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Kanbergs A, Jorgensen K, Agusti N, Viveros-Carreño D, Wu CF, Nitecki R, Harris JA, Woodard T, Ramphul R, Rauh-Hain JA. Patient Location and Disparities in Access to Fertility Preservation for Women With Gynecologic or Breast Cancer. Obstet Gynecol 2024; 143:824-834. [PMID: 38574368 PMCID: PMC11098692 DOI: 10.1097/aog.0000000000005570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To assess the effect of geographic factors on fertility-sparing treatment or assisted reproductive technology (ART) utilization among women with gynecologic or breast cancers. METHODS We conducted a cohort study of reproductive-aged patients (18-45 years) with early-stage cervical, endometrial, or ovarian cancer or stage I-III breast cancer diagnosed between January 2000 and December 2015 using linked data from the California Cancer Registry, the California Office of Statewide Health Planning and Development, and the Society for Assisted Reproductive Technology. Generalized linear mixed models were used to evaluate associations between distance from fertility and gynecologic oncology clinics, as well as California Healthy Places Index score (a Census-level composite community health score), and ART or fertility-sparing treatment receipt. RESULTS We identified 7,612 women with gynecologic cancer and 35,992 women with breast cancer. Among all patients, 257 (0.6%) underwent ART. Among patients with gynecologic cancer, 1,676 (22.0%) underwent fertility-sparing treatment. Stratified by quartiles, residents who lived at increasing distances from gynecologic oncology or fertility clinics had decreased odds of undergoing fertility-sparing treatment (gynecologic oncology clinics: Q2, odds ratio [OR] 0.76, 95% CI, 0.63-0.93, P =.007; Q4, OR 0.72, 95% CI, 0.56-0.94, P =.016) (fertility clinics: Q3, OR 0.79, 95% CI, 0.65-0.97, P =.025; Q4, OR 0.67, 95% CI, 0.52-0.88, P =.004), whereas this relationship was not observed among women who resided within other quartiles (gynecologic oncology clinics: Q3, OR 0.81 95% CI, 0.65-1.01, P =.07; fertility clinics: Q2, OR 0.87 95% CI, 0.73-1.05, P =.15). Individuals who lived in communities with the highest (51 st -100 th percentile) California Healthy Places Index scores had greater odds of undergoing fertility-sparing treatment (OR 1.29, 95% CI, 1.06-1.57, P =.01; OR 1.66, 95% CI, 1.35-2.04, P =.001, respectively). The relationship between California Healthy Places Index scores and ART was even more pronounced (Q2 OR 1.9, 95% CI, 0.99-3.64, P =.05; Q3 OR 2.86, 95% CI, 1.54-5.33, P <.001; Q4 OR 3.41, 95% CI, 1.83-6.35, P <.001). CONCLUSION Geographic disparities affect fertility-sparing treatment and ART rates among women with gynecologic or breast cancer. By acknowledging geographic factors, health care systems can ensure equitable access to fertility-preservation services.
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Affiliation(s)
- Alexa Kanbergs
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nuria Agusti
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Viveros-Carreño
- Unidad Ginecología oncológica, Grupo de Investigación GIGA, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia
- Clínica Universitaria Colombia, Bogotá, Colombia
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John A. Harris
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Terri Woodard
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan Ramphul
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Wallace AR, Splinter K. Does proximity to a fertility centre increase the chance of achieving pregnancy in Northeastern Ontario? CANADIAN JOURNAL OF RURAL MEDICINE 2024; 29:63-70. [PMID: 38709016 DOI: 10.4103/cjrm.cjrm_20_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/05/2023] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Northern Ontario has a population of approximately 800,000 people distributed over 806,707 km2. Before 2018, the only fertility treatment centre in Northern Ontario was located in Thunder Bay; many patients travelled south for care. In 2018, the Northeastern Ontario Women's Health Network (NEOWHN) opened in Sudbury, providing fertility treatments to people living in Northeastern Ontario. The goal of this study was to determine if proximity to this new fertility centre increases one's chance of achieving pregnancy when undergoing fertility treatment. Secondary outcomes included the quantity and types of fertility investigations and treatments completed by patients. MATERIALS AND METHODS A retrospective chart review was performed for all patients seeking fertility treatment at NEOWHN between January 2019 and December 2020. Traveling >100 km to access healthcare was considered to be a clinically significant determinant of health. RESULTS Seven hundred and 5 patients were seen in consultation for fertility services at NEOWHN during the study period. One hundred eighty-one of 478 (37.9%) patients living <100 km from NEOWHN achieved pregnancy compared to 39 of 227 (17.2%) patients living >100 km from NEOWHN (P < 0.01). CONCLUSION Living in proximity (<100 km) to NEOWHN increased the likelihood that individuals in Northeastern Ontario would seek fertility services and would achieve pregnancy. Financial constraints and inaccessibility likely play a role in this, but further studies are needed to explain this difference. INTRODUCTION Le Nord de l'Ontario compte une population d'environ 800,000 personnes réparties sur 806,707 km2. Avant 2018, le seul centre de traitement de la fertilité du Nord de l'Ontario était situé à Thunder Bay; de nombreux patients SE rendaient dans le sud pour recevoir des soins. En 2018, le Northeastern Ontario Women's Health Network (NEOWHN-le Réseau de santé des femmes du Nord-Est de l'Ontario) a ouvert ses portes à Sudbury, offrant des traitements de fertilité aux personnes vivant dans le Nord-Est de l'Ontario. L'objectif de cette étude était de déterminer si la proximité de ce nouveau centre de fertilité augmente les chances d'obtenir une grossesse lors d'un traitement de fertilité. Les résultats secondaires comprenaient la quantité et les types d'examens et de traitements de fertilité effectués par les patients. MTHODES Une étude rétrospective des dossiers a été réalisée pour tous les patients cherchant un traitement de fertilité au NEOWHN entre janvier 2019 et décembre 2020. Le fait de voyager >100 km pour accéder aux soins de santé a été considéré comme un déterminant de la santé cliniquement significatif. RSULTATS Seven hundred and 5 patients ont été vus en consultation pour des services de fertilité au NEOWHN pendant la période d'étude. One hundred eighty-one des 478 (37.9%) patientes vivant à moins de 100 km du NEOWHN ont obtenu une grossesse, contre 39 des 227 (17.2%) patientes vivant à plus de 100 km du NEOWHN (P < 0.01). CONCLUSION Le fait de vivre à proximité (<100 km) du NEOWHN augmente la probabilité que les habitants du Nord-Est de l'Ontario aient recours à des services de fertilité et obtiennent une grossesse. Les contraintes financières et l'inaccessibilité jouent probablement un rôle à cet égard, mais d'autres études sont nécessaires pour expliquer cette différence.
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Affiliation(s)
- Ashley R Wallace
- Undergraduate Medical Education, NOSM University, Thunder Bay, Ontario, Canada
| | - Karen Splinter
- Division of Clinical Sciences, NOSM University, Sudbury, Ontario, Canada
- Department of Obstetrics and Gynecology, Health Sciences North, Sudbury, Ontario, Canada
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Speksnijder JP, van Marion ES, Baart EB, Steegers EA, Laven JS, Bertens LC. Living in a low socioeconomic status neighbourhood is associated with lower cumulative ongoing pregnancy rate after IVF treatment. Reprod Biomed Online 2024; 49:103908. [PMID: 38781882 DOI: 10.1016/j.rbmo.2024.103908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 05/25/2024]
Abstract
RESEARCH QUESTION Does an association exist between neighbourhood socioeconomic status (SES) and the cumulative rate of ongoing pregnancies after 2.5 years of IVF treatment? DESIGN A retrospective observational study involving 2669 couples who underwent IVF or IVF and intracytoplasmic sperm injection treatment between 2006 and 2020. Neighbourhood SES for each couple was determined based on their residential postal code. Subsequently, SES was categorized into low ( p80). Multivariable binary logistic regression analyses were conducted, with the cumulative ongoing pregnancy within 2.5 years as the outcome variable. The SES category (reference category: high), female age (reference category: 32-36 years), body mass index (reference category: 23-25 kg/m2), smoking status (yes/no), number of oocytes after the first ovarian stimulation, embryos usable for transfer or cryopreservation after the first cycle, duration of subfertility before treatment and insemination type were used as covariates. RESULTS A variation in ongoing pregnancy rates was observed among SES groups after the first fresh embryo transfer. No difference was found in the median number of IVF treatment cycles carried out. The cumulative ongoing pregnancy rates differed significantly between SES groups (low: 44%; medium: 51%; high: 56%; P < 0.001). Low neighbourhood SES was associated with significantly lower odds for achieving an ongoing pregnancy within 2.5 years (OR 0.66, 95% CI 0.52 to 0.84, P < 0.001). CONCLUSION Low neighbourhood SES compared with high neighbourhood SES is associated with reducing odds of achieving an ongoing pregnancy within 2.5 years of IVF treatment.
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Affiliation(s)
- Jeroen P Speksnijder
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands..
| | - Eva S van Marion
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Esther B Baart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.; Department of Developmental Biology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Eric Ap Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Joop Se Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Loes Cm Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Fitzgerald O, Dyer S, Zegers-Hochschild F, Keller E, Adamson GD, Chambers GM. Gender inequality and utilization of ART: an international cross-sectional and longitudinal analysis. Hum Reprod 2024; 39:209-218. [PMID: 37943304 DOI: 10.1093/humrep/dead225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
STUDY QUESTION What is the association between a country's level of gender equality and access to ART, as measured through ART utilization? SUMMARY ANSWER ART utilization is associated with a country's level of gender equality even after controlling for the level of development. WHAT IS KNOWN ALREADY Although gender equality is recognized as an important determinant of population health, its association with fertility care, a highly gendered condition, has not been explored. STUDY DESIGN, SIZE, DURATION A longitudinal cross-national analysis of ART utilization in 69 countries during 2002-2014 was carried out. PARTICPANTS/MATERIALS, SETTING, METHODS The Gender Inequality Index (GII), Human Development Index (HDI), and their component indicators were modelled against ART utilization using univariate regression models as well as mixed-effects regression methods (adjusted for country, time, and economic/human development) with multiple imputation to account for missing data. MAIN RESULTS AND THE ROLE OF CHANCE ART utilization is associated with the GII. In an HDI-adjusted analysis, a one standard deviation decrease in the GII (towards greater equality) is associated with a 59% increase in ART utilization. Gross national income per capita, the maternal mortality ratio, and female parliamentary representation were the index components most predictive of ART utilization. LIMITATIONS, REASONS FOR CAUTION Only ART was used rather than all infertility treatments (including less costly and non-invasive treatments such as ovulation induction). This was a country-level analysis and the results cannot be generalized to smaller groups. Not all modelled variables were available for each country across 2002-2014. WIDER IMPLICATIONS OF THE FINDINGS Access to fertility care is central to women's sexual and reproductive health, to women's rights, and to human rights. As gender equality improves, so does access to ART. This relation is likely to be reinforcing and bi-directional, with progress towards global, equitable access to fertility care also improving women's status and participation in societies. STUDY FUNDING/COMPETING INTEREST(S) External funding was not provided for this study. G.D.A. declares consulting fees from Labcorp and CooperSurgical. G.D.A. is the founder and CEO of Advanced Reproductive Care, Inc., as well as the Chair of the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) and the World Endometriosis Research Foundation, both of which are unpaid roles. G.M.C. is an ICMART Board Representative, which is an unpaid role, and no payments are received from ICMART to UNSW, Sydney, or to G.M.C. to undertake this study. O.F., S.D., F.Z.-H., and E.K. report no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Oisín Fitzgerald
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Silke Dyer
- Department of Obstetrics & Gynecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- International Committee for Monitoring Assisted Reproductive Technologies, Vancouver, BC, Canada
| | - Fernando Zegers-Hochschild
- International Committee for Monitoring Assisted Reproductive Technologies, Vancouver, BC, Canada
- Clinica las Condes and Program of Ethics and Public Policies in Human Reproduction, School of Medicine, University Diego Portales, Santiago, Chile
| | - Elena Keller
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - G David Adamson
- International Committee for Monitoring Assisted Reproductive Technologies, Vancouver, BC, Canada
- Equal3 Fertility, Cupertino, CA, USA
| | - Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- International Committee for Monitoring Assisted Reproductive Technologies, Vancouver, BC, Canada
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Brew BK, Donnolley N, Fitzgerald O, Molloy D, Chambers GM. Does a public online IVF prediction tool help set patient expectations? A mixed methods evaluation study. Hum Reprod 2023; 38:1761-1768. [PMID: 37403336 DOI: 10.1093/humrep/dead139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/30/2023] [Indexed: 07/06/2023] Open
Abstract
STUDY QUESTION Does a public online IVF success prediction calculator based on real-world data help set patient expectations? SUMMARY ANSWER The YourIVFSuccess Estimator aided consumer expectations of IVF success: one quarter (24%) of participants were unsure of their estimated IVF success before using the tool; one half changed their prediction of success after using the tool and one quarter (26%) had their expectations of IVF success confirmed. WHAT IS KNOWN ALREADY Several web-based IVF prediction tools exist worldwide but have not been evaluated for their impact on patient expectations, nor for patient perceptions of usefulness and trustworthiness. STUDY DESIGN, SIZE, DURATION This is a pre-post evaluation of a convenience sample of 780 online users of the Australian YourIVFSuccess Estimatorhttps://yourivfsuccess.com.au/ between 1 July and 31 November 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were eligible if they were over 18 years of age, Australian residents, and considering IVF for themselves or their partner. Participants filled in online surveys before and after using the YourIVFSuccess Estimator. MAIN RESULTS AND THE ROLE OF CHANCE The response rate of participants who completed both surveys and the YourIVFSuccess Estimator was 56% (n = 439). The YourIVFSuccess Estimator aided consumer expectations of IVF success: one quarter (24%) of participants were unsure of their estimated IVF success before using the tool; one half changed their prediction of success after using the tool (20% increased, 30% decreased), bringing their predictions in line with the YourIVFSuccess Estimator, and one quarter (26%) had their IVF success expectations confirmed. One in five participants claimed they would change the timing of IVF treatment. The majority of participants found the tool to be at least moderately trustworthy (91%), applicable (82%), and helpful (80%), and would recommend it to others (60%). The main reasons given for the positive responses were that the tool is independent (government funded, academic) and based on real-world data. Those who did not find it applicable or helpful were more likely to have had a worse-than-expected prediction, or to have experienced non-medical infertility (e.g. single women, LGBTQIA+), noting that at the time of evaluation the Estimator did not accommodate these patient groups. LIMITATIONS, REASONS FOR CAUTION Those who dropped out between the pre- and post-surveys tended to have a lower education status or have been born outside of Australia or New Zealand, therefore there may be issues with generalizability. WIDER IMPLICATIONS OF THE FINDINGS With consumers demanding increasing levels of transparency and participation in decisions around their medical care, public-facing IVF predictor tools based on real-world data are useful for aligning expectations about IVF success rates. Given differences in patient characteristics and IVF practices internationally, national data sources should be used to inform country-specific IVF prediction tools. STUDY FUNDING/COMPETING INTEREST(S) The YourIVFSuccess website and evaluation of the YourIVFSuccess Estimator are supported by the Medical Research Future Fund (MRFF) Emerging Priorities and Consumer Driven Research initiative: EPCD000007. BKB, ND, and OF have no conflicts to declare. DM holds a clinical role at Virtus Health. His role did not influence the analysis plan or interpretation of results in this study. GMC is an employee of the UNSW Sydney, and Director of the UNSW NPESU. UNSW receives research funding on behalf of Prof Chambers from the MRFF to develop and manage the Your IVF Success website. Grant ID: MRFF Emerging Priorities and Consumer Driven Research initiative: EPCD000007. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Bronwyn K Brew
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, Discipline of Women's Health, UNSW, Kensington, NSW, Australia
| | - Natasha Donnolley
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, Discipline of Women's Health, UNSW, Kensington, NSW, Australia
- School of Population Health, UNSW, Kensington, NSW, Australia
| | - Oisin Fitzgerald
- Centre for Big Data Research in Health, UNSW, Kensington, NSW, Australia
| | | | - Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical Medicine, Discipline of Women's Health, UNSW, Kensington, NSW, Australia
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Lazzari E, Potančoková M, Sobotka T, Gray E, Chambers GM. Projecting the Contribution of Assisted Reproductive Technology to Completed Cohort Fertility. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:6. [PMID: 36789330 PMCID: PMC9912242 DOI: 10.1007/s11113-023-09765-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/01/2022] [Indexed: 02/12/2023]
Abstract
Assisted reproductive technology (ART) is increasingly influencing the fertility trends of high-income countries characterized by a pattern of delayed childbearing. However, research on the impact of ART on completed fertility is limited and the extent to which delayed births are realized later in life through ART is not well understood. This study uses data from Australian fertility clinics and national birth registries to project the contribution of ART for cohorts of women that have not yet completed their reproductive life and estimate the role played by ART in the fertility 'recuperation' process. Assuming that the increasing trends in ART success rates and treatment rates continue, the projection shows that the contribution of ART-conceived births to completed fertility will increase from 2.1% among women born in 1968 to 5.7% among women born in 1986. ART is projected to substantially affect the extent to which childbearing delay will be compensated at older ages, suggesting that its availability may become an important factor in helping women to achieve their reproductive plans later in life. Supplementary Information The online version contains supplementary material available at 10.1007/s11113-023-09765-3.
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Affiliation(s)
- Ester Lazzari
- grid.10420.370000 0001 2286 1424Department of Demography, University of Vienna (Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna)), Vienna, Austria
| | - Michaela Potančoková
- grid.75276.310000 0001 1955 9478International Institute for Applied Systems Analysis, Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Laxenburg, Austria
| | - Tomáš Sobotka
- grid.10420.370000 0001 2286 1424Vienna Institute of Demography, Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria
| | - Edith Gray
- grid.1001.00000 0001 2180 7477School of Demography, Australian National University, Canberra, Australia
| | - Georgina M. Chambers
- grid.1005.40000 0004 4902 0432National Perinatal Epidemiology and Statistics Unit (NPESU), Centre for Big Data Research in Health and School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
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