Childless Expectations and Childlessness Over the Life Course

Evidence from Finland and Sweden on the relationship between early-life diseases and lifetime childlessness in men and women

The percentage of people without children over their lifetime is approximately 25% in men and 20% in women. Individual diseases have been linked to childlessness, mostly in women, yet we lack a comprehensive picture of the effect of early-life diseases on lifetime childlessness. We examined all individuals born in 1956-1968 (men) and 1956-1973 (women) in Finland (n = 1,035,928) and Sweden (n = 1,509,092) to the completion of their reproductive lifespan in 2018. Leveraging nationwide registers, we associated sociodemographic and reproductive information with 414 diseases across 16 categories, using a population and matched-pair case-control design of siblings discordant for childlessness (71,524 full sisters and 77,622 full brothers). The strongest associations were mental-behavioural disorders (particularly among men), congenital anomalies and endocrine-nutritional-metabolic disorders (strongest among women). We identified new associations for inflammatory and autoimmune diseases. Associations were dependent on age at onset and mediated by singlehood and education. This evidence can be used to understand how disease contributes to involuntary childlessness.

Experiences and intentions of patients undergoing medically indicated oocyte or embryo cryopreservation: a qualitative study

STUDY QUESTION

What structural (logistical) and psychological challenges do patients who cryopreserve oocytes or embryos for medical reasons face, including possible barriers to using their frozen materials?

SUMMARY ANSWER

The majority of women who underwent oocyte or embryo cryopreservation for medical reasons reported a desire to use their frozen oocytes or embryos but had been impeded by ongoing medical issues, the need for a gestational carrier, or the lack of a partner.

WHAT IS KNOWN ALREADY

Current data suggest that many women who have frozen oocytes or embryos for medical indications are concerned about the prospect of infertility and have unique emotional and financial needs that differ from patients with infertility. Further, most patients have not returned to use their cryopreserved materials.

STUDY DESIGN, SIZE, DURATION

This is a qualitative interview study of 42 people who cryopreserved between January 2012 and December 2021. Interviews were conducted between March 2021 and March 2022.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All participants were cisgender women who had undergone oocyte or embryo cryopreservation for medical indications at an academic fertility center. Participants were invited to interview by email if they were younger than 40 years old when their oocytes or embryos were cryopreserved. Interviews were conducted over the internet and transcribed verbatim. Data were analyzed using thematic analysis with the constant comparison method.

MAIN RESULTS AND THE ROLE OF CHANCE

Saturation was reached at 42 interviews. The median age of participants was 35 years old (range 28-43) at interview and 31 years old (range 25-39) at cryopreservation. Of the 42 women, 30 had a cancer diagnosis, while 7 had non-cancer chronic medical conditions, and 5 had hereditary cancer susceptibility syndromes. There were 12 women who banked embryos and 30 who banked oocytes. The majority of women indicated a desire to use their cryopreserved materials, but many were unsure about how or when. Four had already used their frozen oocytes or embryos, while another four had conceived without assisted reproduction. The cryopreservation experience was described by the majority as highly emotionally challenging because they felt out of place among couples receiving infertility treatment and, for cancer patients, overwhelmed by the complex decisions to be made in a short time period. Common reported barriers to using frozen materials included ongoing medical issues preventing pregnancy, the need for a gestational carrier, the lack of a partner, and the desire for unassisted conception. Some were glad to have frozen oocytes or embryos to allow more time to meet a partner or if they were considering becoming single parents.

LIMITATIONS, REASONS FOR CAUTION

The majority of participants had their oocytes or embryos frozen at a single, urban, academic fertility center, which may limit generalizability. We also could not calculate a response rate because the snowball technique was used to identify additional participants, so did not know the total number of people invited to participate. Like other interview studies, our study may be subject to response bias because those who agreed to participate may have particularly positive or negative views about their experiences. Furthermore, the mean follow-up time since freezing was relatively short (3.3 years, median 2.7 years), which may not have been enough time for some patients to use their frozen materials.

WIDER IMPLICATIONS OF THE FINDINGS

Learning about the experiences of patients undergoing medically indicated oocyte and embryo cryopreservation can help clinicians better counsel these patients regarding decisions and hurdles they may encounter. We found that most patients had not returned to use their frozen materials because of ongoing medical issues, the need for a gestational carrier, lack of a partner, or the desire to attempt unassisted reproduction.

STUDY FUNDING/COMPETING INTEREST(S)

This study did not receive any funding. The authors of this study have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Evolving Fertility Goals and Behaviors in Current U.S. Childbearing Cohorts

In the post-Recession era, U.S. fertility rates have continued to fall. It is unclear if these declines are driven by shifts in fertility goals or growing difficulty in achieving goals. In this paper, we construct synthetic cohorts of men and women to examine both cross-cohort and within-cohort changes in fertility goals using multiple cycles of the National Survey of Family Growth. Although more recent cohorts exhibit lower achieved fertility at younger ages than earlier cohorts at the same age, intended parity remains around two children, and intentions to remain childless rarely exceed 15%. There is weak evidence of a growing fertility gap in the early 30s, suggesting more recent cohorts will need considerable childbearing in the 30s and early 40s to 'catch up' to earlier goals, yet low-parity women in their early 40s are decreasingly likely to have unfulfilled fertility desires or intentions to have children. Low-parity men in their early 40s, though, are increasingly likely to intend children. Declines in U.S. fertility thus seem to be largely driven not by changes in early-life fertility goals so much as either a decreasing likelihood of achieving earlier goals or, perhaps, shifts in the preferred timing of fertility that depress period measures.

The Formation and Realization of Fertility Goals Among a US Cohort in the Post-Recession Years

The United States has experienced a sustained fertility decline, with those currently in their childbearing years facing unique constraints. Drawing from the Theory of Conjunctural Action and the Narratives of the Future framework, this work considers how objective and subjective socioeconomic conditions, psychosocial characteristics, and perceptions of well-being are linked to mothers' and childless women's (a) prospective fertility intentions during the Great Recession, (b) realization of those intentions in the post-Recession period, and (c) fertility intentions toward the end of the reproductive years, using Waves IV and V of the National Longitudinal Study of Adolescent to Adult Health. The results confirm the role of standard socioeconomic measures and also highlight the importance of subjective measures. In general, more advantaged women were more likely to intend to have (more) children at both waves and to have children between waves. Furthermore, women who already had children by the Great Recession were more likely than their childless peers to have a(nother) child in the post-Recession period. As this cohort approaches the end of its childbearing years, having unfulfilled fertility plans from earlier in the reproductive life course is a strong predictor of continuing to intend at least one birth.

The Causes and Role of Antinatalism in Poland in the Context of Climate Change, Obstetric Care, and Mental Health

Antinatalism is an umbrella term for numerous moral dilemmas associated with procreation. In the past few years, the deterioration of environmental conditions, social difficulties, global worsening of people's mental health, and pandemics have induced discussion about antinatalism. Therefore, we aimed to characterize antinatalists in the Polish population in terms of the frequency and description of the main reasons behind this phenomenon. The cross-sectional study was performed in the Polish population. An online, four-part survey was performed between 19 and 25 January 2022. The study group comprised 1240 respondents. Antinatalists (n = 472, 38%) were defined as people who do not have children and want to be childless in the future, whereas pronatalists (n = 768, 62%) consisted of people who want to have offspring in the future and/or already have children. The opinion that climate change is a significant reason not to have a child appeared twice as often among antinatalists. Additionally, the performed binary logistic regression model highlighted the importance of the fear of climate change as an independent factor facilitating an antinatalistic attitude. Regarding females, the following factors discouraging them from having a child were observed: fear of child's congenital diseases, pregnancy complications, dissatisfaction with medical services, and fear of exacerbation of maternal chronic diseases. Anxiety, depression, and stress were not found to be statistically different between pro- and antinatalist groups. However, further analysis revealed that female antinatalists were significantly more depressive and anxious. Our study helps us to understand why, as mentioned beforehand, around 38% of respondents prefer to stay childless. In conclusion, antinatalism views have become relatively prevalent in society, and its reasons include environmental antinatalism and medical factors, including depression and anxiety. However, better access to medical services and changes in climate politics were not found to be significant factors in encouraging society to decide to have offspring.

Prevalence, age of decision, and interpersonal warmth judgements of childfree adults

Childfree adults do not want to have children, making them distinct from parents and other adults without children. However, they are difficult to study because they cannot be identified using conventional data on fertility. We use data from a representative sample in the United States to examine the prevalence, age of decision, and interpersonal warmth judgments by and about childfree adults. Our prevalence estimates suggest that childfree adults are quite common, comprising over one-fifth (21.64%) of the population. Our analysis of age-to-decision suggests that most childfree adults reported that they decided they did not want children early in life. Finally, our analysis of interpersonal warmth suggests asymmetric affective polarization among parents and childfree adults driven primarily by parent's ingroup favoritism. We discuss the implications of these findings for our understanding of childfree adults and for future research on this historically overlooked segment of the population.

Life-Course Trajectories of Childless Women: Country-Specific or Universal?

While existing research has documented complexities in biographies of childless women, few studies to date have systematically examined the life-course pathways of the childless from a comparative, cross-country perspective. In this paper, we analyse biographies of childless women in four countries-Germany, Italy, Poland, and the United States-in order to investigate whether pathways into childlessness are country-specific or commonly shared across institutional, cultural, and geographical settings. Partnership, education, and employment histories are examined using sequence analysis with dynamic Hamming distance and cluster analysis. Discrepancy analysis indicates a country-effect in women's biographies although life-course patterns identified in each country share similarities. Overall, seven life-course trajectories have been identified, with the most numerous cluster comprising single, working women who completed their education at a relatively young age. The results highlight a marked variation in the life-courses of childless women. Put together, these findings provide descriptive evidence for both country-specificity and cross-country similarity in the pathways to childlessness.

Predicting the risk of suicide attempt in a depressed population: Development and assessment of an efficient predictive nomogram

The purpose of this study was to develop and validate a user-friendly suicide attempt risk nomogram in depression, supporting timely interventions by clinicians. We collected clinical data of 273 depressed patients from January 2020 to January 2021. Suicide attempt was assessed conducting the Mini International Neuropsychiatric Interview. First, optimized features were filtrated through the least absolute shrinkage and selection operator regression analysis. Subsequently, we selected variables with nonzero coefficients and entered them into multiple logistic regression model and nomogram function to construct a visual predicting suicide attempt model. Additionally, the C-index, calibration plot and decision curve analysis, were applied to assess discrimination, calibration, and clinical practicability. Finally, the bootstrapping validation was applied to assess internal validation. Finally, eleven clinical features are screened out in the prediction nomogram. The model presented tiptop calibration and pleasant discrimination with a C-index of 0.853. A towering C-index value, up to 0.799, could also be attained in the interval validation analysis. In addition, decision curve analysis exhibited that our predictive model is clinically effective when the threshold is no less than 1%. These results demonstrate this predictive model was helpful for clinicians assessing the inpatient's suicide attempt recently and implementing individualized treatment strategies.

Late fertility intentions increase over time in Austria, but chances to have a child at later ages remain low

Childbearing takes place at increasingly older ages, and fertility is continuing to decrease across female birth cohorts. This study investigated whether the proportion of women who unintentionally forwent childbearing increased over time, and linked this to the age profile of fertility intentions and realization among men and women. This study was based on the Austrian Micro-Censuses (1986-2016) and on the Austrian Generations and Gender Surveys (panel data 2008/09 and 2012/13). Across the birth cohorts 1950-1979, an increasing proportion of women wanted to have children after 40 years of age, but more women failed to meet their fertility intentions expressed at 34-36 years of age. At the individual level, from 30 years of age, more than one-third of women and men with a strong fertility intention were found to persist with this intention within four years even at less fertile ages. In addition, women and men with a strong fertility intention became less likely to have a child with age: <10% of women and approximately 20% of men who had expressed a certain and short-term intention to have a child at 39-41 years of age in 2008/09 had a child by 2012/13. In particular, childless women and men, and those with only one child, persisted in certain and short-term positive intentions from 30 years of age, but parity was not a significant factor in their realization. The sharp increase in 'unrealized fertility' over time draws attention to the importance that personal circumstances and context encountered at older ages may have for fertility, and augurs a continued increase in the use of assisted reproduction.

Prevalence and characteristics of childfree adults in Michigan (USA)

Childfree individuals choose not to have children, which makes them a distinctive group from parents who have had children, not-yet-parents who plan to have children, and childless indivduals who would have liked to have children. Most research on parental status and psychosocial characteristics has not effectively distinguished childfree individuals from other non-parents or has relied on non-representative samples. In this study, we use a representative sample of 981 Michigan adults to estimate the prevalence of childfree individuals, to examine how childfree individuals differ from parents and other types of non-parents in life satisfaction, political ideology, and personality, and to examine whether childfree individuals are viewed as an outgroup. We find that over a quarter of Michigan adults identified as childfree. After controlling for demographic characteristics, we find no differences in life satisfaction and limited differences in personality traits between childfree individuals and parents, not-yet-parents, or childless individuals. However, childfree individuals were more liberal than parents, and those who have or want(ed) children felt substantially less warm toward childfree individuals than childfree individuals felt toward each other. Given the prevalence of childfree individuals, the risks of their outgroup status, and their potential role in politics as a uniquely liberal group, it is important for demographic research to distinguish the childfree from others and to better understand these individuals.

Childless by circumstance - Using an online survey to explore the experiences of childless women who had wanted children

Childlessness is increasing globally. This study aimed to explore the experiences of childless women who had wanted children. An online survey study was promoted through social media to recruit women aged ≥46 years who were childless by circumstance. The survey remained open for 15 days. In total, 303 survey responses were collected, 176 of which were complete surveys. In total, 15.3% (27/176) of women who had wanted children reported that they had not tried to have children, most commonly due to the lack of a partner (40.7%, 11/27). Of the 139 women who had tried to have children, 70.5% (98/139) had used calendar-based menstrual cycle tracking methods to identify their fertile window, and many had undergone fertility checks including hormone tests (75.5%, 105/139) and ultrasound scans (71.2%, 99/139). A significant proportion of women had experienced a miscarriage (40.2%, 56/139). Many women had decided not to have any fertility treatment (43.2%, 60/139). For those who did, the majority had tried in-vitro fertilization (74.6%, 59/79). The most common reason that women gave for stopping fertility treatment was due to emotional reasons (74.7%, 59/79). When asked how women felt now about their childlessness, the most common issues identified were unhappiness (85/158, 54%), acceptance (43/158, 27%) and happiness (30/158, 19%). There should be more support for unsuccessful fertility patients and other childless women, and more emphasis should be placed upon fertility education in order to ensure that women are better informed about fertility issues.

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.

Preferences, Partners, and Parenthood: Linking Early Fertility Desires, Marriage Timing, and Achieved Fertility

In the United States, underachieving fertility desires is more common among women with higher levels of education and those who delay first marriage beyond their mid-20s. However, the relationship between these patterns, and particularly the degree to which marriage postponement explains lower fertility among the highly educated, is not well understood. We use data from the National Longitudinal Survey of Youth 1979 cohort to analyze differences in parenthood and achieved parity for men and women, focusing on the role of marriage timing in achieving fertility goals over the life course. We expand on previous research by distinguishing between entry into parenthood and average parity among parents as pathways to underachieving, by considering variation in the impact of marriage timing by education and by stage of the life course, and by comparing results for men and women. We find that women with a bachelor's degree who desired three or more children are less likely to become mothers relative to women with the same desired family size who did not attend college. Conditional on becoming mothers, however, women with at least a bachelor's degree do not have lower completed family size. No comparable fatherhood difference by desired family size is present. Postponing marriage beyond age 30 is associated with lower proportions of parenthood but not with lower parity among parents. Age patterns are similar for women and men, pointing at social rather than biological factors driving the underachievement of fertility goals.

Counting on Potential Grandparents? Adult Children's Entry Into Parenthood Across European Countries

As populations age and longevity rises, the structure of the extended family is changing. Parents of young children are increasingly turning to the children’s grandparents to provide childcare and help them reconcile work and family. This study is the first to investigate whether would-be grandparents’ propensity to care for their grandchildren influences the adult children’s transition to parenthood. Because grandparental childcare provision is not observable at the time of the transition to the first birth, I built a measure based on the characteristics of both actual grandparents and adult children to act as a proxy for the childcare that prospective grandparents are expected to provide in the future. Using data from the first two waves of the Survey of Health, Aging, and Retirement in Europe, I examine changes in the likelihood of having a first birth by different levels of expected future childcare provision. Given that the role grandparents play varies depending on the national context, I estimate distinct models for different groups of countries. Furthermore, I analyze different intensities of grandparental childcare: regular, occasional, and any other type of positive childcare. The comparison across 11 countries reveals that grandparental propensity to provide occasional childcare has a positive effect on the transition to parenthood in all country clusters and that grandparental propensity to provide regular childcare has a positive and significant association with having a first child in both pro-natalist (Belgium and France) and pro-traditional countries (Austria, Germany, Greece, Italy, Spain, and Switzerland).

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.

Pathways to Parenthood in Social and Family Context: Decade in Review, 2020

OBJECTIVE

This article reviews research from the past decade on patterns, trends, and differentials in the pathway to parenthood.

BACKGROUND

Whether, and under what circumstances, people become parents has implications for individual identity, family relationships, the well-being of adults and children, and population growth and age structure. Understanding the factors that influence pathways to parenthood is central to the study of families and can inform policies aimed at changing childbearing behaviors.

METHOD

This review summarizes recent trends in fertility as well as research on the predictors and correlates of childbearing, with a focus on the United States and on research most relevant to family scholars. We document fertility differentials and prevailing explanations for variation across sub-groups and discuss alternative pathways to parenthood, such as adoption. The article suggests avenues for future research, outlines emerging theoretical developments, and concludes with a discussion of fertility policy.

RESULTS

U.S. fertility has declined in recent years; whether fertility rates will increase is unclear. Elements of the broader social context such as the Great Recession and increasing economic inequality have impacted pathways to parenthood, and there is growing divergence in behaviors across social class. Scholars of childbearing have developed theories to better understand how childbearing is shaped by life course processes and social context.

CONCLUSION

Future research on the pathways to parenthood should continue to study group differentials, refine measurement and theories, and better integrate men and couples. Childbearing research is relevant for social policy, but ideological factors impact the application of research to policy.