Factors influencing women's decisions about timing of motherhood

"It was not an accident": Women's experiences of renewing motherhood at 40

In recent decades, there has been an increase in motherhood at an advanced age that has raised several medical and social concerns. We conducted a qualitative interview study, guided by Interpretative Phenomenological Analysis, to focus on the motivations and experiences of Belgian women who 'renewed' their motherhood later in life, meaning they had one or several children and then (at least 10 years later) had another child at the age of 40 or older. We focused on ten women's experiences of motherhood later in life, as well as on the way they managed social norms and expectations regarding family building and the appropriate life course. We identified two main themes. The first theme describes the participants' encounters with social norms that challenged their decision to reproduce and parent later in life, and how they managed and anticipated criticism, surprise, disbelief and incomprehension about their renewed motherhood in various ways. The second theme shows how these women talked about taking responsibility as a (renewed) mother of advanced age. For them, responsible motherhood involved making thoughtful reproductive choices, attending to the range of needs of their children, and making extra efforts to safeguard the social and emotional wellbeing of their youngest children, thereby seeking to reduce potential harm resulting from these reproductive choices. This study provides insight into these women's self-conception and their interactions with prejudiced social views of motherhood and family building.

Deworming coverage and its determinants among 12-59 months old children in East Africa: A population-based study

BACKGROUND

Intestinal parasitic infections are the world's largest public health issue, primarily in developing nations. The World Health Organization (WHO) recommends deworming as a preventative or therapeutic measure for all vulnerable people residing in endemic areas. Despite this issue, there is little data on the prevalence and associated factors of deworming drug use among children under five years of age in East Africa.

OBJECTIVE

This study aimed to evaluate the prevalence and contributing factors of deworming coverage among children under the age of five in East Africa using the most available national health survey data.

METHODS

Data from the Demographic and Health Survey, which included 103,865 weighted children between the ages of 12-59 months, were used in this investigation. Our outcome of interest was taking deworming medicine six months before the interview. A logistic regression model was then fitted. A cutoff P value of 0.2 was used in the binary logistic regression analysis. To identify significant variables, a 95% confidence interval and adjusted odds ratio (AOR) with a value < 0.05 were used.

RESULTS

The prevalence of deworming in East Africa was 54.13% (95% CI: 53.83%-54.43%). The maternal age group of 24-34 years, and from 35-49 years (AOR = 1.37, 95% CI, 1.32,1.42), and (AOR = 1.71, 95% CI, 1.62,1.79), employed women (AOR = 1.62, 95% CI, 1.58,1.67), being from rural(AOR = 1.11,95% CI,1.07,1.15), unmarried mothers (AOR = 1.12,95% CI,1.09,1.15), mothers from poorer, middle, richer, and richest households (AOR = 1.16,95% CI, 1.12,1.21), (AOR = 1.23, 95% CI, 1.18,1.28), (AOR = 1.22,95% CI, 1.16,1.27), and (AOR = 1.27, 95% CI, 1.21,1.34) having at least one antenatal care follow up(AOR = 2.90, 95% CI, 2.63,3.16), health facility delivery(AOR = 1.69, 95% CI,1.64,1.75), mass media exposure AOR = 1.32, 955 CI, 1.29,1.36), having of 3-5 children (AOR = 0.89, 95% CI, 0.86,0.93), more than five children (AOR = 0.79, 95% CI, 0.73,0.86), and parity of 2nd or 3rd birth order (AOR = 1.05, 95% CI, 1.01,1.09) as compared to primi mothers were associated with the deworming among under five children in east Africa respectively.

CONCLUSION

The under-five population in East Africa had a lower prevalence of deworming medication per the most recent DHS findings. Promoting mother and child health services (antenatal care, institutional delivery, family planning), as well as women's empowerment, should be prioritized.

Determinants of childbearing intentions among pregnant women with a suspected fetal congenital heart disease

BACKGROUND

The Saudi population is characterized by a high fertility rate, a conservative sociocultural context, and an ongoing societal and lifestyle transition. Yet, data regarding childbearing intentions and the associated factors is scarce. Furthermore, childbearing intention may be impacted by abnormal pregnancy events, such as the clinical suspicion or diagnosis of a fetal congenital disease and the negative experience that may result from it.

OBJECTIVES

The present study explored childbearing intention and determined the sociodemographic and health-related factors discouraging from future pregnancies among women visiting the cardiology clinic for antenatal screening of congenital heart diseases (CHD).

METHODS

A one-year cross-sectional study involved 150 consecutive pregnant women aged between 18 and 47 years old, who presented for antenatal screening of CHD at the fetal echocardiography clinic for, of a teaching hospital in Jeddah, Saudi Arabia. An interview-based questionnaire was administered before the clinic visit and collected sociodemographic data, obstetrical history, risk factors of congenital diseases, mothers' knowledge about fetal echocardiography and CHDs, and childbearing intention (the primary outcome).

RESULTS

Fetal echocardiography and CHD were correctly described by 60 % and 31.3 % of the participants respectively, while 40.7 % and 12 % recognized the association of congenital diseases with consanguinity and advanced maternal age respectively. Childbearing intentions showed 68.0 % of the participants declared desiring a future baby while the remaining 32.0 % declared having no further pregnancy expectations. Attitudes towards a hypothetical baby with CHD were positive in 97.3 % of the participants, and only 30 % declared that the fetal echocardiography results will impact their future childbearing decision. However, childbearing intention showed no significant association with knowledge or attitudes towards CHD. On the other hand, childbearing intention was independently associated with the number of children (OR=0.34; p<0.001), consanguinity with husband (OR=3.64; p = 0.010), and history of gestational diabetes (OR=0.28; p = 0.040).

CONCLUSION

Fertility expectations among Saudi mothers are more likely to be impacted by the personal experience and judgment of own pregnancy fitness, while no significant impact of fetal risks and events. This demonstrates a certain level of autonomy balanced with deeply rooted religious ethics yet combined with a lack of awareness about fetal and maternal risks associated with advanced maternal age and consanguinity. We emphasize the unmet need of education and family planning.

Planned oocyte cryopreservation: the state of the ART

The objective of this review is to provide an update on planned oocyte cryopreservation. This fertility preservation method increases reproductive autonomy by allowing women to postpone childbearing whilst maintaining the option of having a biological child. Oocyte cryopreservation is no longer considered experimental, and its use has increased dramatically in recent years as more women delay childbearing for personal, professional and financial reasons. Despite increased usage, most patients who have undergone oocyte cryopreservation have not yet warmed their oocytes. Most women who cryopreserve oocytes wait years to use them, and many never use them. Studies have demonstrated that oocyte cryopreservation results in live birth rates comparable with IVF treatment using fresh oocytes, and does not pose additional safety risks to offspring. Based on current evidence, cryopreserving ≥20 mature oocytes at <38 years of age provides a 70% chance of one live birth. However, larger studies from a variety of geographic locations and centre types are needed to confirm these findings. Additional research is also needed to determine the recommended age for oocyte cryopreservation, recommended number of oocytes to cryopreserve, return and discard/non-use rates, cost-effectiveness, and how best to distribute accurate and up-to-date information to potential patients.

Does information on age-related fertility decline and fertility policies affect university students' family and career expectations? Evidence from a randomized controlled trial

BACKGROUND

Past research shows that young adults have poor knowledge of age-related fertility decline and that the provision of information can improve fertility knowledge. We provide university students with information on age-related fertility and fertility-related policies and investigate whether the provision of such information affects their family formation and career expectations.

METHODS

A three-armed randomized controlled trial was conducted online in Singapore between September and October 2021. A total of 1000 undergraduate students were recruited through campus advertisements to complete a 30- to 45-minute online survey, which randomly exposed participants to one of three informational brochures on age-related fertility decline, fertility policies, or diabetes (control group). Participants answered questions on family formation and career expectations both before and after the information intervention. Analysis of covariance was used to assess the effects of the information intervention.

RESULTS

Exposure to age-related fertility information resulted in significant reductions in the ideal age at first childbirth, significant increases in the expected probability of marriage before age 30, and (among female participants) significant increases in the expected likelihood of undergoing social egg-freezing. No difference existed in child-number ideals, educational aspirations, and income expectations between groups after exposure. No difference existed between the fertility policy information group and the control group after exposure in any of the outcomes of interest.

CONCLUSIONS

Information on age-related fertility decline brought forward university students' expected timing of childbearing and marriage without reducing their educational and career expectations. The provision of fertility information at early ages, such as during university, can help correct widespread inaccurate beliefs about fertility and promote realistic family formation planning without adversely affecting educational and career goals.

TRIAL REGISTRATION

ClinicalTrials.gov.

Iranian women's attitude toward childbearing and its' association with generalized trust, social support, marital satisfaction and governmental childbearing incentives

Background

Having a child is important event for families worldwide. Attitudes toward childbearing are influenced by many factors. The aim of the present study was to investigate Iranian women's attitude toward childbearing and its association with generalized trust, social support, marital satisfaction, mental health, and socio-economic characteristics in Qazvin province.

Methods

A cross-sectional survey study was conducted between April and July 2022. Using convenience sampling, 347 women with no children or one child in Qazvin province (Iran) participated in the study. Data were collected via the Iranian online platform Porsline. The survey included a demographic and fertility characteristics questionnaire, Attitudes Toward the Government's Childbearing Incentives Scale (ATGCIS), Attitudes Toward Fertility and Childbearing Scale (ATFCS), ENRICH Marital Satisfaction Scale (ENRICH MSS), Patient Health Questionnaire (PHQ-4), Multidimensional Scale of Perceived Social Support (MSPSS), and Generalized Trust Scale (GTS).

Findings

The average age of participants was 35.66 years (SD = 6.89). The score of attitudes toward fertility and childbearing was 84.66 out of 134 (SD = 19.17). The average number of expected children by the couple was 2.36 (SD = 1.35). Multivariable linear regression found a positive and significant relationship between participants' attitudes toward fertility and childbearing (ATFC) and (i) governmental childbearing incentives (β = 0.365, p < 0.001, with 1.37 increase in ATFC with each unit increase in this scale) (ii) generalized trust (i.e., individual's expectation of others' trustworthiness), (β = 0.155, p < 0.003, with 0.60 increase in ATFC with each unit increase in generalized trust) and (iii) marital satisfaction (β = 0.146, p < 0.005, with 0.26 increase in ATFC with each unit increase marital satisfaction). The multivariable linear regression model also showed that attitudes toward fertility and childbearing was the only predictor of couples' expected number of children in the future (β = 0.214, p < 0.001, with 0.38 increase in couples' expected number of children with each unit increase in ATFC).

Conclusion

Government incentives were the strongest independent predictor of participants' attitudes toward childbearing which can indirectly influence couples' expected number of children in the future. Consequently, governments may be able to influence couples' childbearing decisions by providing appropriate incentives. Generalized trust and marital satisfaction were other significant predictors of attitudes toward childbearing. Therefore, implementing programs to improve generalized trust, and increasing marital satisfaction might be other influential measures in couples' childbearing decisions.

Ideal family size decision and its associated factors among women of reproductive age: community survey in southern Ethiopia

Background

Understanding fertility preferences is important for population studies and planning programs. The ideal family size, which is the number of children wanted in one's lifetime, is one of variables used to measure fertility preferences. However, there was limited information on ideal family size decision in Southern Ethiopia. Therefore, this study was designed to assess ideal family size decision and its associated factors among women of reproductive age in Southern Ethiopia.

Methods

A community based cross-sectional study was conducted in 2015 in Southern Ethiopia. Multi-stage stratified cluster sampling was used to select 3,205 study subjects. Data on socio-demographic characteristics, reproductive history, deciding ideal number of children, knowledge and utilization of contraceptives were considered. Descriptive statistics and binary logistic regression were done to describe and assess factors associated with deciding ideal family size. The association between variables was presented using odds ratios with 95% confidence intervals.

Results

We included 3,205 women of reproductive age from which 37.5% respondents could not read and write and 56.5% were housewives. About half of the respondents, 47.1%, did not decide ideal numeric family size or failed to report numeric preferences while 21.6% desire to have five or more children. The mean ideal number of children preferred was 4.5 ± 1.62. Educational status (P < 0.001), overall knowledge about contraceptives (P < 0.001), current contraceptive use (P < 0.001), place of residence (P < 0.001), age (P < 0.004), marital status (P < 0.003) and number of living children (P < 0.003) were factors associated with deciding ideal family size.

Conclusion

Only about half of respondents decided ideal family size from which one fifth prefer high fertility. The mean ideal number of children was comparable with that of Sub-Saharan estimate. Counselling that can empower women to decide family size should be strengthened to empower less empowered women.

Ensuring Population Health in the Era of Aging in Vietnam: Policy Review and Factors Associated with Intentions of Childbearing before the Age of 30 among Youths

Background: Delayed childbearing has become a concern among policymakers across the world. In Vietnam, population policies have been adjusted to cope with this issue. In 2020, Decision 588/QD-TTg was ratified to encourage people to marry and give birth before the age of 30. This study reviewed recent changes in Vietnam's population policies and assessed the intention of giving birth before 30 in young Vietnamese to provide insights into the potential effectiveness of the policy changes among young people. Methods: This study combined two approaches: a desk review and a survey of a group of youths. An online cross-sectional study was conducted on 116 respondents aged 16 to 30 in Vietnam from June to July 2020. The intention of childbearing before 30 and the importance and responsiveness of different social-environmental factors were asked using a structured questionnaire. We used multivariate logistic regression to identify associated factors of such intention. Results: The incentives set out by the Vietnamese government shared similarities with those of other countries. The plan of childbearing before the age of 30 among young adults in Vietnam was demonstrated to correlate with age, socioeconomic and biological characteristics, resources of the local health systems, as well as a clean and safe living environment. Conclusion: This study highlighted the recent crucial shift in Vietnam's population policy. However, the quantitative analysis suggested that measures relating to environmental factors should be incorporated under this policy, implying that further interventions need to be taken into account to cope with delayed childbearing.

The importance of the 'family clock': women's lived experience of fertility decision-making 6 years after attending the Fertility Assessment and Counselling Clinic

This study explored women's lived experience of making fertility decisions six years after attending the Fertility Assessment and Counselling (FAC) clinic in Copenhagen, Denmark, which is a personalised fertility awareness intervention. We conducted a qualitative interview study with 24 women who attended the FAC clinic 6 years earlier. Interviews were semi-structured and broadly examined the women's perceptions and experience of the intervention during follow-up. Data was analysed using a phenomenological framework and themes were identified related to women's experience of making fertility decisions after attending the FAC clinic. The overarching theme regarding the women's lived experience of making fertility decisions after attending the FAC clinic was: Fertility decisions were guided by the 'family clock'. There were four themes: (i) Deciding to 'get started' by attending the FAC clinic; (ii) Sense of making informed and empowered decisions; (iii) Influence of partner status on fertility decisions; and (iv) Decisions dictated by circumstance over preference and knowledge. At follow-up, the majority (21 women, 88%) had become parents. More than half of the women said that they had not achieved their desired family size. Consideration of women's 'family clock' is necessary in personalised fertility awareness interventions to enable women to achieve their family goals.

Triple careers of athletes: exploring the challenges of planning a pregnancy among female elite athletes using semi-structured interviews

Background

The challenging factors that elite athletes perceive for combining their sportive career with planning a pregnancy and motherhood need to be identified in order to develop supportive measures. Therefore, this phenomenological qualitative study aimed to explore challenges associated with planning a pregnancy among female, non-pregnant elite athletes.

Methods

Semi-structured skype-interviews were performed among female elite athletes (athletes competing on national or international level) aged 28 years or older. Using Mayring’s qualitative content analysis approach, anchor examples served to identify potential challenges of planning a pregnancy which were categorized independently by two researchers.

Results

Interviews of 16 elite athletes (mean age 30.7 years) entered analysis. Eleven challenges of planning a pregnancy were identified, categorized into organizational / environmental, financial, personal, and physical factors.

Conclusions

With regard to financial challenges, we propose mandatory maternity leave and continuation of the contracts and salary. Furthermore, mentoring programs may help to provide support and advice to new generations of female elite athletes and help to reduce concerns regarding the wish of becoming pregnant during a sportive career. In order to reduce physical concerns regarding pregnancy and exercise, we see a need for scientific studies investigating the association of sport discipline specific characteristics on sportive performance and the mother´s, fetus’ and child´s health. Finally, the results of the current study may be used in future quantitative studies to test specific hypotheses.

Prevalence and predictors of elective and emergency caesarean delivery among reproductive-aged women in Bangladesh: evidence from demographic and health survey, 2017-18

Background

Over the years, an increasing trend of unnecessary caesarean section (c-section) deliveries has raised concerns in Bangladesh. So far, many studies have reported the risk factors of c-section delivery in Bangladesh. However, most of these studies did not estimate the predictors of the two c-section procedures (i.e., emergency and elective) separately based on the timing of the c-section decision. This study solely brings forward the role of socio-demographic and economic factors that may be associated differently with emergency and elective c-section deliveries.

Methods

Data for the study were drawn from the 2017–18 Bangladesh Demographic and Health Survey with 5,299 women aged 15–49 years who gave birth at a health facility during three years preceding the survey. Descriptive statistics along with bivariate analysis were used to fulfill the study objectives. Further, multivariable logistic regression analysis was conducted on binary outcome variables of elective/emergency c-section deliveries.

Results

Approximately one-third of women in the reproductive-age group opted for delivery through c-section. Out of them, 18.7% of women had elective c-sections, and 14.1% had emergency c-sections. Women who had mass media exposure were 32% more likely to deliver through elective c-sections than women who had no exposure [AOR: 1.32; CI: 1.02–1.72]. Women with higher education had a 56% lower likelihood of delivering through emergency c-section than women with no educational status [AOR: 0.44; CI: 0.24–0.83]. Children from the third or higher birth order were significantly more likely to be delivered through elective c-sections than those from the first birth order [AOR: 2.67; CI: 1.75–4.05]. In contrast, children with higher birth order had fewer chances of emergency c-section than children with first birth order [AOR: 0.29; CI: 0.18 -0.45]. Both elective and emergency c-section deliveries were significantly higher among private health facilities.

Conclusion

Although c-section delivery has emerged as a life-saving intervention, the overuse of such practice has created lucrative risks for the mother and unborn child. Proper sensitization of mothers and families can enhance the knowledge of the unsafe nature of unnecessary c-section deliveries. Authorizations in case of over-use of elective and emergency c-sections should be observed to minimize the unnecessary c-sections and related complications and to increase normal institutional deliveries in Bangladesh.

Women's decision-making capacity and its association with comprehensive knowledge of HIV/AIDS in 23 sub-Saharan African countries

BACKGROUND

Globally, Human Immunodeficiency Virus (HIV) that causes Acquired Immunodeficiency Syndrome (AIDS) remains a public health problem with a higher burden in sub-Saharan African countries. Though the coverage is low in sub-Saharan Africa (SSA), comprehensive knowledge about HIV is vital for preventing and controlling the transmission of the virus. Women's decision-making power is significantly linked with the knowledge and use of healthcare services. However, there is no available evidence on women's decision-making capacity and comprehensive knowledge of HIV. Therefore, this study investigated the association between women's decision-making capacity within households and comprehensive knowledge of HIV/AIDS in SSA.

METHODS

We derived data from the 2010 to 2020 Demographic and Health Surveys of 23 sub-Saharan African countries for the analysis. Using Stata version 14, both bivariate logistic regression and multivariate multilevel logistic regression analyses were used to examine the association between women's decision-making capacity and comprehensive knowledge of HIV/AIDS at p ≤ 0.05. Results were reported using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI).

RESULTS

The pooled results show that comprehensive HIV/AIDS knowledge among married women in the studied countries was 35.5%, from 18.3% in Chad to 77.1% in Rwanda. Regarding sub-regional distribution, comprehensive knowledge of HIV/AIDS in Southern Africa was 73.2%, followed by East Africa (52.4%), West Africa (43.6%), and Central Africa (35.5%). The study showed higher odds of comprehensive knowledge of HIV/AIDS among married women who had decision making power (yes-aOR = 1.20, 95% CI; 1.16-1.25) compared to those who had no decision-making power. Age, women and partner's level of education, place of residence, exposure to media, HIV testing status, community socio-economic status, parity, religion, and distance to health facilities also had significant association with comprehensive HIV/AIDS knowledge.

CONCLUSIONS

Comprehensive knowledge of HIV/AIDS in SSA is low but varies per country. Married women with decision-making capacity were more likely to have comprehensive knowledge of HIV compared to those with no decision-making capacity. Therefore, comprehensive knowledge of HIV/AIDS can be increased through enhancing women's decision-making capacities, strengthening employment opportunities, socioeconomic capacities and creating awareness through media. Moreover, improving access to health care facilities working closely with religious leaders, can be considered to increase coverage of comprehensive knowledge of HIV among married women in SSA.

The making of 'old eggs': the science of reproductive ageing between fertility and anti-ageing technologies

This article proposes going back in the history of reproductive medicine to shed light on the role of assisted reproductive technology (ART) in the making of 'old eggs'. Focusing on two key technologies - egg donation and cytoplasmic transfer - both of which contributed significantly to the production of scientific knowledge about reproductive ageing, the article suggests that ART can be analysed as 'in-vivo models' playing a pivotal role in the shift from age as a demographic variable to ageing understood in biological terms. It will shed light on the role of ART in locating age in the eggs and producing a cellular understanding of fertility decline. It argues that ART not only offers new means of reconfiguring the biological clock by extending fertility, but also reconfigures the biology of reproductive ageing itself. This becomes both the target and the means for new technological interventions, imaginaries and norms, anchored in women's bodies and a more plastic biology, and thereby illuminates hitherto underexplored aspects of the encounter between the science and technology of reproduction and anti-ageing.

Prevalence and risk factors of short birth interval in Bangladesh: Evidence from the linked data of population and health facility survey

The Sustainable Development Goals 3 targets significant reductions in maternal and under-five deaths by 2030. The prevalence of these deaths is significantly associated with short birth intervals (SBI). Identification of factors associated with SBI is pivotal for intervening with appropriate programmes to reduce occurrence of SBI and associated adverse consequences. This study aimed to determine the factors associated with SBI in Bangladesh. A total of 5,941 women included in the 2017/18 Bangladesh Demographic and Health Survey 2017/18 and 1,524 healthcare facilities included in the 2017 Bangladesh Health Facility were linked and analysed. The sample was selected based on the availability of the birth interval data between the two most recent subsequent live birth. SBI was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization and was the outcome variable. Several individual-, households-, and community-level factors were considered as exposure variables. We used descriptive statistics to summarise respondents' characteristics and multilevel Poisson regression to assess the association between the outcome variable with exposure variables. Around 26% of live births occurred in short intervals, with a further higher prevalence among younger, uneducated, or rural women. The likelihoods of SBI were lower among women aged 20-34 years (PR, 0.14; 95% CI, 0.11-0.17) and ≥35 years (PR, 0.03; 95% CI, 0.02-0.05) as compared to the women aged 19 years or less. Women from households with the richest wealth quintile experienced lower odds of SBI (PR, 0.61; 95% CI, 0.45-0.85) compared to those from the poorest wealth quintile. The prevalences of SBI were higher among women whose second most recent child died (PR, 5.23; 95% CI, 4.18-6.55), those who were living in Chattogram (PR, 1.52; 95% CI, 1.12-2.07) or Sylhet (PR, 2.83, 95% CI, 2.08-3.86) divisions. Availability of modern contraceptives at the nearest healthcare facilities was 66% protective to the occurrence of SBI (PR, 0.34; 95% CI, 0.22-0.78). Also, the prevalence of SBI increased around 85% (PR, 1.85; 95% CI, 1.33-2.18) for every kilometer increase in the distance of nearby health facilities from women's homes. Targeted and tailored regional policies and programmes are needed to increase the awareness of SBI and associated adverse health outcomes and availability of modern contraception in the healthcare facilities.

Women Aged over 40 with Twin Pregnancies Have a Higher Risk of Adverse Obstetrical Outcomes

Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies.

The role of uncertainty tolerance and meaning in life on depression and anxiety throughout Covid-19 pandemic

The aim of the current study was to investigate the predictive role of intolerance to uncertainty, meaning in life, gender, marital status, having a child, chronic illness, living with a relative over the age of 65, having health care worker relative, the presence of someone infected with Covid-19 around, and frequency of hand washing on depression and anxiety throughout Covid-19 pandemic. 426 adults (263 women, 163 men) participated to the study. The range of age was between 18 and 74, with the mean of 37.40. Intolerance to Uncertainty Scale, Meaning in Life Scale, Beck Anxiety Scale, Beck Depression Scale were used to collect data. The results indicated that 13.8% (59) of participants had depression, 7% had moderate, 7.5% severe anxiety. Findings yielded that meaning in life and intolerance of uncertainty were significant predictors of depression and anxiety. Chronic illness significantly predicted anxiety, the frequency of washing hand significantly predicted depression. It was concluded that the most important variables predicting both depression and anxiety was intolerance to uncertainty and meaning in life.

The effect of adolescent and advanced-age pregnancies on maternal and early neonatal clinical data

BACKGROUND

This study compared early post-natal clinical data of adolescent and advanced maternal-age mothers and their infants and early post-natal clinical data of mothers 20-34 years old who delivered and their infants.

METHODS

This retrospective study included 1676 newborns who were born at or after 25 gestational weeks and 1638 puerperal women who gave birth at the Health Sciences University Bakırköy Dr. Sadi Konuk Health Practice and Research Center Gynecology and Obstetrics Clinic between January 2017 and January 2018. Maternal demographic and clinical data and neonatal demographic, anthropometric, and early delivery room clinical data of the study group patients were transcribed from clinical file records to electronic records.

RESULTS

We found that the intensive care admission/2nd- or 3rd-level intensive care referral rates of newborns of advanced-age and adolescent mothers were significantly higher than those of the control group. No significant differences were found between intensive care admission and referral rates among age groups when only healthy pregnancies were considered. Cesarean sections, abortion and smoking rates of mothers with advanced maternal age; LGA rates of newborns of women in this age group; macrosomic rates; and free-flow oxygen requirements were significantly higher than in the other age groups. In advanced-age healthy pregnancies, abortion rates were the same as those in the control group, and there was no significant difference in the LGA rate or free-flow oxygen requirement of newborns in this group. Additionally, the 1-min APGAR scores of the newborns of advanced-age mothers were significantly lower than those of the control newborns, and the pCO₂ values measured in the cord or blood gases obtained within the first hour were significantly higher. In healthy pregnancies, no significant differences in APGAR scores or pCO₂ values were found between age groups. The cord or blood gas lactate values of newborns who were born from adolescent pregnancies taken within the first hour were significantly higher than those of newborns born in other age groups; considering only healthy adolescent pregnancies, the results did not change. Newborns born from healthy adolescent pregnancies had significantly lower resuscitation needs than those born from other age groups.

CONCLUSIONS

Newborns who are born from adolescent and advanced-age pregnancies are more likely to have risky early post-natal clinical findings than are newborns who were born from mothers 20-34 years of age. The early period clinical approach and follow-up of newborns born from adolescent and advanced-age maternal pregnancies are very important for pediatric management.

Utilization of deworming medication and its associated factors among pregnant married women in 26 sub-Saharan African countries: a multi-country analysis

BACKGROUND

Deworming is one of the strategies to reduce the burden of anemia among pregnant women. Globally, pregnant women in sub-Saharan Africa are more affected by anemia. Therefore, this study examined both the coverage and demographic, socioeconomic, and women empowerment-related factors associated with the utilization of deworming medication among pregnant married women in sub-Saharan Africa.

METHODS

We used data from the most recent Demographic and Health Surveys of 26 countries in sub-Saharan Africa conducted between 2010 and 2019. Using Stata version-14 software, analysis was done on 168,910 pregnant married women. Bivariate and multivariable logistic regression analyses were conducted to examine the factors associated with the utilization of deworming medication. The results were presented using adjusted odds ratios (aORs) at 95% confidence intervals (CIs).

RESULTS

The pooled results showed that about 50.7% (95% CI 48.2-53.3%) of pregnant married women in the studied countries took deworming medications, and this varied from as high as 84.1% in Sierra Leone to as low as 2% in Angola. Regarding sub-regional coverage, the highest and lowest coverages were seen in East Africa (67.6%, 95% CI 66.0-69.1%) and West Africa (24.3%, 95% CI 22.4-26.4%) respectively. We found higher odds of utilization of deworming medication among older pregnant married women (aOR=1.93, 95% CI 1.32-2.84), women with educated husbands (aOR=1.40, 95% CI 1.11-1.77), wealthier women (aOR=3.12, 95% CI 1.95-4.99), women exposed to media (aOR=1.46, 95% CI 1.18-1.80), and those who had four or more antenatal care visits (aOR=1.51, 95% CI 1.24-1.83).

CONCLUSIONS

Enhancing women's education, disseminating information about maternal healthcare services through mass media, and ensuring that women from economically disadvantaged households benefit from national economic growth can be considered as deworming medication improvement strategies in sub-Saharan Africa. Moreover, providing more attention to adolescents or young pregnant women and increasing the number of antenatal care visits could be considered to increase deworming uptake among pregnant married women.

Investigating the effect of behavioral and demographic characteristics of Iranian women on the number of children ever born

Background: The number of children ever born (CEB) to a woman, as an index of her fertility behavior, are interesting for the governments and demographer policymakers. In recent years, a notable reduction of fertility and population aging in Iran has caused concern among politicians, and it has led to starting new changes in demographic policies. Therefore, to adopting new demographic and health policies programs, identification of factors that affecting CEB is essential.

Methods: To evaluate determinant factors on CEB, information of 20093 married Iranian women aged between 15 and 54 years has been analyzed from the Iranian National Institute of Health Research survey. Based on the structure of data and the possible influential unobserved population heterogeneity on CEB in each city and province, a multilevel count regression model was applied. The analysis was performed using the ‘R’ software (version 3.5) with a significant level of 0.05.

Results: Findings show that the mean and median number of CEB was 2.82 and 2.00 for all women, respectively. Meanwhile, these values were 4.56 and 4.00 for the women who reached menopause. There was a significant unobserved heterogeneity affecting CEB in each province (σ_p=0.018). Also, the results of the multilevel model show that living in an urban area (RR=0.90), higher age at first marriage (RR=0.96), higher education (RR=0.84, RR=0.81), and exposure to mass media (RR=0.87) decrease the risk ratio of the number of CEB (p <0.001).

Conclusion: It seems that the tendency of women to academic education and their access to mass media has a significant effect on reducing childbearing. Therefore, in future planning, attention to these two factors can be useful and helpful to move to increase fertility.

The Association between Assisted Reproduction Technology (ART) and Social Perception of Childbearing Deadline Ages: A Cross-Country Examination of Selected EU Countries

The advancement of assisted reproductive technologies (ART) has gained much attention in relation to childbearing postponement. Our study's purpose was to empirically examine how perceptions of childbearing deadline age vary in association with availability and prevalence of ART across different countries. The present study used data from the 2006 European Social Survey and the 2006 European Society of Human Reproduction and Embryology to examine selected EU countries. A total sample of 17,487 respondents was examined. Multilevel regression modeling was used. Results showed that first, younger generations were more generous with maternal childbearing ages but stricter with paternal deadline ages. Second, respondents residing in countries with higher percentage of reproductive clinics per population were more generous with maternal ages, however no significant association was observed with regard to paternal childbearing ages. Third, on the contrary, respondents residing in countries with higher utilization of ART treatments were stricter with maternal ages, which may be because they are more likely to be aware of the physiological and financial difficulties associated with ART treatments. The present study is meaningful in that it is the first study to empirically examine social perceptions of childbearing ages in relation with ART.

Uninformed decision-making and regret about delaying childbearing decisions: A cross-sectional study

Aim

The aim of this study was to examine regret over the timing of the childbearing decision and reasons for its delay.

Design

A cross-sectional study.

Methods

This cross-sectional study included 219 women and 169 men referred to fertility facilities in Japan from July-December 2018. Participants completed a questionnaire on the reasons for their delay in childbearing decision and the degree of regret regarding their decision. Multiple linear regression was used to analyse the association between degree of regret and the reasons for the delay.

Results

The top three reasons for the delay in childbearing decision in women were "Establishing the relationship," "Health problems," and "Financial security." The top three reasons in men were "Establishing the relationship," "Financial security," and "Lack of fertility knowledge." Multiple linear regression showed that lack of fertility knowledge was associated with regret over the timing of childbearing decisions in women and men.

Relationship Between Advanced Maternal Age and Timing of First Developmental Evaluation in Children with Autism

OBJECTIVE

Mothers of advanced maternal age (AMA) at childbirth (age ≥35 years) may have different perceptions of autism spectrum disorder (ASD) risk, independent of sociodemographic factors, that may affect ASD identification. We aimed to estimate associations between AMA and both age of a child's first evaluation noting developmental concerns and time from first evaluation to first ASD diagnosis.

METHODS

We used data for 8-year-olds identified with ASD in the 2008 to 2012 Autism and Developmental Disabilities Monitoring Network. We estimated differences in age at first evaluation noting developmental concerns and time to first ASD diagnosis by AMA using quantile and Cox regression.

RESULTS

Of 10,358 children with ASD, 19.7% had mothers of AMA. AMA was associated with higher educational attainment and previous live births compared with younger mothers. In unadjusted analyses, AMA was associated with earlier first evaluation noting developmental concerns (median 37 vs 40 mo) and patterns in time to first evaluation (hazard ratio: 1.12, 95% confidence interval: 1.06-1.18). Associations between AMA and evaluation timing diminished and were no longer significant after adjustment for socioeconomic and demographic characteristics. Children's intellectual disability did not modify associations between AMA and timing of evaluations.

CONCLUSION

Advanced maternal age is a sociodemographic factor associated with younger age of first evaluation noting developmental concerns in children with ASD, but AMA was not independently associated likely, because it is a consequence or cofactor of maternal education and other sociodemographic characteristics. AMA may be a demographic factor to consider when aiming to screen and evaluate children at risk for ASD.

Effect of advanced maternal age on pregnancy outcomes: a single-centre data from a tertiary healthcare hospital

The aim of this study was to assess the effect of advanced maternal age on pregnancy and neonatal outcomes in patients attending a tertiary centre hospital. Between January 2013 and December 2016, the records of all patients who were referred for pregnancy follow-ups and delivery were retrospectively reviewed and were divided according to their parity and age. Patients over 35 years old were categorised as advanced maternal age; (1) 35-40 years old. (2) 40-45 years old. (3) 45 years and over. Most of the prenatal complications were found to increase in the advanced maternal age group. The caesarian section rate was found to be higher in all advanced maternal age groups. There was no significant relationship between 5 Minute Apgar scores of <7 and perinatal mortality and post-term pregnancy and parity. Globally, advanced maternal age pregnancy shows an increase as a result pregnancy complication will increase. It is important to make a appropriate follow-up for pregnancies of advance maternal age mothers. Impact statement What is already known on this subject? Advanced maternal age is a poor prognostic factor for pregnancy outcomes. But there remains no consensus opinion or a plan for the management of pregnancy in this particular risk group. What do the results of this study add? This clinical study makes a contribution to the literature for advanced maternal age and pregnancy complications. This study is one of the few studies emphasising the importance of parity in advanced maternal age and the relationship between first trimester pregnancy complications and advanced maternal age. What are the implications of these findings for clinical practice and/or further research? After the ART pregnancies increasing all around the world not only advanced age but the parity become an important role. Due to an increase in advanced maternal age pregnancies in all around the world, we think that better understanding and management of the complications to be encountered in advanced maternal age and parity pregnancies will be appropriate.

Elective egg freezing without medical indications

The aim of this review is to provide current knowledge on fertility preservation for non-medical reasons in women willing to postpone childbearing. The topic is highly debatable, starting from disagreement about its terminology, the number of eggs necessary to predict chances of success, and the safety and socio/ethical point of view. Cost analysis and discrepancies among countries' recommendations and regulations are described to confirm the controversies and unsolved issues around this very interesting topic. Finally, an overview on the returning rate of women among "egg bankers" and reasons behind their decisions are illustrated.

Paths to Parenthood Among Self-Identified Bisexual Individuals in the United States

Bisexual parents have been notably absent from prior research on parenting, despite comprising the largest proportion of parents among "lesbian, gay, and bisexual" (LGB) individuals. Indeed, recent national probability data indicate that young bisexual women are more likely than their heterosexual counterparts to report having at least one child. Intentions to have children, patterns of family planning and contraception use, and related issues have important implications for health and healthcare-related decisions and priorities among bisexual parents. We conducted in-depth interviews with a sample of 33 bisexual parents from across the U.S. who reported having at least one child (genetic, adopted, step or foster child, guardian, and/or warden of the state). In cases of intentional pregnancies, participants considered relationship and financial stability, job security and their ideal family size. Unintentional pregnancies, as well as pregnancy terminations, were often reframed as positive experiences. After deciding not to have more children, participants reported using contraceptive methods, including sterilization or long-acting reversible contraceptive methods (e.g., intrauterine devices). Instances of deception, in which partners deceived participants with false beliefs regarding their contraceptive use, were recalled negatively for the relatively small number of participants who reported such experiences. Overall, our findings point to a diversity in the intentions and ways bisexual individuals become parents, similar to parents of other sexual identities. Acknowledgements of the diverse experiences and concerns faced by bisexual parents may be beneficial in improving efforts related to providing appropriate and relevant health- and healthcare-related services.

Delaying first pregnancy in reducing burden of unintended pregnancy among married adolescents in urban slums of Bangladesh

Purpose

The purpose of this paper is to assess the effect of delaying first pregnancy in reducing burden of unintended pregnancy (UP) among married adolescent girls in urban slums of Bangladesh.

Design/methodology/approach

This cross-sectional survey was conducted among 783 married adolescents in five urban slums of Bangladesh during January 2013–January 2014.

Findings

Half of the respondents’ first pregnancy was reported as unintended. Of the respondents, 58 percent with no school education had experienced UP which was 38 percent among respondents with eight year’s education. Respondents who did not willingly agreed to their marriage experienced more UP (61 percent) than those who were agreed/got married by their own choice (51 percent). Respondents having five years of age difference with their husbands experienced more UP (58 percent) than those with ten years of age difference (46 percent). Respondents aged 14 years at first conception experienced 63 percent UP, while the respondents aged 18 years had 35 percent UP experience. Of the respondents, 66 percent who became pregnant within one year of marriage reported their pregnancy as unintended which was 29 percent among those who delayed their first pregnancy for three years.

Originality/value

Significant association was observed between pregnancy intention with respondents’ educational status (p=0.03), age difference with husbands (p=0.02), age at first conception (p<0.01) and delaying first pregnancy (p<0.001).

Counseling patients on reproductive aging and elective fertility preservation-a survey of obstetricians and gynecologists' experience, approach, and knowledge

PURPOSE

What are the experience, approach, and knowledge of US Obstetricians and Gynecologists' (ob-gyn) towards counseling patients on reproductive aging (RA) and elective fertility preservation (EFP).

METHODS

A cross-sectional survey emailed by the American College of Obstetricians and Gynecologists (ACOG) to 5000 ACOG fellows consisting of 9 demographic and 28 questions relating to counseling patients on RA and EFP.

RESULTS

Seven hundred and eighty-four responders completed the survey. Although 82.8% agreed that conversations relating to RA should take place with patients desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these women aged 18-34 years old, compared to 75.8% aged 35-44 years old (P < 0.01). Limited time (75.8%) and limited knowledge (41.4%) were amongst the most frequent reported barriers towards counseling patients on RA. Fifty-eight percent stated that they have been asked about EFP by patients. Although 74.8% agreed that conversations should take place related to EFP in women desiring future childbearing and delaying due to social reasons, only 27.6% stated that they frequently counsel these patients on EFP (P < 0.01). Limited time (75%) and limited knowledge (59.9%) were amongst the most frequent barriers towards counseling on EFP.

CONCLUSIONS

In the USA, methods to improve patient counseling and provider knowledge on RA and EFP are warranted and further studies are needed to address optimal methods to improve counseling and knowledge related to these topics.

Attitudes towards family formation among men attending fertility counselling

Men and women are increasingly postponing childbearing until an age where fertility has decreased, meaning that they might have difficulties in achieving their desired family size. This study explored childless men's attitudes towards family formation. Data were collected through semi-structured qualitative interviews with 21 men attending the Fertility Assessment and Counselling Clinic in Copenhagen or Horsens, Denmark. Data were analysed using content analysis. The men envisioned a nuclear family with their own biological children, but they experienced doubts and ambivalence about parenthood and feeling 'ready'. Their lack of readiness was linked to their awareness of the sacrifices and costs involved with parenthood, and their belief that they could safely delay parenthood. The men did not consider that they may be unable to have their own biological children. This study highlights the importance of considering men's attitudes and preferences towards family formation when understanding couples' decision-making. Contrary to common understanding, the findings show that men are as concerned with the planning and timing of parenthood as women, but their knowledge of the age-related decline in fertility is poor. Men need to gain more awareness of the limitations of fertility and the impact of female and male age on the ability to achieve parenthood aspirations.

Exploring the perception of childbearing barriers in a low fertility subgroup of Iran: a qualitative study

Background

In Iran, the total fertility rate is 1.8 and it is especially low in highly educated women. Also, there is a considerable difference between the ideal and realized fertility in this sub-population. Clear knowledge on the barriers to achieve the ideal family size is necessary to formulate policies.

Objective

The study aimed at explaining the barriers of childbearing in this sub-population.

Methods

This was a qualitative study using conventional content analysis. The study was conducted from April 2015 to January 2016 across the colleges of Kerman University of Medical Sciences in the southeast of Iran. The study population consisted of PhD students and faculty members who were studying and working in this university. We used semi-structured interviews to collect data. The sampling procedure was purposeful sampling and it continued until data saturation was achieved. Conventional content analysis was performed to analyze the gathered data.

Results

Twenty two participants took part, all of whom were married and half of whom were women. Eight of the participants were faculty members and the rest were PhD students. Two categories were extracted, including lake of enabling environment and personal preferences as the main barriers to childbearing in the highly educated subpopulation. Each of the categories included corresponding secondary and primary categories.

Conclusions

Different factors affect childbearing decision making in highly educated people. Taking into account these barriers is important at the time of formulating pro-natalist policies.

Conceptualising women's motivations for social egg freezing and experience of reproductive delay

As the average age of motherhood in many Western countries continues to rise, the spectacle of the older mother and the trend towards delayed childbearing has been the subject of much public debate and interest. Concurrent to this trend has been the development and use of a new form of fertility preservation - social egg freezing - a technology which by its very nature is meant to enable reproductive delay. Whilst previous studies have been able to provide insights into the complex and often interrelating structural, economic, and relational factors shaping the timing of motherhood, and in some cases women's use of social egg freezing, fewer studies have clearly demonstrated the way these factors themselves, as well as the accounts of individual women, can be seen as being shaped by ideological and discursive forces. Drawing on interviews with 31 users of social egg freezing this article will demonstrate how women's accounts of reproductive delay and use of egg freezing technology can be seen as being shaped by neoliberal rationality, heteronormativity, discourses of 'appropriate parenting' and gendered ideologies of parenthood.

Reproductive ageing-turning back the clock?

BACKGROUND

Unintended childlessness is a distressing, and often unintended, consequence of delayed childbearing and reproductive ageing. The average maternal age at first birth has risen steadily in many industrialised countries since the 1980s. There are many societal factors involved in the decision to postpone motherhood. As a result, many women are postponing having children until it is too late. In this review, we aim to summarise the reasons behind delayed childbearing, the impact of delayed childbearing and the scientific advances that seek to reverse reproductive ageing and ensure reproductive autonomy for women.

METHODS

An extensive literature search of PubMed was conducted to include all published articles on delayed childbearing and the consequences of reproductive ageing. Secondary articles were identified from key paper reference listings.

CONCLUSION

If the current reproductive trends continue, many women will find themselves in the harrowing position of being unintentionally childless. In addition, many will inevitably turn to assisted reproductive technologies in an effort to protect and preserve their reproductive autonomy. However, it is not always possible to reverse the effects of reproductive ageing.

Is egg freezing a good response to socioeconomic and cultural factors that lead women to postpone motherhood?

In western societies, a growing number of women are currently turning to social egg freezing, a technique that makes it possible to freeze oocytes and thus preserve female reproductive possibilities. The current ethical debate has focused on normative aspects concerning the question of whether social egg freezing empowers women's reproductive autonomy. Due to this narrow focus on autonomy, deeper questions concerning the socio-economic conditions and cultural factors that lead women to delay reproduction, to feel pressured by their biological clock, and thus to consider social egg freezing have not yet received sufficient attention and analysis. The aim of this study was to broaden the ethical debate by focusing on whether social egg freezing is a good response to the socioeconomic and cultural constraints that lead women to postpone motherhood, and therefore whether it can be seen as a means of achieving what in virtue ethics is known as a 'good life'. I will argue that while social egg freezing can be seen as a means to empower women to adapt to current socioeconomic constraints, it is not an adequate response to cultural factors, as these cannot be solved by simply extending a woman's fertility.

Better informed is better decided: Addressing the risks of delaying childbearing for female higher educational students

Objective Delayed childbearing has gradually started to become the norm for higher educational students, with possible increased future fertility risks and psychological distress as a consequence. What do female students expect from their general practitioners (GP) and other health care providers (HCPs) with regard to delaying childbearing? We also looked into indicators that can be used by HCPs to detect female university students who have issues regarding delayed childbearing. Methods Cross sectional study: A total of 398 female students (mean age 21.83; SD = 2.4) from at least three different universities completed the questionnaire (distributed through the Internet and at a students' health service). Potential predictors for having an issue regarding delayed childbearing were assessed with multivariate logistic regression. Results Thirteen percent of 398 female students experienced being childless as more or less problematic. Forty-nine percent thinks having children deserves more attention and 33% of the students expect attention from their GP regarding a possible desire to have children during contraceptive consultations. Four factors demonstrated significant associations with having an issue concerning delayed childbearing: age (these issues also occur in younger students), worrying about fertility, not opting for an abortion if pregnant and dissatisfaction with current contraceptive use. Conclusion HCPs should discuss delayed childbearing with female students, addressing both the decrease of fertility after a certain age (30), the limited range of fertility methods, and the possible negative physical and psychological consequences of postponement. These elements could be included into programmes of sexual and reproductive health training and into pre-conception care and pre-conception education.

Mental health-related quality of life and the timing of motherhood: a 16-year longitudinal study of a national cohort of young Australian women

PURPOSE

We examine timing of motherhood in a longitudinal cohort of young Australian women, and its relationship with mental health-related quality of life (SF-36 MHI-5), and with sociodemographic, health behaviour and health-related variables.

METHODS

We analysed longitudinal self-report data from a nationally representative cohort of 10,332 Australian women born 1973-1978, surveyed 6 times between 1996 (aged 18-23) and 2012 (aged 34-39).

RESULTS

Group-based trajectory modelling identified four groups. Normative Mothers (46%, mean age at motherhood 30.5 years) made the transition to motherhood close to the Australian median age. Early Mothers (25%, 25.2 years) and Very Early Mothers (7%, 20.0 years) made this transition earlier; Not Mothers (22%) had not given birth. Generalised linear mixed models showed that all groups improved mean MHI-5 scores over time. Patterns of group differences were complex: Normative and Early Mothers scored consistently highest; Very Early Mothers scored lowest at most surveys; Not Mothers' scores increased relative to others over time. Most effects disappeared after adjustment for confounders. Early and Very Early Mothers showed multiple indicators of social disadvantage, while Not Mothers had very low rates of marriage.

CONCLUSIONS

Timing of motherhood is embedded in sociodemographic and personal contexts. Women with socioeconomic advantages were characterised by higher mental health-related quality of life and later transition to motherhood, but adjustment for relative advantage attenuated differences in mental health-related quality of life. The overall findings suggest a pattern of positive adaptation to circumstances, with mental health-related quality of life improving through early adulthood regardless of timing of motherhood.

A retrospective study of the effect of increasing age on success rates of assisted reproductive technology

OBJECTIVE

To demonstrate the effect of increasing age on the outcome of assisted reproductive technology, particularly among women aged 40 years or older.

METHODS

A retrospective analysis was conducted using prospectively collected data for all in vitro fertilization and intracytoplasmic sperm injection cycles among women aged 30-35 years or 40-44 years conducted at Merrion Fertility Clinic, Dublin, Ireland, between January 1, 2010, and December 31, 2014. The relationship between age and treatment outcome was assessed.

RESULTS

Among women aged 30-35 years, 726 cycles led to 281 (38.7%) clinical pregnancies and 242 (33.3%) live births. By contrast, among women aged 40-44 years, 433 cycles led to 102 (23.6%) clinical pregnancies and 64 (14.8%) live births (both P<0.001). The live birth rate was particularly low after cycles among the women aged 42 years (5/89 [5.6%]) or 43 years (2/30 [6.7%]).

CONCLUSION

The success rates of assisted reproductive technology are decreased among women aged older than 40 years. Fertility clinics have a responsibility to fully inform this group about the limitations of assisted reproductive technology.

Association of maternal age with child health: A Japanese longitudinal study

Average maternal age at birth has been rising steadily in Western and some Asian countries. Older maternal age has been associated with adverse pregnancy and birth outcomes; however, studies on the relationship between maternal age and young children’s health remain scarce. Therefore, we sought to investigate the association of maternal age with child health outcomes in the Japanese population. We analyzed data from two birth cohorts of the nationwide Japanese Longitudinal Survey of Babies in 21^st Century (n₂₀₀₁ = 47,715 and n₂₀₁₀ = 38,554). We estimated risks of unintentional injuries and hospital admissions at 18 and 66 months according to maternal age, controlling for the following potential confounders: parental education; maternal parity, smoking status, and employment status; household income; paternal age, and sex of the child. We also included the following as potential mediators: preterm births and birthweight. We observed a decreasing trend in the risks of children’s unintentional injuries and hospital admissions at 18 months according to maternal age in both cohorts. In the 2001 cohort, compared to mothers <25 years, odds ratios of hospital admission at 18 months were 0.97 [95% CI: 0.86, 1.09], 0.92 [0.81, 1.05], 0.76 [0.65, 0.90], and 0.71 [0.51, 0.98] for mothers aged 25.0–29.9, 30.0–34.9, 35.0–39.9, and >40.0 years, respectively, controlling for confounders. Our findings were in line with previous findings from population-based studies conducted in the United Kingdom and Canada suggesting that older maternal age may be beneficial for early child health.

Ignorance could hurt: an assessment of fertility awareness, childbirth intentions and parenting attitudes among university students

BACKGROUND

An emerging pattern of increasing median age at first birth among women has been well documented in Western countries. A similar but less remarkable trend is being experienced in sub-Saharan Africa. There is a paucity of information in Sub-Saharan Africa about awareness of age-related fertility decline. The aim of this study was to assess the perception of fertility, childbirth intentions and parenting attitudes among university students.

MATERIALS AND METHODS

A cross-sectional survey of 231 female and 158 male students randomly selected university undergraduates in Nigeria using a self-reported questionnaire.

RESULTS

The respondents overestimated the ages of slight (92.1%) and marked decline (89.4%) in female fertility. The chance of pregnancy after unprotected sex during ovulation was overestimated by 93.1% of the respondents. Over three-quarters of them overestimated the success rate of in-vitro fertilization. The sources of information regarding fertility issues were mainly school (40.1%), the media (20.6%) and family members (18.8%). About 98.7% of the childless respondents reported an intention to have children in the future. The mean number of children desired was 3.29±1.14. Females desire to have their first and last children earlier than males (p=0.000). The perceived potential obstacles to having the desired children were the pursuit of career aspirations (35.5%) and the pursuit of personal interests (20.8%).

CONCLUSIONS

Misconceptions about fertility issues have grave implications for involuntary childlessness and secondary infertility. Comprehensive family planning education that will address the misconceptions about female fecundity and parenting issues are required.

Effects of fertility education on knowledge, desires and anxiety among the reproductive-aged population: findings from a randomized controlled trial

STUDY QUESTION

What are the effects of fertility education on knowledge, childbearing desires and anxiety?

SUMMARY ANSWER

Providing fertility information contributed to greater knowledge, but increased anxiety.

WHAT IS KNOWN ALREADY

Past studies have found that exposure to educational material improved fertility awareness and changed desires toward childbearing and its timing. Existing educational websites with evidence-based medical information provided in a non-judgmental manner have received favorable responses from reproductive-aged men and women.

STUDY DESIGN, SIZE, DURATION

This three-armed (one intervention and two control groups), randomized controlled trial was conducted using online social research panels (SRPs) in Japan in January 2015.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 1455 participants (726 men and 729 women) between 20 and 39 years of age who hoped to have (more) children in the future were block-randomized and exposed to one of three information brochures: fertility education (intervention group), intake of folic acid during pregnancy (control group 1) or governmental financial support for pregnancy and childbirth (control group 2). Fertility knowledge was measured with the Japanese version of the Cardiff Fertility Knowledge Scale (CFKS-J). Knowledge, child-number and child-timing desires, subjective anxiety (i.e. whether participants felt anxiety [primary outcome]), and scores on the State-Trait Anxiety Inventory were assessed immediately after exposure. Non-inferiority comparisons were performed on subjective anxiety with non-inferiority declared if the upper limit of the two-sided 95% confidence interval (CI) for risk difference did not exceed a margin of 0.15. This test for non-inferiority was only performed for subjective anxiety; all the other variables were tests of superiority.

MAIN RESULTS AND THE ROLE OF CHANCE

Posttest scores on the CFKS-J (mean, SD) were higher in the intervention group than that of the control groups: intervention versus Control 1 and versus Control 2: 52.8 (28.8) versus 40.9 (26.2) (P< 0.001) versus 45.1 (27.1) (P = 0.003) among men and 64.6 (26.0) versus 50.8 (26.9) (P< 0.001) versus 53.0 (26.4) (P< 0.001) among women.The percentage of participants who felt subjective anxiety after exposure to the intervention brochure was significantly higher than that of the control groups: intervention versus Control 1 and versus Control 2: 32.6 versus 17.8% (risk difference [RD] = 0.149, 95% CI: 0.073-0.225) versus 14.5% (RD = 0.182, 95% CI: 0.108-0.256) among men, and 50.2 versus 26.3% (RD = 0.239, 95% CI: 0.155-0.322) versus 14.0% (RD = 0.362, 95% CI: 0.286-0.439) among women. Non-inferiority of the intervention was inconclusive (i.e. the CI included 0.15) among men whereas inferiority was declared among women. The incidence of anxiety was higher in the intervention group than that of the control groups especially among men aged 30 and older and among women aged 25 and older. No difference existed in childbearing desires between groups after exposure.

LIMITATIONS, REASONS FOR CAUTION

The possibility of selection bias associated with the use of SRPs (higher socioeconomic status and education) and volunteer bias toward those more interested in fertility may limit the generalizability of these findings.

WIDER IMPLICATIONS OF THE FINDINGS

In addition to education targeting a younger generation, psychological approaches are needed to alleviate possible anxiety caused by fertility information.

STUDY FUNDING/COMPETING INTERESTS

This study was funded by National Center for Child Health and Development, Seiiku Medical Study Grant (24-6), the Daiwa Foundation Small Grants and Grant-in-Aid for JSPS Fellows (26-1591). No competing interest declared.

TRIAL REGISTRATION NUMBER

UMIN Clinical Trials Registry. Trial registration number, 000016168.

TRIAL REGISTRATION DATE

13 January 2015.

DATE OF FIRST PATIENT'S ENROLMENT

15 January 2015.

Pregnancy in Spanish elite sportswomen: A qualitative study

Pregnancy and motherhood have been historically considered as reasons why elite sportswomen may end their sport careers. During pregnancy, the safety of both mother and baby has been identified as a key reason for ceasing sport participation. Recent "official" statistics on how many elite athletes are mothers suggest that pregnancy, motherhood, and sport could be no longer mutually exclusive. The aim of this qualitative phenomenological study was to describe the lived pregnancy of Spanish elite sportswomen. Spanish elite sportswomen (n = 20) aged between 18 and 65 years that had been pregnant during their sporting professional career and after the end of their pregnancy had taken up again their professional sporting career for at least one year were included. Data were collected from May 2010 to April 2012 using in-depth personal interviews, investigator's field notes, and extracts from the participants' personal letters. Identified themes included: (1) choosing the right moment; (2) fears and doubts; and (3) justifying physical exercise. By giving voice to these elite Spanish sportswomen, their pregnancy experiences are made visible, which might help to gain a better understanding into their expectations and develop policies and practices focused on elite sportswomen during and after pregnancy.

The experiences of pregnant women at an advanced maternal age: an integrative review

Abstract OBJECTIVE To identify in the literature how the experiences of women age 35 or above are described in terms of pregnancy. METHOD Integrative review based on MEDLINE/PubMed, CINAHL, LILACS, and SciELO databases, with no time period constraint. RESULTS Eighteen studies that dealt with the experiences of pregnant women at an advanced maternal age were selected and analyzed. The studies evidenced four theme categories: the search for information, which pointed to a deficit of information supplied by health care professionals; perceiving the risks, which pointed to women's concerns about their own health and their children's; the ideal moment for motherhood, with different reasons for postponing it; and adjusting to a new routine, showing a concern regarding changes in daily life. CONCLUSION From the results, it was possible to understand that other factors, in addition to those that include risks, are present in the experiences of older pregnant women and point to a need to involve such aspects in nursing care to create comprehensive strategies that are aligned with these women's needs.

“For some people it isn’t a choice, it’s just how it happens”: Accounts of “delayed” motherhood among middle-class women in the UK

Over the past few decades the number of women having their first babies over the age of 35 in the United Kingdom has increased. Women’s timing of motherhood is invariably bound up with a discourse of “choice”, and in this paper we consider the role choice plays in the timing of motherhood among women who have been defined as “older” mothers. This article is based on data from 11 semi-structured interviews that explored the transition to motherhood among “older” middle-class mothers. The interviews were analysed using critical discursive psychology. The women drew upon two dominant repertoires when making sense of their timing of motherhood. Within the first repertoire, “older motherhood as circumstance”, older motherhood was presented as the outcome of life circumstances beyond their control, with a lack of the “right” circumstances facilitating “delayed” motherhood. Within the second repertoire, “older motherhood as readiness”, women constructed themselves as (now) prepared for motherhood. “Readiness” was bound up with notions of self-fulfilment, yet also assessments of their ability to be “good” mothers. We conclude that, far from a straightforward choice, the timing of motherhood is shaped by cultural definitions of the “right” circumstances for parenthood, but also cultural definitions of “good” motherhood, which may define when women are “ready”.