Differences in Delaying Motherhood Across European Countries: Empirical Evidence from the ECHP

Scenarios of Delayed First Births and Associated Cohort Fertility Levels

Fertility rates among individuals in their 20s have fallen sharply across Europe over the past 50 years. The implications of delayed first births for fertility levels in modern family regimes remain little understood. Using microsimulation models of childbearing and partnership for the 1970-1979 birth cohorts in Italy, Great Britain, Sweden, and Norway, we implement fictive scenarios that reduce the risk of having a first child before age 30 and examine fertility recovery mechanisms for aggregate fertility indicators (the proportion of women with at least one, two, three, or four children; cohort completed fertility rate). Exposure to a first birth increases systematically in the ages following the simulated reduction in first-birth risks, leading to a structural recovery in childbearing that varies across countries according to their fertility and partnership regimes. Full recovery requires an increase in late first-birth risks, with greater increases in countries where late family formation is uncommon and average family sizes are larger: in scenarios where early fertility declines substantially (a linear decline from 50% at age 15 to 0% at age 30), first-birth risks above age 30 would have to increase by 54% in Great Britain, 40% in Norway and Sweden, and 20% in Italy to keep completed fertility constant.

Alkali and alkaline earth elements in follicular fluid and the likelihood of diminished ovarian reserve in reproductive-aged women: a case‒control study

BACKGROUND

Imbalances in alkali elements (AEs) and alkaline earth elements (AEEs) cause reproductive disorders. However, it remains unclear whether AEs/AEEs in follicular fluid have a relationship with the serious reproductive disorder known as diminished ovarian reserve (DOR).

METHODS

A nested case‒control study was carried out in China. Follicular fluid samples from 154 DOR patients and 154 controls were collected and assessed for nine AEs/AEE levels. Both the mixed and single effects of the elements on DOR were estimated with a Bayesian kernel machine (BKMR) and logistic regressions.

RESULTS

The DOR group had higher median concentrations of Li, Na, and K in follicular fluid (all P values < 0.05). The logistic regression showed that compared with their lowest tertile, the high tertiles of K [OR:2.45 (1.67-4.43)], Li [OR: 1.89 (1.06-3.42)], and Cs [OR: 1.97 (1.10-3.54)] were significantly associated with the odds of DOR. The BKMR model reported that the DOR likelihood increased linearly across the 25th through 75th percentiles of the nine-AE/AEE mixture, while the AE group contributed more to the overall effect.

CONCLUSION

This study revealed an association in which the likelihood of DOR increased with higher overall concentrations of AE/AEEs in follicular fluid. Among the nine detected elements, K, Li, and Cs exhibited significant individual associations with DOR. We provide new clues for the environmental factors on female fertility decline.

TRIAL REGISTRATION

Retrospectively registered.

Home-based work and childbearing

We examine the timely yet greatly under-researched interplay between home-based work (HBW) and women's birth transitions. Past research has shown that HBW may facilitate and/or jeopardize work-family balance, depending on the worker's family and work circumstances. Following that research, we develop here a theoretical framework on how HBW can facilitate or hinder fertility. Using the UK Household Longitudinal Study 2009-19 and random-effects cloglog regression, we study the link between HBW and first- and second-birth risks. We find that HBW is negatively associated with the transition to motherhood and unrelated to the progression to a second child. We also show that HBW helps to enable women to have children if they would otherwise face a long commute. All in all, our findings do not support the idea that the spread of HBW will lead to an immediate increase in fertility.

Exploring the knowledge, attitudes, and perceptions of women of reproductive age towards fertility and elective oocyte cryopreservation for age-related fertility decline in the UK: a cross-sectional survey

STUDY QUESTION

What are the knowledge, perceptions and attitudes towards fertility and elective oocyte cryopreservation (OC) for age-related fertility decline (ARFD) in women in the UK?

SUMMARY ANSWER

Awareness of OC for ARFD has reportedly improved compared to studies carried out almost a decade ago, but inconsistencies in knowledge remain regarding the rate of miscarriage amongst specific age groups, the financial costs and optimal age to undergo OC for ARFD.

WHAT IS KNOWN ALREADY

The age of first-time motherhood has increased amongst western societies, with many women of reproductive age underestimating the impact of age on fertility. Further understanding of women's awareness of their fertility, the options available to preserve it and the barriers for seeking treatment earlier are required in order to prevent the risk of involuntary childlessness.

STUDY DESIGN, SIZE, DURATION

A hyperlink to a cross-sectional survey was posted on social media (Instagram) between 25 February 2021 and 11 March 2021.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women from the general population aged 18-50 years were invited to complete the survey.

MAIN RESULTS AND THE ROLE OF CHANCE

In total, 5482 women fulfilled the inclusion criteria and completed the survey. The mean age of participants was 35.0 years (SD 10.25; range 16-52). Three quarters (74.1%; n = 4055) disagreed or strongly disagreed they felt well informed regarding the options available to preserve their fertility, in case of a health-related problem or ARFD. The majority overestimated the risk of miscarriage in women aged ≥30 years old, with 14.5% correctly answering 20%, but underestimated the risks in women ≥40, as 20.1% correctly answered 40-50%. Three quarters (73.2%; n = 4007) reported an awareness of OC for ARFD and 65.8% (n = 3605) reported that they would consider undergoing the procedure. The number of women who considered OC for ARFD across age groups were as follows: 18-25 (8.3%; n = 300), 26-30 (35.8%; n = 1289), 31-35 (45.9%; n = 1654), 36-40 (9.6%; n = 347), 41-45 (0.3%; n = 13), and 46-50 (0.1%; n = 2). The majority of women (81.3%; n = 4443) underestimated the cost of a single cycle of OC for ARFD (<£5000). Furthermore, 10.4% (n = 566) believed a single cycle would be adequate enough to retrieve sufficient oocytes for cryopreservation. Approximately 11.0% (n = 599) believed OC for ARFD may pose significant health risks and affect future fertility. Less than half agreed or strongly agreed that the lack of awareness regarding OC for ARFD has impacted the likelihood of pursuing this method of fertility preservation further (41.4%; n = 2259).

LIMITATIONS, REASONS FOR CAUTION

Results from cross-sectional studies are limited as interpretations made are merely associations and not of causal relationships. The online nature of participant recruitment is subject to selection bias, considering women with access to social media are often from higher socioeconomic and education backgrounds, thus limiting generalizability of the findings.

WIDER IMPLICATIONS OF THE FINDINGS

Further education regarding the financial costs and optimal age to undergo elective OC to increase the chances of successful livebirth are required. Clinicians should encourage earlier fertility counselling to ensure that OC is deemed a preventative measure of ARFD, rather than an ultimate recourse to saving declining fertility.

STUDY FUNDING/COMPETING INTEREST(S)

No funding was required for this article. There are no conflicts of interests to declare.

TRIAL REGISTRATION NUMBER

N/A.

Partnership dynamics and entry into parenthood: Comparison of Finnish birth cohorts 1969-2000

During the past decade, the stability of close-to-replacement-level fertility ended in all Nordic countries, with its decline to the lowest level in Finland. It is unclear whether and how partnership dynamics have changed, and whether they play a role in fertility developments. We focus on the patterns and associations between the formation and stability of co-residential partnerships and first birth among Finnish women and men, and on whether and how these associations have changed across birth cohorts. We utilise total population register data on persons born between 1969 and 2000 in Finland, and adopt the event history method. Our results indicate that half of the women formed their first co-residential partnerships by the age of 22 years. Cohorts born in the early 1990s were the first to delay the formation of non-marital first partnerships. In contrast, first births are increasingly postponed, and the proportion of women and men, who become parents, has declined across recent cohorts. Among men, we observe higher median ages for family formation events and higher likelihoods of not forming a family. As a result of fertility decline and increase in partnership instability, for the first time, the probability of separation is higher than that of first births among partnered women born in the 1990s. Our findings show that at a behavioural level, the once close link between partnership formation and parenthood has progressively eroded across consecutive birth cohorts. Together with the ongoing tendency to delay first births, decreasing partnership stability, and first indications of delaying partnership formation, the potential of witnessing a marked increase of fertility levels in the near future is delimited. Our study's results contribute to a better understanding of the demographic mechanisms behind the decline in fertility in Finland, over the recent decade.

Reproductive outcomes from ten years of elective oocyte cryopreservation

RESEARCH QUESTION

To assess the relationship between the number of oocytes retrieved during elective oocyte cryopreservation (EOC) cycles with various clinical, biochemical, and radiological markers, including age, body mass index (BMI), baseline anti-Müllerian hormone (AMH), antral follicle count (AFC), Oestradiol level (E2) and total number of follicles ≥ 12 mm on the day of trigger. To also report the reproductive outcomes from women who underwent EOC.

METHODS

A retrospective cohort of 373 women embarking on EOC and autologous oocyte thaw cycles between 2008 and 2018 from a single London clinic in the United Kingdom.

RESULTS

483 stimulation cycles were undertaken amongst 373 women. The median (range) age at cryopreservation was 38 (26-47) years old. The median numbers of oocytes retrieved per cycle was 8 (0-37) and the median total oocytes cryopreserved per woman was 8 (0-45). BMI, E2 level and number of follicles ≥ 12 mm at trigger were all significant predictors of oocyte yield. Multivariate analysis confirmed there was no significant relationship between AFC or AMH, whilst on univariate analysis statistical significance was proven. Thirty six women returned to use their cryopreserved oocytes, of which there were 41 autologous oocyte thaw cycles undertaken. There were 12 successful livebirths achieved by 11 women. The overall livebirth rate was 26.8% per cycle. No livebirths were achieved in women who underwent EOC ≥ 40 years old, and 82% of all livebirths were achieved in women who had done so between 36 and 39 years old.

CONCLUSION

Clinical, biochemical and radiological markers can predict oocyte yield in EOC cycles. Reproductive outcomes are more favourable when cryopreservation is performed before the age of 36, with lower success rates of livebirth observed in women aged 40 years and above.

Fertility Decision-Making in the UK: Insights from a Qualitative Study among British Men and Women

Scholars are interested in better understanding the low fertility observed in higher income countries. While some people are choosing to have smaller families, countries also report a ‘fertility gap’, which is the proportion of people who end up with fewer children than originally desired. This paper investigates some causes of the fertility gap in the UK. We amassed qualitative data from seven focus groups conducted among men and women of reproductive age with different educational backgrounds. These focus groups suggest that social support is an influential factor for Britons thinking about having children, although discussions differed in terms of whether this was support from partners or parents. Discussions with university-educated women featured themes of career opportunity costs, and non-university men contributed insights on the financial burden of parenthood. This exploratory study provides up-to-date material on unwanted childlessness and the low fertility in the UK, and highlights the merit of using qualitative methods in understanding the fertility gap.

Polarized adult fertility patterns following early parental death

Death of a parent during childhood has become rare in developed countries but remains an important life course event that may have consequences for family formation. This paper describes the link between parental death before age 18 and fertility outcomes in adulthood. Using the large national 2011 French Family Survey (INSEE-INED), we focus on the 1946-66 birth cohorts, for whom we observe entire fertility histories. The sample includes 11,854 respondents who have lost at least one parent before age 18. We find a strong polarization of fertility behaviours among orphaned males, more pronounced for those coming from a disadvantaged background. More often childless, particularly when parental death occurred in adolescence, some seem to retreat from parenthood. But orphaned men and women who do become parents seem to embrace family life, by beginning childbearing earlier and having more children, especially when the deceased parent is of the same sex.

European countries with delayed childbearing are not those with lower fertility

At the individual level, a very strong negative relationship is observed between age at first birth and total number of children. However, at the country level, it is possible that no relationship exists between factors that reduce fertility at younger ages and stimulate it at older ages. Hence, across countries, the size of the decline in youth fertility is potentially unrelated to the size of the increase in fertility at older ages or the decline in total fertility. We study the fertility of women and their age at childbirth, with particular attention to their evolution over the last 40 years in countries across Europe. Comparing these countries, the increase in births after age 30 has occurred relatively independently of the decline at younger ages according to both period and cohort, and we find no positive relationship between the delay of first birth and decline in total fertility. On the contrary, an inverse relationship evidently exists at the country level, as longer delays generally correspond to smaller declines in total fertility. Context effects largely dominate individual constraints and play an important role in the occurrence of later births.

Oocyte yield in social, medical and donor oocyte cryopreservation cycles

To determine if oocyte yield in women undergoing cryopreservation for social (SOC), medical (MOC) and oocyte donation (OD) cycles is comparable when matched for age. 315 oocyte retrievals were performed for SOC, 116 for MOC and 392 for OD. Non-parametric Kruskal-Wallis tests and Poisson regression were used to assess the impact of age stratification. The median ages of women undergoing SOC, MOC, and OD were 38, 31 and 26 years respectively. The median (IQR) number of oocytes in the three categories was 7, 10, and 12. The oocyte yield was significantly higher in women aged 30-34 years undergoing SOC, compared to the MOC group. For the SOC group, age in years, oestradiol levels per 1000 pmol/and follicle count >12mm on the day of trigger were significant predictors of oocyte yield. Women embarking on SOC are significantly older than those undergoing MOC and OD, and thus oocyte yield is reduced when stratified for age. This study highlights the significant predictors of oocyte yield amongst women undergoing oocyte cryopreservation for specific indications. The findings can be used to optimise the yield and overall chance of successful livebirth.

The diversity of pathways to childlessness in the Czech Republic: The union histories of childless men and women

Despite the fact that not having a partner is a strong predictor for remaining childless, few studies have explored the heterogeneity of partnership trajectories among childless persons. This article fills the gap in knowledge about the pathways to childlessness in Central Europe by exploring the within-group diversity of partnership trajectories among childless persons between the ages of 18 and 40 under state socialism and during the post-1989 transformation in the Czech Republic. Based on data from the Gender and Generations Survey, we identify different types of union history among childless persons using sequence analysis and optimal matching-based clustering. Moreover, we directly assess variations in partnership trajectories across gender, education, and birth cohorts by analysing sequence discrepancy and the complexity index. In both the state-socialist and post-socialist contexts the most prevalent trajectory types were 'never partnered' and 'long-term partnerships', with only a small proportion of unstable partnership trajectories. Childless women experience more diverse and complex trajectories than childless men and their partnership trajectories vary more pronouncedly across educational groups than those of men. In contrast, cohort differences are more pronounced among childless men. We discuss the findings against the backdrop of the transition from a state-socialist to a post-socialist welfare state. The findings thus contribute to a more comprehensive understanding of the social and historical embeddedness of pathways to childlessness and show how the links between gender, education, and family life-courses are context-specific.

The nexus between education and fertility in six European countries

Given the many linkages between education and family behaviour, the expansion of higher education especially among women in recent decades may have important consequences for fertility in Europe. This is a crucial factor in both the New Home Economics (NHE) theory and the Second Demographic Transition (SDT) that predict a negative association between fertility and education. However, more recently, the Gender Revolution (GR) approach has emphasised the role of gender egalitarianism both in society and within households as a boost for fertility. By adopting a comparative perspective on six European countries, this paper reports our research on the effect of education on the fertility choices in light of the foregoing three different theoretical explanations. Using data from the second wave of Generation and Gender surveys (GGS) for Bulgaria, Czech Republic, France, Germany, and Poland, and the ISTAT survey “Famiglie e Soggetti Sociali” for Italy, we estimated the propensity to have the first and the second child birth on women born between 1940 and 1979 by means of multiprocess hazard models.

For the first childbirth, the influence of education on fertility behaviours not only remains important but also tends to increase among younger cohorts. This result matches the NHE and SDT explanation, suggesting a similar evolution towards an erosion of the family. Conversely, for the second childbirth we found marked differences among countries suggesting an East-West polarisation giving support to the GR approach. However, peculiarities for the Italian case linked to a tempo effect emphasize the need to go beyond the West-East dichotomy.

Latest-Late Fertility? Decline and Resurgence of Late Parenthood Across the Low-Fertility Countries

After decades of fertility postponement, we investigate recent changes in late parenthood across low-fertility countries in the light of observations from the past. We use long series of age-specific fertility rates from the Human Fertility Database (1950-2016) for women, and new data covering the period 1990-2016 for men. In 1950, the contribution of births at age 40 and over to female fertility rates ranged from 2.5 to 9 percent, but then fell sharply until the 1980s. From the 1990s, however, the prevalence of late first births increased rapidly, especially so in countries where it was initially lowest. This has produced a late fertility rebound in the last two decades, occurring much faster for women than for men. Comparisons between recent and past extremely late (age 48+) fertility levels confirm that people are now challenging the natural fertility barriers, particularly for a first child.

The limited effect of increasing educational attainment on childlessness trends in twentieth-century Europe, women born 1916-65

During the twentieth century, trends in childlessness varied strongly across European countries while educational attainment grew continuously across them. Using census and large-scale survey data from 13 European countries, we investigated the relationship between these two factors among women born between 1916 and 1965. Up to the 1940 birth cohort, the share of women childless at age 40+ decreased universally. Afterwards, the trends diverged across countries. The results suggest that the overall trends were related mainly to changing rates of childlessness within educational groups and only marginally to changes in the educational composition of the population. Over time, childlessness levels of the medium-educated and high-educated became closer to those of the low-educated, but the difference in level between the two better educated groups remained stable in Western and Southern Europe and increased slightly in the East.

The impact of women's education, workforce experience, and the One Child Policy on fertility in China: a census study in Guangdong, China

The impact of women’s education on fertility is of interest to researchers, particularly in China. However, few studies have provided well-founded assessments of how women’s education, workforce experience, and birth control policy jointly affect fertility in China. This study, conducted in Guangdong Province, aimed to analyze how these three factors influenced the timing of births and affected women at different stages of their reproductive lives. We used census data for Guangdong Province (1990, 2000, and 2010) to make cross-sectional age-specific comparisons to examine the effects of women’s education and workforce participation on fertility outcomes under China’s One Child Policy. We found that: (1) under circumstances of low fertility, women tend to have more children with greater educational attainment; (2) the impact of women’s education and workforce experience on fertility varied across age groups, with the effect of education showing a bimodal curve peaking at 25–29 years and 40–44 years, and a workforce experience effect at 25–34 years; and (3) the fertility time-squeeze effect by educational attainment was relatively small, the effect by workforce participation was larger, and the most important effect was birth control policy and its implementation. These results suggest that educational attainment and workforce experience have a substantial effect on women’s fertility, and a tradeoff between them is unavoidable. China’s 2015 birth control policy adjustment should be considered in planning future services to accommodate anticipated increases in the birth rate. More attention should be directed to the causal mechanism (women’s preference and selection effects) behind the factors analyzed in this study.

The fertility myth: Israeli students' knowledge regarding age-related fertility decline and late pregnancies in an era of assisted reproduction technology

BACKGROUND

As in many advanced societies, the age at first birth and the rate of post-menopausal pregnancies in Israel are constantly increasing. Since Israeli university students are the most likely population to postpone parenthood, this study aims at evaluating their awareness of: (i) women's age-related fertility decline; (ii) age-dependent success rates of IVF technology and (iii) medical procedures allowing late and post-menopausal pregnancies.

METHODS

Israeli undergraduate students (n= 410), attending four academic institutions and studying in different fields, completed a structured questionnaire in the 2009/2010 academic year.

RESULTS

Students overestimated women's chances of spontaneous pregnancy in all age groups, whereas women's chances of achieving a live birth following IVF treatment were overestimated only for ages 40 years and above. Regarding both spontaneous and IVF pregnancies, success rates of very late pregnancies (beyond 45 years and after menopause) were greatly overestimated. Only 11% of the students knew that genetic motherhood is unlikely to be achieved from the mid-40s onward, unless using oocytes frozen in advance.

CONCLUSIONS

The findings demonstrate entrenched fertility myths among Israeli students, particularly the false belief in the possibility of late (beyond 35 years) and very late genetic motherhood. This can be explained by technological 'hype' and favorable media coverage of very late pregnancies. Since this may culminate in involuntary childlessness, it is highly important to increase the awareness of the Israeli public on the subject of fertility. However, as our sample is not representative of the Israeli student population, our findings should be tested in future studies.

Normative or economic behavior? Fertility and women's employment in Israel

Women's employment and childrearing are competing activities, which exert much pressure on their time and energy. Many studies have found that women in paid employment, especially in a demanding career, limit their fertility and have few children or none. This negative correlation was explained mainly in terms of opportunity costs and the incompatibility of women's employment and childrearing. This study focuses on the interplay between women's employment and fertility decisions in Israel, a socially diverse country, characterized by high levels of both fertility and female employment. We argue that in an environment which supports and encourages high fertility women's employment activity is less consequential for family planning. The study analyzes simultaneously the decision to have a third child and the decision to work. The findings show that fertility affects negatively women's work activity, but women's employment has no effect on their decision to have an additional child. Also, cultural variables affect the fertility decision but not economic considerations, while the opposite holds for the work decision.