Fertility Postponement Research Articles

Economic Cycles and Entry into Parenthood: Is the Association Changing and Does it Affect Macro-Level Trends? Micro-Level Hazard and Simulation Models of Belgian Fertility Trends, 1960–2010

The association between economic cycles—typically measured in terms of GDP growth or swings in unemployment—and macro-level fertility trends has received ample attention in the literature. Compared to studies that consider macro-level fertility, individual-based models can address the association between economic cycles and specific stages of family formation (e.g. entry into parenthood) more precisely while allowing for structural factors that contribute to fertility postponement. Using population-wide longitudinal microdata from the Belgian censuses we combine discrete-time hazard models of entry into parenthood for the period 1960 to 2010 with microsimulation models to assess whether economic cycles in tandem with educational expansion can account for year-to-year variation in the proportion of women entering parenthood and variation in the pace of fertility postponement at the macro-level. Results indicate that educational expansion has been a structural driver of fertility postponement, whereas the procyclical effect of economic cycles accounts for accelerations and decelerations of fertility postponement throughout the period considered. Microsimulation of macro-level fertility trends indicates that individual-based models predict the annual proportion of women entering parenthood and the mean age at first birth with average errors of prediction below 1 per cent and 3 months, respectively, while also showing strong correlations between first differences of observed and simulated time-series. Because the extended observation window encompasses several severe recessions, we test whether the association between economic cycles and entry into parenthood has changed over time and how this affected macro-level trends, discussing several mechanisms that may account for such temporal variation.

Fertility Postponement, Economic Uncertainty, and the Increasing Income Prerequisites of Parenthood

AbstractRich societies have witnessed a postponement of parenthood over the past two decades, and young adults’ economic conditions are often invoked to explain this trend. However, macro‐level trends in both “subjective” perceptions of economic uncertainty and “objective” measures of actual income provide no satisfactory explanation for the postponement of parenthood. We propose a potential solution to this puzzle by hypothesizing that the economic prerequisites of parenthood have increased over the past two decades. We expect that this has raised the degree of perceived economic certainty and the level of income that people wish to achieve before having a first child. To test this hypothesis, we draw on individual‐level longitudinal data from seven countries from the Comparative Panel File. Our findings show that young adults’ perceived economic uncertainty is not consistently associated with the transition to parenthood. Moreover, the effects of perceived economic uncertainty did not change over time. In contrast, we find consistent evidence that the link between income and first birth has become more strongly positive over the past two decades. This is true mainly for women but also for men, and suggests that increasing income prerequisites are a key mechanism behind the postponement of parenthood.

Shifting Parental Age Differences in High‐Income Countries: Insights and Implications

AbstractAge differences within couples are of considerable importance for the power relations between partners. These age differences become particularly relevant when couples transition to having a(nother) child, as such an event often results in a renegotiation of the gendered division of labor. Surprisingly, the literature on female empowerment and fertility postponement has so far paid little attention to parental age differences. This paper makes use of a new data set to present a demographic analysis of trends in parental age differences at childbirth in 15 high‐income countries, covering a period in which all of these countries experienced changes in gender relations and fertility postponement. The general trends in rising mean ages at childbirth have evolved quite similarly among men and women. However, we demonstrate that these similarities hide previously unexplored and highly gendered disparities in parental age differences. Older mothers report much smaller mean parental age differences than younger mothers, and this age pattern among mothers has further polarized over time. By contrast, older fathers report larger parental age differences than younger fathers, while the disparities by age among fathers have not changed much over time. We discuss the relevance of our findings at both the individual and the societal level.

The influence of the increasing use of assisted reproduction technologies on the recent growth in fertility in Czechia

This study aims to enhance the understanding of how the increasing use of assisted reproductive technologies (ART) has contributed to the increase in the total fertility rate (TFR) and to further delaying childbearing. Moreover, it addresses the gap in the methodology concerning the quantification of the effect of ART on fertility postponement. Czechia is one of few countries that are able to serve for the study of the demographic impacts of ART. ART and non-ART fertility rates were calculated using unique data on all children born in Czechia. Excluding mothers who received cross-border reproductive care, the proportion of ART live births in Czechia has not exceeded 4%. However, without ART the TFR would have stood at just 1.65 instead of 1.71 in 2020. ART significantly contributed to a reduction in childlessness and to the increase in fertility rates at ages over 35. Applying the decomposition method, the contribution of the use of ART to delaying childbearing between 2013 and 2020 was 4%. The findings have important policy implications. ART has the potential to support fertility recovery in the context of delayed childbearing. The findings served to alleviate concerns about the contribution of ART to the further undesired delay of childbearing.

Tri desaťročia transformácie plodnosti v Česku a na Slovensku v prierezovom a generačnom pohľade

Since the beginning of the 1990s, there have been significant changes in fertility quantum and tempo in Czechia and Slovakia. We are also witnessing significant age pluralization of reproduction. These and other transformational changes can be observed not only in a cross-sectional view but also in a cohort perspective. The main goal of the article is to analyse the main changes in the fertility process in Czechia and Slovakia after 1989. We focus on changes in the intensity and timing of childbirth and the age distribution of fertility. We identify the development trajectories of the two countries and the similarities and differences between them brought about by the transformation period. By analysing the process of the postponement and recuperation of cohort fertility, we also try to point out the future development of completed cohort fertility and the parity structure of women born in the second half of the 1970s and 1980s.

Does advanced maternal age explain the longer hospitalisation of mothers after childbirth?

Fertility postponement, which has comprised the most significant reproductive trend in developed countries over the last few decades, involves a number of social, personal and health consequences. The length of stay (LOS) in hospital following childbirth varies considerably between countries. Czechia, where the fertility postponement process has been particularly dynamic, has one of the longest mean LOS of the OECD member countries. We analyse the influence of the age of mothers on the LOS in hospital associated with childbirth. We employed anonymised individual data provided by the General Health Insurance Company of the Czech Republic on women who gave birth in 2014. Kaplan-Meier survival plots and binary logistic regression were employed to identify factors associated with long stays (> = 7 days for vaginal births, > = 9 days for CS births). The impact of the maternal age on the LOS is U-shaped. A higher risk of a longer hospitalisation period for young mothers was identified for both types of birth (OR = 1.58, 95% CI 1.33-1.87, p˂0.001 for age less than 20, OR = 1.31, 95% CI 1.20-1.44, p˂0.001 for age 20-24 compared to 30-34). The risk of a longer stay in hospital increases with the increasing age of the mother (OR = 1.23, 95% CI 1.13-1.35, p˂0.001 for age 35-39, OR = 2.05, 95% CI 1.73-2.44, p˂0.001 for age 40+ compared to 30-34), especially with concern to vaginal births. The probability of a long LOS increases significantly after the age of 35, especially in the case of vaginal births. Thus, the fertility postponement process with the significant change in the age structure of mothers contributes to the increase in health care costs associated with post-birth hospitalisation.

Measuring Fertility Intentions During Times of Crisis: An Example Using Survey Data Amid the Covid-19 Pandemic.

Fertility intentions-intentions regarding whether and when to have children-predict reproductive health outcomes. Measuring fertility intentions is difficult, particularly during macrostructural shocks, for at least two reasons: (1) fertility intentions may be especially volatile during periods of uncertainty and (2) macrostructural shocks may constrain data collection. We propose a set of indicators that capture how a macrostructural shock directly alters fertility intentions, with a particular focus on the Coronavirus disease 2019 (Covid-19) pandemic. We advance the conceptualization and construct of fertility intentions measures in three ways. First, we demonstrate the value of direct questions about whether women attributed changes in fertility intentions to the pandemic. Second, we highlight the importance of a typology that delineates fertility postponement, advancement, foregoing, and indecision. Third, we demonstrate the importance of incorporating a granular time window within a two-year period to capture short-term changes to fertility intentions. We exemplify the value of our proposed measures using survey data from a probabilistic sample of women aged 18-34 in Pernambuco, Brazil. We discuss the self-reported change in intentions due to Covid in wave 1 as well as panel change across waves. We further ground our contributions by uncovering important variations by social origin and parity.

Fertility postponement and labor market outcomes

Fertility postponement and labor market outcomes

The Impact of Coronavirus Disease 2019 Pandemic on Female Patients Seeking or Undergoing Fertility Treatment in a Single In vitro Fertilisation Clinic in Greece: An International, Cross-sectional Study.

The temporary delay in fertility treatments due to the coronavirus disease 2019 (COVID-19) pandemic, in combination with the imposed lockdowns, has created psychological distress and anxiety amongst infertile patients. The aim of this study was to evaluate how the pandemic has influenced assisted reproduction technology (ART) patients in Greece, during the second wave of the pandemic. An additional aim was to examine the effects of the pandemic on cross-border patients in particular, compared to national ones. This study was a cross-sectional, questionnaire-based study, distributed to 409 patients of a single in vitro fertilisation (IVF) clinic in Greece, during the period between January until the end of April 2021. The survey was conducted online via E-mail and was distributed to national and international female patients of a single IVF clinic in Greece, who were undergoing ART treatment during the second wave of the COVID-19 pandemic. Patient participation was anonymous, and participants provided informed consent for collection and publication of data. The mean values of baseline characteristics, along with answer percentages per questionnaire item, were calculated. Collected data were cross-tabulated, and the Chi-square test was used as a measurement of the differences between national and cross-border patients. A P value lower than 0.05 was considered statistically significant. All analyses were conducted using the SPSS Statistics software. From 409 initial candidates, 106 women, with a mean age of 41.2 years, completed the questionnaire (26% response rate). The majority of national patients did not experience any delays in their fertility plans (62%), while cross-border patients experienced over 6 months of delays (54.7%). The main reason for fertility postponement was travel restrictions due to COVID-19 for cross-border patients (62.5%), while national patients cited additional reasons. The majority of patients experienced a degree of stress (65.2%) due to the delays, however were not fearful of COVID-19 infection (54.7%). Most patients were aware of the protective measures taken by IVF clinics (80.2%), and this was a determinant factor (71.7%) for their decision to restart their fertility treatment. The COVID-19 pandemic lockdowns had a significant emotional impact on patient receiving or undergoing ART treatment in Greece. This impact was more pronounced on cross-border patients. This highlights the need for continuation of ART care, with the appropriate protective measures, during the pandemic, as well as during similar times of crisis in the future.

Globalization, Fertility, and Marital Behavior in a Lowest-Low Fertility Setting.

Declines in marriage and fertility rates in many developed countries have fostered research debate and increasing policy attention. Using longitudinal data from the German Socio-Economic Panel, we analyze the effects of exposure to globalization on fertility and marital behavior in Germany, which was a lowest-low fertility setting until recently. We find that exposure to greater import competition from Eastern Europe led to worse labor market outcomes and lower fertility rates. In contrast, workers in industries that benefited from increased exports had better employment prospects and higher fertility. These effects are driven by low-educated individuals, married men, and full-time workers and reflect changes in the likelihood of having any child (the extensive margin). We find evidence of some fertility postponement and significant effects on completed fertility, but we see little evidence of a significant impact on marital behavior. Our results inform the public debate on fertility rates in settings with lowest-low fertility, such as Germany, during the period under investigation.

P-727 The demographic impact of increasing ART use on fertility - the case of Czechia

Abstract Study question What is the contribution of ART usage to the recent fertility trends - the total fertility rate (TFR) and birth timing - in Czechia? Summary answer The results revealed the contribution of the increasing use of ART to the ongoing childbearing postponement process. What is known already The demographic importance of the use of ART has increased substantially over the last two decades in the context of the ongoing fertility postponement process. The use of ART is likely to reduce involuntary childlessness and helps to offset part of the effect of increasing infertility due to fertility postponement. However, its use cannot make up for all births lost by the natural decline in fertility after age 35. The use of ART pushes the age limits of childbearing to extremely late ages. Moreover, ART may serve to create the illusion that childbearing can be postponed until late reproductive ages. Study design, size, duration The study is based on anonymised individual data from national health registers managed by the Institute of Health Information and Statistics and data available from the Czech Statistical Office. A unique database of individual data on each child born in the years 2013-2018 in Czechia allows the construction of detailed demographic fertility indicators in terms of the use/non-use of ART. Participants/materials, setting, methods The study employs demographic indicators characterising the level of fertility and its timing (total fertility rate, age-specific fertility rates, mean age of mothers at childbirth). These indicators are constructed using data for live births and are further disaggregated by whether or not the mother has undergone ART. Main results and the role of chance Both the number and the proportion of live births following ART increased steadily between 2013 and 2018. The proportions of ART-live births increased significantly with the age of the mothers (around 5% of children were born following ART to mothers aged 35-39 years, less than 10% to mothers aged 40-44, almost 40% to mothers aged 45-49 years). The ART-total fertility rate between 2013 and 2018 increased from 0.045 to 0.058 and the relative impact of ART on the TFR increased from 3.1% to 3.4%. Concerning childbearing timing, fertility after ART is significantly shifted towards the age of 39 years when the possibility of the financial contribution of health insurance companies ends in Czechia. The mean age of mothers at childbirth following ART reached 34.5 years in 2018, which was significantly higher than the non-ART mean age at childbirth (30.0 years). The difference in the ART and non-ART mean age at childbirth increased from less than 4 years in 2013 to 4.6 years in 2018. Therefore, the increase in ART usage is, on the one hand, a consequence of the fertility postponement process, but on the other hand, ART can be seen also as one of the “drivers” of fertility postponement. Limitations, reasons for caution Information on the use of ART was estimated based on information on ART cycles performed in Czechia; women who underwent ART abroad were classified as non-ART. Given that Czechia is more likely to be a destination country for cross-border reproductive care, we did not anticipate significant bias in the results. Wider implications of the findings The contribution of the increasing use of ART to the ongoing childbearing postponement process remains significant. Trial registration number not applicable

The role of cohorts in the understanding of the changes in fertility in Czechia since 1990

This article presents a detailed analysis of the fertility changes in Czechia since 1990 using the cohort approach and contributes to the overall understanding of the fertility postponement process. Because the timing of childbearing since 1990 has changed significantly, particular attention is devoted to the differences in the timing of fertility between cohorts. Data from the Human Fertility Database was analyzed via both standard (based on age-specific fertility rates) and advanced methods (postponement and recuperation indicators, parity progression ratio). Four groups of cohorts with specific fertility patterns were identified: 1965–1970, 1971–1976, 1977–1982, and 1983–1990. These groups were impacted by the political, economic and social transformation of the 1990s, the financial crisis of 2008–2012 and other socio-economic changes during the study period in different ways. While the 1965–1970 cohort was associated with the rapid occurrence of postponement, it still reflected the early fertility pattern. The 1971–1976 cohort was associated with the most intensive degree of postponement, the 1977–1982 cohort can be linked to the onset of the deceleration of the postponement process, and the 1983–1990 cohort appears to be the first to stabilize their fertility at later ages.

Has the cesarean epidemic in Czechia been reversed despite fertility postponement?

BackgroundAlthough the percentage of cesarean sections (CS) in Czechia is below the average of that of other developed countries (23.6%), it still exceeds WHO recommendations (15%). The first aim of the study is to examine the association between a CS birth and the main health factors and sociodemographic characteristics involved, while the second aim is to examine recent trends in the CS rate in Czechia. MethodsAnonymized data on all mothers in Czechia for 2018 taken from the National Register of Expectant Mothers was employed. The risk of cesarean delivery for the observed factors was tested via the construction of a binary logistic regression model that allowed for adjustments for all the other covariates in the model.ResultsDespite all the covariates being found to be statistically significant, it was determined that health factors represented a higher risk of a CS than sociodemographic characteristics. A previous CS was found to increase the risk of its recurrence by 33 times (OR = 32.96, 95% CI 30.95–35.11, p<0.001). The breech position increased the risk of CS by 31 times (OR = 31.03, 95% CI 28.14–34.29, p<0.001). A multiple pregnancy increased the odds of CS six-fold and the use of ART 1.8-fold. Mothers who suffered from diabetes before pregnancy were found to be twice as likely to give birth via CS (OR = 2.14, 95% CI 1.76–2.60, p<0.001), while mothers with gestational diabetes had just 23% higher odds of a CS birth (OR = 1.23, 95% CI 1.16–1.31, p<0.001). Mothers who suffered from hypertension gave birth via CS twice as often as did mothers without such complications (OR = 2.01, 95% CI 1.86–2.21, p<0.001).ConclusionsThe increasing age of mothers, a significant risk factor for a CS, was found to be independent of other health factors. Accordingly, delayed childbearing is thought to be associated with the increase in the CS rate in Czechia. However, since other factors come into play, further research is needed to assess whether the recent slight decline in the CS rate is not merely a temporal trend.

Subnational spatial variations of fertility timing in Europe since 1990

Compared with European fertility trends, little is known on the spatial variations of fertility timing. This is particularly true within countries. While theories such as the Second Demographic Transition have brought good understanding to both the nature and origins of the recent changes in fertility behaviours including concerning fertility postponement, the predilection for empirical studies and cross-country analyses left the spatial organization of fertility timings relatively unrecognised. However, spatially differentiated fertility behaviours are expected theoretically. This geographical analysis presents spatial variations of fertility timing across Europe. The focus on subnational yet transnational data contribute to highlight the importance of local contexts on fertility patterns.After discussing the validity of the indicators and methods, we used mean age at birth in NUTS-2 regions and age specific fertility rates for the fine NUTS-3 spatial units to map the patterns of fertility in more than 30 countries over the 1990-2017 period. Several major results emerged. Despite general postponement of fertility to later ages in Europe resulting in a slight trend towards homogenisation, results reveal existing subnational differences. Most importantly, these differences are spatially organised. Across time the East-West divide remains a structuring contrast but other important disparities strengthen, highlighting the specificity of fertility patterns in Southern Europe and in the largest urban settlements. Eventually this inductive analysis discusses theories to explain the main spatial variations exposed. The study proves the importance to consider subnational contexts, especially metropolitan ones, when studying fertility behaviours.

Perceived consequences of the COVID-19 pandemic and childbearing intentions in Poland

Objective: We aim to investigate how the perceived consequences of COVID-19 affect people's childbearing intentions in Poland.&#x0D; Background: With the pandemic having an impact on virtually all spheres of people's lives, some evidence already exists that it will lead to fertility postponement, as people are reluctant to make their reproductive choices in such uncertain times.&#x0D; Method: We analyse a nationally representative sample of 1000 respondents aged 18-49. In the sample, 234 respondents declared that they had intended to have a child before the outbreak of the pandemic and about 20% of them stated having postponed or foregone their intention because of COVID-19. We perform logistic regression analyses to verify which perceived consequences of the pandemic are most decisive for this choice. We supplement our analyses with insights from qualitative, open-ended question on the effects of the pandemic.&#x0D; Results: We find that people’s decision to postpone childbearing is related to respondents' perceived lower sense of financial security and worse mental well-being in the pandemic. In the model, where both factors are included, only mental well-being remains significant. Qualitative analyses point to several other factors important to fertility decisions in the pandemic, e.g., women’s fear of lonely childbirth.&#x0D; Conclusion: People’s decision to postpone childbearing because of COVID-19 is mostly related to pandemic-induced financial insecurity and this effect seems to be mediated by the psychological reaction to the situation.

Fertility Postponement between Social Context and Biological Reality: The Case of Serbia

Fertility Postponement between Social Context and Biological Reality: The Case of Serbia

Review of “Freezing Fertility Oocyte Cryopreservation and the Gender Politics of Aging”

Reviewer: Skye A. Miner, National Institutes of Health Department of Bioethics, Bethesda, MD, USA Lucy van de Wiel expands the concept of reproductive aging in her book Freezing Fertility by examining how oocyte cryopreservation (OC) creates a postfertile condition, being neither fully fertile nor infertile. This cultural analysis critically reimagines what fertility means once preservation becomes “commonplace,” an accepted way of anticipating infertility (16). Thus, Freezing Fertility asks us to think about frozen eggs outside of individual means of empowerment or undue inducement but rather as a technology that provides a redefinition of fertility—one that destabilizes national boundaries, kinship structures, and gendered organizations of time. The argument that OC has allowed for the neoliberal postponement of fertility, making the individual solely responsible for not reproducing during her “fertile time,” is not new. However, Freezing Fertility goes beyond investigating the societal pressures that have led to delayed childbearing—educational attainment, establishment of...

CHILDBIRTH POSTPONEMENT AND AGE-RELATED INFERTILITY IN SERBIA

Childbirth postponement has been a widely discussed topic since the 1990s, and was pushed to the top of the demographic agenda with the emergence of the Second Demographic Transition (SDT) paradigm. Mechanisms of childbirth postponement mostly explained by economists or sociologists were understood as rational-based decisions of individuals (or couples) trying to cope with the requirements of modern society. These mechanisms explained by income and consumption rationale (Becker, Modigliani), or by liberal and postmodern values (Van de Kaa, Lestheage), barely mention the physiological limitations of the individual choice. These limitations given by the human species reproductive span, with no exception, affect everyone trying to make an optimal reproductive choice. There are two main effects of fertility postponement on births and fertility rates. The first effect arises when couples postpone childbearing to a later age during a certain period and fewer births take place than in the absence of such postponement – the ‘tempo effect’. The second is a negative effect of fertility postponement on completed fertility and increased childlessness attributable to the age-related increase in infertility. This second negative effect in particular is our field of interest. The decline in cohort fertility due to postponement has been mostly studied using data on age at first birth and subsequent fertility, as well as models of fecundity, pregnancy loss and time to conception by age, which we will try to apply to the period data. Using period data, we will try to quantify the potential number of births that would occur in the absence of childbirth postponement in Serbia during the past two decades.

Under-5 mortality and morbidity outcomes of fertility postponement in Turkey: explanations by observed and unobserved characteristics

ABSTRACT This paper investigates the association between advanced maternal age and under-5 mortality and morbidity in Turkey, and is the first such study in the country to use a sibling comparison model to analyze this phenomenon. The study is based on data obtained from the 2013 Turkey Demographic and Health Survey, and analyzes the association of advanced maternal age with: (1) under-five mortality, using Cox proportional hazard models and their stratified versions to compare sibling groups born to the same mother in the 1978–2013 period, and (2) under-five morbidity; specifically, being born with low birth weight, stunting, underweight, and wasting based on between- and within-sibling groups models for the 2008–2013 period. Overall, our findings suggest that the hazard of under-5 mortality increases as maternal age increases. We conclude that period effects have failed to reverse the impeding effects of advanced maternal age on child mortality. Between-sibling group models indicate a positive but close to null association between advanced maternal age and child morbidity in general, although these positive associations vanish once we apply within-sibling group models. This result can be partially attributed to our controlling for unobserved characteristics specific to sibling groups, in addition to other methodological differences.

Simulating family life courses: An application for Italy, Great Britain, Norway, and Sweden

Family patterns in Western countries have changed substantially across birth cohorts. The spread of unmarried cohabitation, the decline and postponement of marriage and fertility, and the rise in nonmarital births, partnership instability, and repartnering