Icelandic Women Research Articles

Association between Adverse Childhood Experiences and Multiple Sclerosis in Icelandic Women-A Population-Based Cohort Study.

A growing literature, mostly based on selected populations, indicates that traumas may be associated with autoimmune diseases, yet few studies exist on adverse childhood experiences (ACEs) and multiple sclerosis (MS) in the general population. We assessed cross-sectional associations between self-reported ACEs and MS among Icelandic women in the population-based Stress-And-Gene-Analysis (SAGA) cohort. Participants (n = 27,870; mean age 44.9 years) answered a web-based survey that included the ACE-International Questionnaire and a question about MS diagnosis. Log-linear Poisson regression models estimated MS prevalence ratios and 95% confidence intervals for ACEs adjusted for covariates. 214 women reported having been diagnosed with MS (crude prevalence = 7.7 per 1000). Compared to women without MS, women with MS reported more fatigue, body pain and bladder problems. The average cumulative number of ACEs was 2.1. After adjustment for age, education, childhood deprivation, smoking and depressive symptoms, MS prevalence did not increase with increasing ACEs exposure (PR = 1.00, 95% CI = 0.92, 1.09). Thirteen ACE categories, including abuse, neglect, household dysfunction and violence were not individually or independently associated with MS. Limited by self-reported data and cross-sectional design, results do not consistently support associations between ACEs in the development of MS among adult Icelandic women.

Epistemic Violence Toward Immigrant Women in Iceland: Silencing, Smothering, and Linguistic Deficit

This paper is an examination of how stories shared as a result of the #metoo movement in Iceland exemplify aspects of how culture and institutions in Iceland are complicit in the silencing of immigrant women who experience violence, both in intimate partner and employment situations. Through a critical analysis of 10 of the narratives shared by immigrant women in Iceland, the authors explore how testimonial smothering and silencing are both producing and reproducing epistemic violence in the women’s lives. We argue that the focus on linguistic purity of the Icelandic language maintains these exclusionary practices. Recognition of hegemonic practices is important in the continued development of a more equitable society and a first step in the inclusion of diverse voices in the continued development of the diversifying Icelandic knowledge society.

Risk factors for workplace sexual harassment and violence among a national cohort of women in Iceland: a cross-sectional study

SummaryBackgroundSexual harassment and violence in the workplace are a serious public health concern for women worldwide with substantial costs due to sick leave and personnel turnover. Yet little is known about the prevalence of sexual harassment and violence at a population level, especially across work sectors. The aim of this study was to investigate the prevalence of workplace sexual harassment and violence by demographic factors and work sectors among Icelandic women.MethodsFor this cross-sectional study we analysed nationally representative, de-identified individual-level data from women who had responded to an online survey item about self-labelled current and lifetime workplace sexual harassment or violence as part of the Stress and Gene Analysis (SAGA) study, a cross-sectional nationally representative study done from March 1, 2018, to July 1, 2019. Eligible participants were women who resided in Iceland, were aged between 18 and 69 years, spoke Icelandic, and had a registered address from the Icelandic Population Register or a telephone number from the online 1819 service. We used binomial and Poisson regression analysis to study the cross-sectional association between workplace sexual harassment and violence and demographic factors (eg, age, sexual orientation, and education) and factors relating to the workplace (eg, work schedule), across works sectors.FindingsOf 113 814 eligible women, 104 197 were invited to complete the online survey, of whom 30 403 women responded and were included in the SAGA cohort. 15 799 women answered the item about exposure to workplace sexual harassment or violence. 11 286 [71·4%] of 15 799 women answered the question about sexual orientation that were included in the survey from June, 2018. 5291 (33·5%) of 15 799 of participants reported having experienced workplace sexual harassment or violence during their lifetime, and 1178 (7·5%) in their current workplace. Such exposure in the current workplace was most common among women who were young (age 18–24 years: prevalence ratio [PR] 3·89 [95% CI 2·66–5·71]; age 25–34 years: 3·66 [2·53–5·31]), single (1·27 [1·12–1·43]), and worked shifts (2·32 [2·02–2·67]), with the highest prevalence rates observed among women in work sectors of public figures (15·67 [9·34–25·12]), tourism (15·01 [11·01–20·13]), and the legal system and security (13·56 [7·00–24·66]). Lifetime exposure to workplace sexual harassment or violence was more common among women who belonged to sexual minorities than among heterosexual women (PR 1·35 [1·24–1·46]).InterpretationLifetime exposure to workplace sexual harassment or violence seems common among women in a Nordic welfare state. These findings provide nuanced targets for prevention and for public policies aimed at promoting women's safety in the work environment.FundingIcelandic Gender Equality Fund, European Research Council, and Icelandic Centre for Research.

Perceived stress and hair cortisol concentration in a study of Mexican and Icelandic women.

Hair cortisol concentration (HCC) represent a potential biomarker of chronic psychological stress. Previous studies exploring the association between perceived stress and HCC have been limited to relatively small and selected populations. We collected hair samples from 881 women from the Mexican Teachers' Cohort (MTC) and 398 women from the Icelandic SAGA pilot-cohort following identical protocols. HCC was quantified using liquid chromatography coupled with tandem mass spectrometry. The self-reported Perceived Stress Scale (PSS, 10 and 4 item, range 0-40 and 0-16) was used to assess psychological stress. We conducted multivariable linear regression analyses to assess the association between perceived stress and log-transformed HCC in the combined sample and in each cohort separately. MTC participants had slightly higher HCC and PSS scores than SAGA participants (median HCC 6.0pg/mg vs. 4.7pg/mg and mean PSS-10 score 12.4 vs. 11.7, respectively). After adjusting for sociodemographic factors and health behaviors, we observed a 1.4% (95% CI 0.6, 2.1) increase in HCC for each unit increase in the PSS-10 score in the combined sample. Furthermore, PSS-10 quintiles were associated with a 24.3% (95% CI 8.4, 42.6, mean logHCC 1.8 vs 1.6) increase in HCC when comparing the highest to the lowest quintile, after multivariable adjustment. Similar results were obtained when we analyzed each cohort separately and when using the PSS-4. Despite relatively small absolute differences, an association between perceived stress and HCC was found in a sample of women from two diverse geographical and cultural backgrounds supporting the hypothesis that HCC is a viable biomarker in studies of chronic psychological stress.

Nordic War Stories: World War II as History, Fiction, Media, and Memory

Nordic War Stories: World War II as History, Fiction, Media, and Memory

Long-term survival of Icelandic women following acute myocardial infarction

Objective. To evaluate the impact of sex on treatment and survival after acute myocardial infarction (AMI) in Iceland. Methods. A retrospective, nationwide cohort study of patients with STEMI (2008–2018) and NSTEMI (2013–2018) and obstructive coronary artery disease. Patient and procedural information were obtained from a registry and electronic health records. Survival was estimated with Kaplan–Meier method and Cox regression analysis used to identify risk factors for long-term mortality. Excess mortality from the AMI episode was estimated by comparing the survival with age- and sex-matched population in Iceland at 30-day interval. Results. A total of 1345 STEMI-patients (24% women) and 1249 NSTEMI-patients (24% women) were evaluated. Women with STEMI (mean age: 71 ± 11 vs. 67 ± 12) and NSTEMI (mean age: 69 ± 13 vs. 62 ± 12) were older and less likely to have previous cardiovascular disease. There was neither sex difference in the extent of coronary artery disease nor treatment. Although crude one-year post-STEMI survival was lower for women (88.7% vs. 93.4%, p = .006), female sex was not an independent risk factor after adjusting for age and co-morbidities after STEMI and was protective for NSTEMI (HR 0.67, 95% CI: 0.46–0.97). There was excess 30-day mortality in both STEMI and NSTEMI for women compared with sex-, age- and inclusion year-matched Icelandic population, but thereafter the mortality rate was similar. Conclusion. Women and men with AMI in Iceland receive comparable treatment including revascularization and long-term survival appears similar. Prognosis after NSTEMI is better in women, whereas higher early mortality after STEMI may be caused by delays in presentation and diagnosis.

Sleep disturbances among women in a Subarctic region: a nationwide study.

Study ObjectivesTo date, few studies have assessed sleep problems among women residing in Subarctic regions. Therefore, the aim of this large-scale population-based study was to assess the prevalence of severe sleep problems and associated factors among Icelandic women, living at 63–66°N.MethodsParticipants were 29 681 women (18–69 years old) who took part in the Icelandic Stress-And-Gene-Analysis study in 2018–2019. Background information, health-related behavior, and mental health symptoms were assessed with an online questionnaire. The Pittsburgh Sleep Quality Index (PSQI) was used to assess severe sleep problems during the past month. Adjusting for age, marital status, number of children, education, personal income, work schedule, region, and response period, we used modified Poisson log-linear models to obtain prevalence ratios (PRs) with 95% confidence intervals (CIs).ResultsOverall, 24.2% of women reported severe sleep problems (PSQI >10). Women responding in the winter presented with an overall higher prevalence of severe sleep problems, compared to those responding in the summer (PR 1.21; 95% CI, 1.15 to 1.28). Severe sleep problems were more prevalent among young and late-midlife women, those who were single, had children, socio-economic challenges, worked shifts, and flexible hours. Furthermore, obesity, suboptimal health behaviors, excessive screen time, and mental health problems were associated with severe sleep problems.ConclusionSevere sleep problems are more common among women in Subarctic regions than elsewhere, particularly during winter. These findings motivate the development of preventive strategies and interventions for women in the Subarctic who suffer from sleep problems.

Correlation between intake of fish or supplements containing omega-3 fatty acids and early pregnancy plasma concentrations.

Long-chain polyunsaturated omega-3 fatty acids are considered important for fetal development, but previous studies suggest suboptimal intake in part of pregnant women in Iceland. The study aim was to evaluate intake of food and supplements containing omega-3 fatty acids, among pregnant women in Iceland and correlations to fatty acid composition in plasma. Subjects were 853 pregnant women attending their 11-14 weeks ultrasound appointment. Information on intake of food and supplements containing long-chain omega-3 fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) as well as background was obtained by a questionnaire. Blood samples were collected for analysis of plasma fatty acids. Correlation was evaluated using the Spearman correlation. Median intake of lean fish was 1.3 times per week, while fatty fish was consumed once monthly. About 50% of the women took omega-3 containing supplements daily. Higher intake of both fish and omega-3 containing supplements was reflected in higher omega-3 plasma levels (r=0.37 p<0.001). A positive correlation was seen between intake of cod liver oil/capsules (r=0.23, p=0.001), omega-3 oil/capsules (r=0.20, p=0.001) and plasma concentration of omega-3. However, no correlation was seen between intake of a maternal multivitamin containing omega-3 and corresponding plasma concentration (r=0.03, p=0.98). Intake of food and supplements containing omega-3 fatty acids was reflected in plasma concentration, except for an Icelandic maternal multivitamin. One third of the women followed the recommendation of eating fish at least twice weekly. About 50% had a daily intake of supplements containing omega-3 fatty acids.

Use of pain management in childbirth among migrant women in Iceland: A population-based cohort study.

BackgroundImmigration is rapidly increasing in Iceland with 13.6% of the population holding foreign citizenship in 2020. Earlier findings identified inequities in childbirth care for some women in Iceland. To gain insight into the quality of intrapartum midwifery care, migrant women's use of pain management methods during birth in Iceland was explored.MethodsA population‐based cohort study including all women with a singleton birth in Iceland between 2007 and 2018, in total 48 173 births. Logistic regression analyses with odds ratios (ORs) and 95% confidence intervals (CIs) were used to investigate the relationship between migrant backgrounds defined as holding foreign citizenship and the use of pain management during birth. The main outcome measures were use of nonpharmacological and pharmacological pain management methods.ResultsData from 6097 migrant women were included. Migrant women had higher adjusted OR (aORs) for no use of pain management (aOR = 1.23 95% CI [1.12, 1.34]), when compared to Icelandic women. Migrant women also had lower aORs for the use of acupuncture (0.73 [0.64, 0.83]), transcutaneous electrical nerve stimulation (TENS) (0.92 [0.01, 0.67]), shower/bath (0.73 [0.66, 0.82]), aromatherapy (0.59 [0.44, 0.78]), and nitrous oxide inhalation (0.89 [0.83, 0.96]). Human Development Index (HDI) scores of countries of citizenship <0.900 were associated with lower aORs for the use of various pain management methods.ConclusionsOur results suggest that being a migrant in Iceland is an important factor that limits the use of nonpharmacological pain management, especially for migrant women with citizenship from countries with HDI score <0.900.

Arab Muslim Immigrant Women in Iceland: Immigration experiences and future expectations

The present study explores the perceptions and the experiences of Arab Muslim immigrant women who immigrated from Arab countries to live in Iceland. This study focuses on the main challenges and obstacles faced by Arab Muslim immigrant women and how these factors continue to affect their adaptation into Icelandic society. I explore how Arab women identified themselves and how the new environment and the socio-cultural values impacted their integration in Iceland. Interviews were conducted with nine women living outside the capital area. The findings indicate that Islam plays an important role in their immigration experience and the adaptation process. The findings suggest that the women’s experiences are affected by other factors such as the cultural differences and the support of the local community, which impacts the development and maintenance of the women’s identity. Children’s schooling and education also influence the women’s lives in Iceland. The analysis suggests that there is a lack of knowledge about the women’s culture and religion, which causes misunderstanding or confusion.

Early pregnancy plasma fatty acid profiles of women later diagnosed with gestational diabetes

IntroductionFatty acid (FA) concentrations have previously been associated with gestational diabetes mellitus (GDM). However, few studies on GDM have examined FA profiles in early pregnancy or before diagnosis. This study...

Challenges in migrant women's maternity care in a high-income country: A population-based cohort study of maternal and perinatal outcomes.

IntroductionThis study aims to explore maternal and perinatal outcomes of migrant women in Iceland.Material and methodsThis prospective population‐based cohort study included women who gave birth to a singleton in Iceland between 1997 and 2018, comprising a total of 92 403 births. Migrant women were defined as women with citizenship other than Icelandic, including refugees and asylum seekers, and categorized into three groups, based on their country of citizenship Human Development Index score. The effect of country of citizenship was estimated. The main outcome measures were onset of labor, augmentation, epidural, perineum support, episiotomy, mode of birth, obstetric anal sphincter injury, postpartum hemorrhage, preterm birth, a 5‐minute Apgar <7, neonatal intensive care unit admission and perinatal mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) for maternal and perinatal outcomes were calculated using logistic regression models.ResultsA total of 8158 migrant women gave birth during the study period: 4401 primiparous and 3757 multiparous. Overall, migrant women had higher adjusted ORs (aORs) for episiotomy (primiparas: aOR 1.43, 95% CI 1.26–1.61; multiparas: 1.39, 95% CI 1.21–1.60) and instrumental births (primiparas: 1.14, 95% CI 1.02–1.27, multiparas: 1.41, 95% CI 1.16–1.72) and lower aORs of induction of labor (primiparas: 0.88, 95% CI 0.79–0.98; multiparas: 0.74, 95% CI 0.66–0.83), compared with Icelandic women. Migrant women from countries with a high Human Development Index score (≥0.900) had similar or better outcomes compared with Icelandic women, whereas migrant women from countries with a lower Human Development Index score than that of Iceland (<0.900) had additionally increased odds of maternal and perinatal complications and interventions, such as emergency cesarean and postpartum hemorrhage.ConclusionsWomen’s citizenship and country of citizenship Human Development Index scores are significantly associated with a range of maternal and perinatal complications and interventions, such as episiotomy and instrumental birth. The results indicate the need for further exploration of whether Icelandic perinatal healthcare services meet the care needs of migrant women.

“We at least say we are equal”: Gender equality and class in healthcare professionals’ discursive framing of migrant mothers

In the last few decades, the demography of Iceland has become increasingly diverse with an immigrant population similar to that of the other Nordic countries. Women comprise almost half of all international migrants and many of those female migrants require maternity care in their host countries. While some literature describes how migrant women experience the healthcare provisions of their host countries, less is known about the experience of providing the service, from the perspective of the healthcare practitioners. In this study we adopt a social constructionist perspective to explore the discourses of knowledge healthcare professionals in Iceland draw on in their discussion of prenatal and postpartum healthcare in Iceland. Interviews were conducted with 16 healthcare professionals with extensive experience of providing maternity care to migrant women to understand how they construct and make sense of the needs and behaviour of migrant women seeking maternity care. Our findings suggest that some healthcare professionals subject migrant women to normative professional discourses of parenting, without considering how those ideals are tailored to white, middle class women. Migrant mothers and pregnant women are thus excluded from the middle-class mothering norms that are ascribed to Icelandic women. Our findings also highlight how national identity, such as being part of a gender equal society and the image of Iceland as a classless society, influences how healthcare professionals view migrant women. This underscores the importance of cultural reflexivity, and policies and scholarship where an intersectional understanding of gender, class and migrant worker status is at the forefront.

Higher Alkylresorcinol Concentrations, a Consequence of Whole-Grain Intake, are Inversely Associated with Gestational Diabetes Mellitus in Iceland

BackgroundA diet rich in whole grains may provide benefits for pregnant women due to whole grains’ high nutritional value and dietary fiber content. ObjectivesTo study the associations of whole-grain consumption, as well as the plasma alkylresorcinol concentration, a whole-grain consumption biomarker, in early pregnancy with gestational diabetes mellitus (GDM) diagnoses. MethodsSubjects were women from the prospective study Pregnant Women in Iceland II (PREWICE II; n = 853) who attended their ultrasound appointment in gestational weeks 11–14 during the period from October 2017 to March 2018. During that visit, whole-grain consumption was estimated using a diet screening questionnaire, and blood samples were collected for analysis of plasma alkylresorcinols (ARs). Information on GDM diagnoses was later extracted from medical records. Multivariate log-binomial regression was used to evaluate the association of dietary whole-grain and AR concentrations with GDM. ResultsIn total, 14.9% of the women adhered to the national food-based dietary guidelines (n = 127), which recommend 2 portions of whole grains daily. GDM was diagnosed in 127 women (14.9%). The frequency of whole-grain consumption was lower in women who were later diagnosed with GDM compared to the women without GDM (median, 5 times/week vs. 6 times/week, respectively; P = 0.02). This difference was reflected in the lower median concentration of total AR in women diagnosed with GDM (163 nmol/L vs. 209 nmol/L, respectively; P < 0.01). The quartile with the highest concentrations of AR had a RR of 0.50 (95% CI: 0.27–0.90) of being diagnosed with GDM, in comparison to the lowest quartile. There was a significant dose response in the GDM risk with higher AR levels. ConclusionsWe found that a higher consumption of whole grains, reflected both by reported consumption according to the FFQ and AR biomarkers, was associated with a decreased risk of receiving a GDM diagnosis.

Vitamin D status and association with gestational diabetes mellitus in a pregnant cohort in Iceland.

BackgroundVitamin D deficiency has been associated with an increased risk of gestational diabetes mellitus (GDM), one of the most common pregnancy complications. The vitamin D status has never previously been studied in pregnant women in Iceland.ObjectiveThe aim of this research study was to evaluate the vitamin D status of an Icelandic cohort of pregnant women and the association between the vitamin D status and the GDM incidence.DesignSubjects included pregnant women (n = 938) who attended their first ultrasound appointment, during gestational weeks 11–14, between October 2017 and March 2018. The use of supplements containing vitamin D over the previous 3 months, height, pre-pregnancy weight, and social status were assessed using a questionnaire, and blood samples were drawn for analyzing the serum 25‑hydroxyvitamin D (25OHD) concentration. Information regarding the incidence of GDM later in pregnancy was collected from medical records.ResultsThe mean ± standard deviation of the serum 25OHD (S-25OHD) concentration in this cohort was 63±24 nmol/L. The proportion of women with an S-25OHD concentration of ≥ 50 nmol/L (which is considered adequate) was 70%, whereas 25% had concentrations between 30 and 49.9 nmol/L (insufficient) and 5% had concentrations < 30 nmol/L (deficient). The majority of women (n = 766, 82%) used supplements containing vitamin D on a daily basis. A gradual decrease in the proportion of women diagnosed with GDM was reported with increasing S-25OHD concentrations, going from 17.8% in the group with S-25OHD concentrations < 30 nmol/L to 12.8% in the group with S-25OHD concentrations ≥75 nmol/L; however, the association was not significant (P for trend = 0.11).ConclusionApproximately one-third of this cohort had S-25OHD concentrations below adequate levels (< 50 nmol/L) during the first trimester of pregnancy, which may suggest that necessary action must be taken to increase their vitamin D levels. No clear association was observed between the vitamin D status and GDM in this study.

14232 Basal cell carcinoma: An emerging epidemic in women in Iceland

Background: An epidemic of basal cell carcinoma (BCC) has led to a significant health care burden in Caucasian populations.

Basal cell carcinoma: an emerging epidemic in women in Iceland

Basal cell carcinoma (BCC) is the most common type of skin cancer and largely caused by ultraviolet radiation (UVR), such as from the sun or tanning beds. While it rarely spreads throughout the body, it can be locally destructive (i.e. at the site of the cancer) and can cause serious harm to patients.

Good long-term survival of Icelandic women following acute myocardial infarction

Abstract Background Mortality from coronary artery disease has decreased considerably in recent decades in Western societies, but less in women compared with men. Possible explanations for this difference include delayed medical attention, atypical presenting symptoms and also a higher incidence of myocardial infarction with non-obstructive coronary arteries in women. In addition, recent studies suggest that women with acute myocardial infarction (AMI) are less likely to receive treatment according to guidelines, which results in worse prognosis for women. Iceland is listed as one of the most gender-equal countries in the world and we hypothesised that this may reduce the gender gap in treatment and survival following AMI. Purpose The aim of this nationwide study was to compare clinical characteristics and treatment of men and women with AMI, identify independent risk factors for long-term mortality and estimate the impact of gender on relative survival. Methods This was a retrospective cohort study on all patients in Iceland with STEMI (2008–2018) and NSTEMI (2013–2018) who had obstructive coronary artery disease on coronary angiography. Information about patients and angiography results and treatment were obtained from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) and electronic health records. Data for all-cause mortality was extracted through linkage with Statistics Iceland and survival was estimated with Kaplan-Meier method and Cox regression analysis used to identify significant risk factors for long-term mortality. Excess mortality from the AMI episode was estimated by comparing the survival with age- and gender-matched population in Iceland in 30-day intervals. Results A total of 1345 STEMI patients (24% women) and 1249 NSTEMI patients (24% women) were evaluated. Women with both STEMI (mean age: 71±11. vs. 67±12) and NSTEMI (mean age: 69±13 vs. 62±12) were older and less likely to have a cardiovascular history. There was no gender difference in the extent of coronary artery disease or treatment. Whilst long-term survival for women following STEMI (A) was lower, female gender was not found to be an independent risk factor for mortality after adjusting for age and comorbidities (HR 0.98, 95%-CI: 0.75–1.29). The survival after NSTEMI was similar between genders (B) and female gender was a protective prognostic factor (HR 0.67, 95% CI: 0.46–0.97). There was an excess 30-day mortality following STEMI (C) and NSTEMI (D) for both women and men compared to the matched Icelandic population, but thereafter the mortality rate was similar. Conclusion Our findings indicates that women and men in Iceland receive comparable treatment for AMI, including invasive treatment. Prognosis following NSTEMI is better in women. Higher early mortality after STEMI may be caused by delays in presentation and diagnosis as well as older age of women because female gender was not a significant risk factor for mortality. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University hospital of Iceland, 4 weeks research leave

Rising incidence of basal cell carcinoma in women in Iceland: is it sunbed use?

Rising incidence of basal cell carcinoma in women in Iceland: is it sunbed use?

A Nation of Bastards? Registered Cohabitation, Childbearing, and First-Marriage Formation in Iceland, 1994\u20132013

Nowhere in Europe is extramarital childbearing more pervasive than in Iceland. Roughly, 70% of children born in 2018 were conceived outside of marriage, thereof 83% of firstborn, which, on the surface, puts Iceland at the vanguard of a development often associated with a second demographic transition. In this study, we investigate the union formation behaviour of Icelandic women during a period of 20 years (1994–2013) with the objectives of gaining insight into the interplay of childbearing, registered cohabitation, and marriage and to enhance our understanding of the function of registered cohabitation in the family-building process. We use administrative population register data, covering the childbearing and marital history of the total female population born in Iceland during 1962–1997. The data are analysed by means of event history techniques and presented as annual indices of first-registered cohabitation and first-marriage formation, respectively. We find indications of forceful postponement of registering cohabitation over time, but a stable portion of around 80% of women registered cohabitation before any first marriage or age 46. Around 70% of women married before age 46, and the standardized marriage rates remained relatively stable during most of our study period. Our findings suggest that within a context such as the Icelandic one, most people tend to marry, regardless of the prevalence of cohabitation. We propose that registered cohabitation should be seen as providing a semi-regulated union status for prospective parents in relation to childbearing. Marriage on the other hand could be seen as providing an elevated union status to couples.