In pursuit of higher education, do we postpone parenthood too long?

Banned by the law, practiced by the society: The study of factors associated with dowry payments among adolescent girls in Uttar Pradesh and Bihar, India

Background

Despite the prohibition by the law in 1961, dowry is widely prevalent in India. Dowry stems from the early concept of ’Stridhana,’ in which gifts were given to the bride by her family to secure some personal wealth for her when she married. However, with the transition of time, the practice of dowry is becoming more common, and the demand for a higher dowry becomes a burden to the bride’s family. Therefore, this study aimed to determine the factors associated with the practice of dowry in Bihar and Uttar Pradesh.

Methods

We utilized information from 5206 married adolescent girls from the Understanding the lives of adolescents and young adults (UDAYA) project survey conducted in two Indian states, namely, Uttar Pradesh and Bihar. Dowry was the outcome variable of this study. Univariate, bivariate, and multivariate logistic regression analyses were performed to explore the factors associated with dowry payment during the marriage.

Results

The study reveals that dowry is still prevalent in the state of Uttar Pradesh and Bihar. Also, the proportion of dowry varies by adolescent’s age at marriage, spousal education, and household socioeconomic status. The likelihood of paid dowry was 48 percent significantly less likely (OR: 0.52; CI: 0.44–0.61) among adolescents who knew their husbands before marriage compared to those who do not know their husbands before marriage. Adolescents with age at marriage more than equal to legal age had higher odds to pay dowry (OR: 1.60; CI: 1.14–2.14) than their counterparts. Adolescents with mother’s who had ten and above years of education, the likelihood of dowry was 33 percent less likely (OR: 0.67; CI: 0.45–0.98) than their counterparts. Adolescents belonging to the richest households (OR: 1.48; CI: 1.13–1.93) were more likely to make dowry payments than adolescents belonging to poor households.

Conclusion

Limitation of the dowry prohibition act is one of the causes of continued practices of dowry, but major causes are deeply rooted in the social and cultural customs, which cannot be changed only using laws. Our study suggests that only the socio-economic development of women will not protect her from the dowry system, however higher dowry payment is more likely among women from better socio-economic class.

Fertility awareness and parenthood intentions among medical students in three European countries

PURPOSE

The aim of this study was to investigate medical undergraduate students' fertility awareness and parenthood intentions in three European countries, as well as possible differences across genders and countries.

MATERIALS AND METHODS

A cross sectional survey among 656 medical students in Sweden, Belgium and Greece. The utilised questionnaire comprised 23 questions.

RESULTS

Three fourth of participants (n = 472/629) correctly stated that women are most fertile at 20-25 years of age. Approximately 91% correctly answered that women's fertility starts to significantly decline before the age of 35, which differed among countries of participation. Social oocyte or sperm freezing was considered by 67% of Belgians, 49% Greeks, and 16.5% Swedes (p < 0.001). Approximately 95% expressed a wish of having a child in the future and the median age was 29 years for the first and 35 years for the last child.

CONCLUSIONS

Knowledge about fertility among medical students was in general satisfactory, albeit varying by country and gender. Medical curricula and social policies for childbearing should be respectively updated in EU countries suffering population growth.

Fertility and Reproductive Health in Women Physicians

Background: Our aim was to evaluate trends of childbearing during medical training, evaluate issues of infertility, and measure institutionalized barriers to childbearing among women physicians. Materials and Methods: Attendees of a national women physician's leadership conference (Brave Enough Women Physicians Continuing Medical Education Conference) were surveyed during the conference using Qualtrics^© (2019 Qualtrics, Provo, UT), in September 2019. Survey data included demographics, training level, and medical specialty. Data related to reproductive health factors, pregnancy status and history, current number of children, medical history related to pregnancy, breastfeeding history, institutional family planning support, and use of previous fertility treatments were collected. Descriptive analyses were done using IBM SPSS v26.0. Results: Three hundred seventy-seven survey participants were included in the study. 10.6% of respondents reported at least one pregnancy during medical school, versus 78.8% as a practicing physician. Of the participants, 25.8% reported having taken off 1 month or less of clinical duties after giving birth, 39.4% reported that their job prevented breastfeeding for the desired length of time, and 52.2% reported significant workplace limitations to breastfeeding. Of them, 25.5% reported having had fertility issues in the past. Fertility drugs (72.9%) was the most common fertility treatment method used, followed by fertility tracking (54.2%). Demands of training (72.9%) and long work hours (61.5%) were the most cited factors in delaying having children as reported by women physicians. Conclusions: This study reported several barriers related to fertility, family planning, and reproductive health among women physicians. Our results highlight the need for a paradigm shift in fertility awareness and institutional support for childbearing during medical training, postgraduate training programs, and in practice for women in medicine.

Knowledge about the impact of age on fertility: a brief review

Delayed childbearing is currently a major challenge in reproductive medicine as increased age has an important impact on successful conception, both in natural and in assisted reproduction. There is a lack of knowledge about the impact of age on fertility, even in highly educated populations. A number of initiatives have been taken to increase fertility awareness. Health care providers have been encouraged to talk with patients about their reproductive life plan (RLP) for almost a decade based on recommendations from the Centres for Disease Control and Prevention. This concept has been explored successfully in Swedish contraception counselling. A growing number of online interventions aim to raise fertility awareness. These websites or interactive tools provide relevant information for individuals and couples as they consider whether they want children, when they should have them, and how many they may wish to have. These interventions are important, because research depicts that knowledge helps people in their decision-making process. With new fertility preservations such as egg freezing now available, additional education is needed to be sure that women and couples are well informed about the cost and low success rates of this intervention.

Single women and motherhood: right now or maybe later?

Purpose: The decision to have a child might be postponed by the lack of partner, and elective egg freezing (EEF) can afford single women more time to find a suitable companion to reach the desired family structure. Alternatively, some women decide to have a child on their own thorough in vitro fertilization (IVF) or intrauterine insemination (IUI) with donor sperm. This study investigates the motivations and personal characteristics of single women undergoing IVF/IUI or EEF.Materials and methods: This is a cross-sectional study including 281 heterosexual single women who underwent either IVF/IUI with donor sperm for solo motherhood (208) or EEF (73) in 2015 at a large fertility center. An anonymous electronic survey was sent after starting the treatment.Results: The most common reason for not having fulfilled the motherhood desire was lack of partner (72.4% IVF/IUI and 65.9% EEF). We found that women undergoing IVF/IUI report a longer motherhood desire, >10 years (71.3% vs. 54.3%), live closer to their families (75.5% vs. 56.5%), and perceive a stronger family support than women undergoing EEF (85.4% vs. 68.8%). Finally, 100% of EEF obviously knew about the possibility of IVF/IUI with donor sperm, while 59.9% of IVF/IUI knew about EEF.Conclusion: Our results underscore the relevance of family ties in the decision to undergo IVF/IUI as single women. Moreover, these women might not be fully informed about social freezing as an option to postpone motherhood. Health professionals should be aware of these differences when counseling single women on fertility choices.

A population-based survey on family intentions and fertility awareness in women and men in the United Kingdom and Denmark

BACKGROUND

Across several European countries family formation is increasingly postponed. The aims of the study were to investigate the desire for family building and fertility awareness in the UK and Denmark.

METHODS

A population-based internet survey was used among women (n = 1,000) and men (n = 237) from the UK (40%) and Denmark (60%). Data covered socio-demographics, family formation, and awareness of female age-related fertility. Data analysis used descriptive statistics and logistic regression analysis for studying associations between low fertility awareness and desired family formation.

RESULTS

The majority of all participants desired two or three children. Two-thirds of the childless participants desired a first child at 30+ years, and one-fifth of the women and one-third of the men desired a last child at age 40. Overall, 83% of women and 73% of men were aware that female fertility starts to decline around 25-30 years. Men had significantly lower fertility awareness. Women who underestimated the impact of age on female fertility were significantly more likely to have a desire or attempted their first child at a higher age.

CONCLUSION

Even though the majority were aware of the age-related decrease in female fertility, most desired having children at an age when female fertility has declined. Women who were not sufficiently aware of the impact of advanced age were significantly more likely to have their first child at a higher age. There is a need for developing educational programs for women and men in order to increase the population's knowledge of fertility and risk factors for infertility.

Prevalence of infertility and help seeking among 15 000 women and men

STUDY QUESTION

What is the prevalence of infertility and of help seeking among women and men in Britain?

SUMMARY ANSWER

One in eight women and one in ten men aged 16–74 years had experienced infertility, defined by unsuccessfully attempting pregnancy for a year or longer, and little more than half of these people sought medical or professional help.

WHAT IS KNOWN ALREADY

Estimates of infertility and help seeking in Britain vary widely and are not easily comparable because of different definitions and study populations.

STUDY DESIGN, SIZE, DURATION

A cross-sectional population survey was conducted between 2010 and 2012 with a sample of 15 162 women and men aged 16–74 years.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Participants completed the Natsal-3 questionnaire, using computer-assisted personal interviewing (CAPI) and computer-assisted self-interview (CASI).

MAIN RESULTS AND THE ROLE OF CHANCE

The reported prevalence of infertility was 12.5% (CI 95% 11.7–13.3) among women and 10.1% (CI 95% 9.2–11.1) among men. Increased prevalence was associated with later cohabitation with a partner, higher socio-economic status and, for those who had a child, becoming parents at older ages. The reported prevalence of help seeking was 57.3% (CI 95% 53.6–61.0) among women and 53.2% (CI 95% 48.1–58.1) among men. Help seekers were more likely to be better educated and in higher status occupations and, among those who had a child, to have become parents later in life.

LIMITATIONS, REASONS FOR CAUTION

These data are cross-sectional so it is not possible to establish temporality or infer causality. Self-reported data may be subject to recall bias.

WIDER IMPLICATIONS OF THE FINDINGS

The study provides estimates of infertility and help seeking in Britain and the results indicate that the prevalence of infertility is higher among those delaying parenthood. Those with higher educational qualifications and occupational status are more likely to consult with medical professionals for fertility problems than others and these inequalities in help seeking should be considered by clinical practice and public health.

STUDY FUNDING/COMPETING INTEREST(S)

Funding was provided by grants from the Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health. AMJ is a Governor of the Wellcome Trust. Other authors have no competing interests.

Ukrainian medical students' attitudes to parenthood and knowledge of fertility

OBJECTIVES

The aim of our study was to investigate Ukrainian medical students' intentions and attitudes in relation to future parenthood, and their knowledge about fertility.

METHODS

A classroom survey was carried out of randomly selected groups among 3568 Russian-speaking medical students. The response rate was 88.8%; 858 were female and 407 were male; the mean age was 20.6 (standard deviation [SD] 2.4) years.

RESULTS

One in four male and 16% of female respondents did not want to have children, 3.3% had children and 17% wanted one child only. Female respondents wished to have their first child when they were 24.4 (SD 2.4) years of age, and male respondents when they were 26.8 (SD 3.4) years of age. Around 60% of respondents reported there was a pronounced decline in female fertility after the age of 45 years.

CONCLUSIONS

The desire to have children in the future is not apparent among medical students, especially not among men. Gaps in students' knowledge about fertility need to be addressed by sexual and reproductive education.

Does a surgical career affect a woman's childbearing and fertility? A report on pregnancy and fertility trends among female surgeons

BACKGROUND

Increases in pregnancy complication rates and use of assisted reproductive technology (ART) have been demonstrated in female urologists and orthopaedic surgeons when compared with the general US population. To determine if childbearing differences exist across specialties, we evaluated female surgeons in all fields, particularly with regard to fertility.

STUDY DESIGN

An anonymous, 199-item survey was distributed via specialty female surgeon interest groups and word of mouth to general surgery, gynecology, neurosurgery, ophthalmology, orthopaedics, otolaryngology, plastic surgery, podiatry, and urology. The 1,021 responses were analyzed and compared with Centers for Disease Control National Survey for Family Growth and National Institute of Health data to identify differences between populations.

RESULTS

Of women surgeons, 32% reported fertility difficulty; 84% of whom underwent infertility workup. Seventy-six percent of these women used ART to attempt pregnancy. In comparison, only 10.9% of women in the general US population report infertility, and 11% seek infertility services. Of all babies born to female surgeons, at least 13% were conceived using ART. Surgeons had 1.4 biological children, less than the national average. Age at first pregnancy was 33 years, compared with a national average of 23. If ART was implemented, surgeon age at first birth increased to 35.4 years. Highest rates of infertility existed in otolaryngology (29%), general surgery (22%), and orthopaedics (18%).

CONCLUSIONS

Female surgeons have first pregnancies later in life, fewer children, and report more issues with infertility. Assisted reproductive technology is implemented more often by female surgeons than the general population. Differences in fertility exist between specialties and warrant additional study.

Conceiving of change: a brief intervention increases young adults' knowledge of fertility and the effectiveness of in vitro fertilization

OBJECTIVE

To examine the effectiveness of an educational intervention in increasing knowledge of fertility and the effectiveness of IVF among university students in Australia.

DESIGN

Two-group, pretest-posttest design.

SETTING

A large metropolitan university in Queensland, Australia.

PATIENT(S)

One hundred thirty-seven male and female undergraduate students.

INTERVENTION(S)

Online information brochure on fertility (intervention group), or an online information brochure on home ownership (control group).

MAIN OUTCOME MEASURE(S)

Knowledge of fertility, knowledge of IVF effectiveness, and desired age at commencement and completion of childbearing, assessed immediately before and after exposure to the brochure.

RESULT(S)

Exposure to the brochure resulted in significant increases in knowledge of fertility and knowledge of IVF effectiveness in the intervention group and significant decreases in desired age at commencement and completion of childbearing. No changes were observed in the control group.

CONCLUSION(S)

Educational intervention is a worthwhile endeavor that can increase knowledge of fertility and IVF effectiveness in the short-term. Further research is needed to evaluate whether increased knowledge persists and affects intentions in the longer-term. Because the determinants of timing of childbearing are highly multifactorial, fertility education should be paired with policies and practices that support men and women to make informed decisions about the timing of childbearing.

Childbearing and pregnancy characteristics of female orthopaedic surgeons

BACKGROUND

The number of women entering orthopaedic surgery is steadily increasing. Information regarding pregnancy and childbearing is important to understand as it increasingly affects residency programs, clinical practices, and the female surgeons and their offspring.

METHODS

One thousand and twenty-one female surgeons completed an anonymous, voluntary, 199-item online survey distributed via individual female surgeon interest groups and word of mouth in nine specialties: general surgery, gynecology, neurosurgery, ophthalmology, orthopaedics, otolaryngology, plastic surgery, podiatry, and urology. Two hundred and twenty-three survey responses from orthopaedic surgeons were compared with those of the other surgical specialists as well as American Pregnancy Association national data to assess differences, if any, in pregnancy characteristics, demographics, and satisfaction.

RESULTS

The overall reported complication rate for all pregnancies among orthopaedic surgeons was significantly higher than the rate in the general American population (31.2% [eighty-two of 263] compared with 14.5%). There was an increased risk of preterm delivery among orthopaedic surgeons compared with a cohort of the general U.S. population matched according to age, race, health, and socioeconomic status (risk ratio, 2.5; 95% confidence interval [CI], 1.3 to 4.6). There was an increased risk of preterm labor and preterm delivery among women who reported working more than sixty hours per week (odds ratio, 4.95; 95% CI, 1.4 to 36.6). Female orthopaedic surgeons took shorter maternity leave during training than during clinical practice (median, four compared with seven weeks). The mean duration of breastfeeding was significantly shorter during training than during clinical practice (4.7 compared with 8.3 months, p = 0.03).

CONCLUSIONS

Female orthopaedic surgeons had an increased risk of pregnancy complications, particularly preterm delivery, compared with the general U.S. population. We found an increased risk of increased risk of preterm labor and delivery in surgeons working more than sixty hours per week during pregnancy.

Sooner or later? Young Australian men's perspectives on timing of parenthood

Postponed parenthood has been identified as a significant driver of the trends towards smaller families and underachieved fertility aspirations. Understanding men's preferred timing and circumstances for fatherhood is needed to complement existing research among young women and increase understanding of postponed parenthood. We collected quantitative and qualitative data on attitudes regarding the timing of parenthood from 382 young Australian men attending university. Participants valued having a stable relationship and personal maturity before having children, with completed studies, financial security and a permanent yet flexible job also important. Programmes and policies which facilitate the establishment of important 'preconditions' for parenthood would support individuals to achieve their reproductive aspirations.

Do women residents delay childbearing due to perceived career threats?

PURPOSE

To assess gender differences among residents regarding their plans to have children during residency and determine the most influential reasons for these differences.

METHOD

Using the Health Belief Model as a framework, the authors created an instrument to survey 424 residents from 11 residency programs at three academic medical institutions about their intentions to have children during residency. The authors developed a scale to assess the perceived career threats of having children during residency, evaluated its psychometric properties, and calculated the effect of the mediators.

RESULTS

The response rate was 77% (328/424). Forty-one percent of men versus 27% of women planned to have children during residency (P = .01). The instrument measured four career threats-extended training, loss of fellowship positions, pregnancy complications, and interference with career plans-on a five-point Likert scale. The scale had a Cronbach alpha of 0.84 and an eigenvalue of 2.2. Compared with men, women had higher scores for each item and a higher mean score (2.9 versus 2.1, P = .001), signifying greater belief in the potential of pregnancy to threaten careers. After adjusting for age, institution, postgraduate year, and knowledge of parental leave policies, women were less likely to plan to have children during residency (odds ratio 0.46 [95% confidence interval 0.25-0.84]). In mediation analysis, threats to career explained 67% of the gender variance.

CONCLUSIONS

Women residents intentionally postpone pregnancy because of perceived threats to their careers. Medical educators should be aware of these findings when counseling female trainees.