Contact? The Case of Infertility

ABSTRACT Studies of medical help-seeking presume that self-identifying as having a health problem precedes medical contact, but this ordering of the identity-behavior relationship has not been systematically examined. We used longitudinal data from the National Survey of Fertility Barriers (2004 to 2010) on 412 women with infertility to document the temporal relationship between self-identifying as having a fertility problem and making medical contact. The symbolic interactionist perspective suggests that infertility will be perceived as identity disruption and that in response women will align self-identity and medical behavior over time. Cross-tabulation analysis indicated that more women do self-identify as having a fertility problem first (24%) as opposed to making medical contact first (5.5 percent). There was also a tendency toward aligning self-identification and behavior over time. Latent class analyses revealed six patterns: 1) consistently involved, 2) early consulters, 3) consistently uninvolved, 4) consistent perceivers, 5) medical dropouts, and 6) early perceivers. Strong fertility intent and primary infertility, two identity-relevant characteristics, had the strongest associations with latent class membership. The relationship between self-identification and medical help-seeking is thus dynamic and complex.

Is infertility resolution associated with a change in women's well-being?

Is giving birth associated with improved subjective well-being among involuntarily childless women? Resolution of infertility is associated with increased life satisfaction and self-esteem, but not with a decrease in depressive symptoms. Cross-sectional data and studies of treatment-seekers show that infertility is associated with lower subjective well-being. Childless women with infertility tend to report lower subjective well-being than women who experience secondary infertility, but a prospective study using a random sample of involuntarily childless women over time has not previously been conducted. The sample for the current study includes all women without children who met medical criteria for infertility or perceived a fertility problem (N = 283) at baseline and who were interviewed in both waves (3years apart) of the National Survey of Fertility Barriers (NSFB), in a random-digit dialing telephone survey. It is therefore possible to explore here whether there are differences in the association of infertility resolution and subjective well-being among women who do and do not perceive themselves as having a fertility problem. Depressive symptoms (as measured by the Center for Epidemiologic Studies-Depression Scale), self-esteem (as measured by a modified version of the Rosenberg Self-esteem Scale) and life satisfaction (as measured by a modified version of the Satisfaction with Life Scale) were assessed for all 283 participants at both waves. For all three variables, change scores of 47 involuntarily childless women who resolved their infertility through a live birth were compared to the scores for the 236 women who remained childless. A number of variables shown to be associated with subjective well-being among infertile women were included as controls. No relationship between infertility resolution and change in depressive symptoms was observed (b = -0.04; P > 0.05). Involuntarily childless women who resolved their infertility improved in self-esteem (b = 0.74; P < 0.01) and life satisfaction (b = 1.06; P < 0.01). Women were measured at only two time points. Only 47 women had a live birth between waves. While it is common practice to make causal interpretations based on panel data, such interpretations should be made with caution. In addition, the NSFB was conducted in the USA where medical expenditures are high and most fertility treatment expenses are not covered by insurance. Thus it may not be possible to generalize the findings to other modern industrialized societies. Knowing that resolution of infertility is associated with improved subjective well-being is important for infertile couples and infertility professionals alike. This research was supported in part by NICHD grant R01-HD044144 and NIGMS grant P20-GM109097 from the National Institutes of Health. The authors have no competing interests.

Mutual Influence? Gender, Partner Pregnancy Desires, Fertility Intentions, and Birth Outcomes in U.S. Heterosexual Couples

Competing hypotheses exist with regard to how men’s and women’s pregnancy desires and intentions are associated with births among contemporary heterosexual couples. There are compelling cultural and structural reasons to support either the hypothesis that men’s desires and intentions (patriarchal) or that women’s desires and intentions (matriarchal) will have more influence, or that both partner’s desires and intentions will be associated with births (mutual influence). In addition, patterns of change are likely to differ for couples that have children at wave 1 compared to those who do not. Path analyses of the of heterosexual couples (n = 615) who completed both waves of the National Survey of Fertility Barriers support the matriarchal hypothesis, because among couples without children, only women’s desires were associated with subsequent births. Among couples with children, men’s characteristics and desires are indirectly, and women’s are directly, associated with subsequent births, indicating support for the mutual influence hypothesis.

Stability and Change in Motherhood Status and Fertility Problem Identification: Implications for Changes in Self-Esteem

Because motherhood is a valued status, the life course perspective and the theory of conjunctural action suggest the following hypotheses: for women in the United States, gaining the valued identity “mother” should lead to an increase in self-esteem, while identification with a fertility problem identity should lead to a decrease in self-esteem. Using the nationally representative two-wave National Survey of Fertility Barriers (NSFB), we conducted change-score analysis with chained multiple imputation (MICE) to model attrition. We compared changes in self-esteem by change and stability in motherhood and self-identified fertility problem status among women who initially had no children. Results provide support for the hypotheses. All but one group—those who no longer identified a problem and who had a baby—had declines in self-esteem. Women who persisted with a fertility problem identity and did not have a baby had the steepest decline in self-esteem.

Exploring Experiences with Sterilization among Nulliparous Women

Although nulliparous women who are sterilized appear voluntarily “childfree,” the majority report non-contraceptive reasons for their surgical procedure. Using an analytical subsample of the National Survey of Fertility Barriers, we examined 105 women’s closed- and open-ended responses about the reasons for their sterilization surgeries and whether their sterilization occurred before their childbearing desires were met. We found considerable heterogeneity in the experiences and attitudes of participants. We highlight important implications of women’s experiences for fertility and reproductive health research and practice, particularly by drawing a distinction between voluntarily childfree and involuntarily childless women.

Mental Health across Motherhood Status: An Examination of Mediating Factors

Motherhood represents a valued status in American culture especially for biological mothers within stable first-marriages. Focusing on partnered women, this study examined how and why mental health differed across three motherhood statuses: biological-only, step-only, and double mothers (i.e., both biological and step). Using data from the National Survey of Fertility Barriers (NSFB), we found lower life satisfaction among step-only and double mothers compared to biological-only mothers. More economic hardship, lower quality romantic relationships, and higher rates of cohabitation fully explained the differences between biological-only and double mothers in life satisfaction. Differences between biological-only and step-only mothers are partially explained by self-esteem and cohabitation. Double mothers also reported higher psychological distress than biological-only mothers. This difference is partially explained by lower romantic relationship quality and more economic hardship among double mothers. We found no differences in psychological distress between step-only and biological-only mothers.

Infertility and Self-identification: The Indeterminacy of the Illness-self Relationship

Nearly one-third to one-half of U.S. women meets the medical criteria for infertility at some point in their reproductive lives. Yet many do not view lack of conception as problematic. Why might some women self-identify as having a fertility problem but others do not? Using two waves of the National Survey of Fertility Barriers, we conducted binary and longitudinal multinomial logistic regression to answer this question. Results suggest that only a portion of women actually experience infertility as a “spoiled identity” or as disruptive to their lives. Rather, consistent with symbolic interactionist perspectives, there is evidence that infertility symptoms (i.e., not conceiving) depend upon interpretations and definitions of the situation. Multiple patterns of self-identification over time (identity non-adopters, maintainers, adopters, and relinquishers) suggest an indeterminate association between illness and impacts on the self, even for a condition that is highly medicalized in the United States.

Change in Motherhood Status and Fertility Problem Identification: Implications for Changes in Life Satisfaction.

To determine whether the association between changes in life satisfaction and becoming a mother (or not) depends on fertility problem identification status. Evidence and symbolic interactionist theory suggest that, for women who initially perceive a fertility barrier, gaining the valued identity "mother" should be associated with increases, and continuing to face a blocked goal (i.e. not becoming a mother) should be associated with decreases in life satisfaction. This study used the nationally representative two-wave National Survey of Fertility Barriers to conduct a change-score analysis with chained multiple imputation (MICE). The focal dependent variable was change in life satisfaction. Focal independent variables were Wave 1 life satisfaction, fertility problem identification status, and birth between waves, controlling for stability and change in relationship status, talking to a doctor about how to get pregnant, religiosity, social support, importance of parenthood, importance of leisure, importance of work success, and economic hardship. Among women who perceived a fertility problem at both waves, becoming a mother was associated with increased life satisfaction and not becoming a mother was associated with decreased life satisfaction. Women who gained or lost a fertility problem perception between waves but did not have a live birth experienced a gain in life satisfaction between waves, suggesting the relevance of the duration of fertility problem perception for change in life satisfaction.

Degrees of Medicalization: The Case of Infertility Health-Seeking

ABSTRACTWe examine responses to infertility among a sample of 2,361 women with infertility from the National Survey of Fertility Barriers. Latent class analysis uncovered seven latent classes of behavioral response which can be arranged in a rough continuum from least medicalized to most medicalized response. We then aggregated these seven categories into three schemas representing various degrees of medicalization. Women in each class combine treatment-seeking, knowledge-seeking, socio-emotional support seeking, and non-medical solution-seeking strategies. Even women pursuing the greatest degree of medicalization in their health-seeking (e.g., fertility treatments, assisted reproduction) made use of a variety of medical and non-medical health-seeking resources.

Concerns about treatment for infertility in a probability-based sample of US women

ABSTRACTObjective: Many women experience infertility as distressing, but only about half of US women seek medical services. It is unknown whether concerns about fertility treatment are related to receiving fertility treatment or to distress levels.Methods: Using the nationally representative National Survey of Fertility Barriers, we constructed a nine-item scale measuring fertility treatment concerns. The analytical sample for this study included 1218 women who said that they were trying to become pregnant and who were asked questions regarding treatment concerns. We conducted multiple regression analysis to discover factors associated with treatment concerns and whether treatment concerns were associated with depressive symptoms and fertility-specific distress. We used logistic regression to determine whether treatment concerns were associated with receiving fertility tests.Results: Desiring a(nother) child, infertility stigma, higher family income, higher economic hardship and claiming a Hispanic identity were associated with higher levels of treatment concerns than those in the comparison groups. Having friends and family with children and having private health insurance were associated with lower levels of concern. Treatment concerns were not associated with receiving fertility tests. Higher levels of treatment concern were associated with higher levels of fertility-specific distress and depressive symptoms. Higher infertility stigma was related both directly and indirectly to higher levels of fertility-specific distress and depressive symptoms.Conclusion: For US women, fertility treatment concerns are not associated with whether women pursue fertility testing, but they are associated with higher levels of fertility-specific and general distress.

Stability and change in personal fertility ideals among U.S. women in heterosexual relationships

Background: Demographers typically ask about societal, not personal, fertility ideals. Societal ideals are probably more stable than personal ideals. Assessing whether personal fertility ideals are as stable as societal ideals could inform models of population fertility change and models of well-being associated with fertility outcomes. Methods: We use the two-wave National Survey of Fertility Barriers (NSFB) to model stability and change in fertility ideals among 879 women in heterosexual couples that persisted for both waves. Results: Personal fertility ideals are stable for most (69%) women, but roughly one-third adjust their ideal number between waves. Of the women who changed their personal fertility ideal, approximately half increase and half decrease their personal fertility ideal over time. Multinomial logistic regression indicates that women with a higher fertility ideal at Wave 1 had higher odds of increasing and lower odds of decreasing their fertility ideal by Wave 2. Higher education was associated with lower likelihood of increasing fertility ideals. In addition, full-time employment at the initial interview was associated with higher likelihood of decreasing fertility ideals. Conclusions: Individual characteristics, attitudes, life course, and social cues are associated with changes in personal fertility ideals. More characteristics were associated with decreases than increases in personal fertility ideals. Contribution: By demonstrating that many women change personal fertility ideals over three years, the current study advances understanding of variations in fertility experiences. Importantly, these findings can also inform policies and interventions designed to support child and maternal health.

HIGH PREVALENCE OF VOLUNTARY STERILIZATION AMONG AMERICAN WOMEN EXPLAINED BY TRADE-OFFS RESULTING FROM MALE PARENTAL COMMITMENT.

Tubal ligation is the modal form of family planning among American women aged 30 and older. As the preference for tubal ligation over cheaper, lower risk and more reliable methods, such as vasectomy, has puzzled experts, a theoretical approach that explains this preference would be useful. The present study investigates the high prevalence of voluntary sterilization among American women from the perspective of life history theory, arguing that the trade-offs between investing in current and future offspring will favour tubal ligation when women cannot obtain reliable male commitment to future parental investment. Data came from the National Survey of Fertility Barriers (NSFB), a nationally representative survey of 4712 American women aged 25-45 conducted between 2004 and 2007. Four novel predictions of the prevalence of tubal ligation, drawn from life history theory, were developed and tested: 1) it is most common among unpartnered women with children, and least common among married women with children; 2) it is negatively correlated with age at first birth; 3) it is least common among highly educated women without children, and most common among less educated women with children; and 4) among women with two or more children, it is positively correlated with lifetime number of long-term partners. These predictions were tested using multivariate regression analysis. The first prediction was not supported: women with children were more likely to be sterilized, regardless of their marital status. The other three predictions were all supported by the data. The results suggest that trade-offs influence women's decisions to undergo voluntary sterilization. Women are most likely to opt for tubal ligation when the costs of an additional child will impinge on their ability to invest in existing offspring, especially in the context of reduced male commitment.

Women's career priority is associated with attitudes towards family planning and ethical acceptance of reproductive technologies.

Do women who place high importance on career success have different perceptions of pregnancy planning, delayed reproduction, and the ethical acceptability of ART than women with less emphasis on their career? Career-focused women place more importance on pregnancy planning, have greater confidence in delayed childbearing, and are more ethically accepting of donor gamete ART than women who do not place as much importance on career success. Women in high-professional careers are more likely to delay childbearing while simultaneously possessing a stronger desire for motherhood. The underlying values which enable these competing desires have not been elucidated. This cross-sectional study utilized data from the National Survey of Fertility Barriers (NSFB), a nationally representative telephone survey of US women aged 25-45. Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the NSFB surveyed 4712 women from 2004 to 2007. In addition to demographic data, the NSFB obtained information about the reproductive history and personal values of participants. Weighted multivariate regression analysis was used to assess reproductive values in career-focused women. In total, 48.8% of women considered success in work very important, while 17.3% considered it somewhat or not important. Women who placed less value on career success were less likely to consider pregnancy planning important and were less optimistic about the success of delayed childbearing than their work-centric counterparts. Women less focused on their careers were also more likely to have serious ethical concerns about donor gametes, but less likely to have ethical concerns about IUI or IVF, when compared to career-focused women. Intention to bear children could not be evaluated in the setting of career intentions due to a lack of data on when the participant intended on pursuing motherhood. Political preferences on reproductive health were also not evaluated. The validity of the career priority questions has not been assessed. Additionally, respondents' value statements were not matched to subsequent actions, so it remains possible that these values do not directly impact reproductive behaviors. Our results suggest that reproductive counseling for career-focused women should focus on effective contraception when attempting to delay pregnancy, improved knowledge about age-related fertility decline, and the scope and limitations of current reproductive technologies. In addition, the unique reproductive views of career-focused women suggest that they may benefit from increased employer/insurer support for strategies to enable delayed childbearing, such as fertility preservation and third-party reproduction. None.

Determinants of Ethical Concern With Multifetal Pregnancy Reduction Among U.S. Women of Reproductive Age [17G

INTRODUCTION: Multifetal pregnancy reduction (MFPR) is recognized by the American College of Obstetricians and Gynecologists and the American Society of Reproductive Medicine to be a challenging ethical decision. This study explores the determinants of ethical concern with MFPR among U.S. women of reproductive age. METHODS: Data were obtained from the National Survey of Fertility Barriers (Wave 1, 2004-2007), a random digit dialing telephone survey of 4,794 women aged 25-50. Logistic regression was performed to determine the relationship between ethical concern with MFPR and religion, obstetric history, history of infertility, and history of infertility treatments. RESULTS: Only 14.7% of respondents had no ethical concerns with MFPR, while 44.3% expressed serious concerns. Serious ethical concerns were less likely among women with a history of abortion (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.31-0.58) or with no religious affiliation (OR 0.47, 95% CI 0.31-0.70). Serious ethical concerns were more common among women with a history of multiple gestation (OR 3.30, 95% CI 1.44-7.56) or who attend a weekly religious service (OR 1.55, 95% CI 1.16-2.08). After adjustment, religiosity remained a significant determinant of having serious ethical concern with MFPR (OR 1.18, 95% CI 1.12-1.24). History of infertility and its treatment had no significant association with ethical concerns about MFPR. CONCLUSION: A majority of U.S. women have ethical concerns with MFPR. While religiosity is a significant determinant of this concern, infertility and infertility treatments are not. The overall high level of ethical concern with MFPR underscores the importance of minimizing multiple gestations during infertility treatment.