Assessment of miscarriage factors among Latinas who live in the U.S.: a cross-sectional study

Introduction

Latinas in the US are underrepresented in miscarriage research, yet face several risk factors for having a miscarriage, including intimate partner violence, and increasing maternal age. Increased acculturation is associated to increased risk of intimate partner violence and adverse pregnancy outcomes among Latinas yet is also understudied in the realm of miscarriage. Thus, this study aimed to analyze and compare sociodemographic characteristics, health-related factors, intimate partner violence, and acculturation among Latinas with and without a history of miscarriage.

Methods

This study utilizes a cross-sectional design to analyze baseline data from a randomized clinical trial on the effectiveness of "Salud/Health, Educación/Education, Promoción/Promotion, y/and Autocuidado/Self-care" (SEPA), a human immunodeficiency virus risk reduction intervention for Latinas. Survey interviews were conducted in a private room at the University of Miami Hospital. Survey data analyzed include demographics, a bi-dimensional acculturation scale, a health and sexual health survey, and the hurt, insult, threaten, and scream tool. This study's sample was 296 Latinas, 18 to 50 years old, with and without a history of miscarriage. Data analyses included descriptive statistics, t-tests for continuous variables, negative binomial for counts, and chi-square for dichotomous or categorical variables.

Results

Most Latinas were Cuban (53%), lived in the U.S. an average of 8.4 years, had 13.7 years of education, and a monthly family income of $1,683.56. Latinas with history of miscarriage were significantly older, had more children, more pregnancies, and poorer self-rated health than Latinas without history of miscarriage. Although not significant, a high percentage of intimate partner violence (40%) and low levels of acculturation were reported.

Discussion

This study contributes new data about different characteristics of Latinas who have and have not experienced a miscarriage. Results can help identify Latinas at risk for miscarriage or its adverse-related outcomes and help develop public health policies focusing on preventing and managing miscarriage among Latinas. Further research is warranted to determine the role of intimate partner violence, acculturation, and self-rated health perceptions among Latinas who experience miscarriage. Certified nurse midwives are encouraged to provide Latinas with culturally tailored education on the importance of early prenatal care for optimal pregnancy outcomes.

Effects of Fertility Behaviors on Depression Among the Elderly: Empirical Evidence From China

Background: Increased population aging is associated with increased incidence of depression among the elderly. Existing studies have shown that ill-advised fertility behaviors during their youth also affect the health of the elderly. However, insufficient attention has been paid to depression among elderly in China. This paper focuses on how fertility behaviors affect senile depression among parents by examining the heterogeneity of such effects and tests the applicability of existing theoretical findings in a Chinese sample.

Methods: The effects of fertility behaviors on depression among the elderly were investigated using the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative dataset. The effects of early-age fertility behaviors on the degree of depression among the elderly were investigated using ordinary least squares and ordered probit models that adjusted for demographic and socioeconomic factors.

Results: (1) The age of first childbirth, childbearing period, and number of births were significantly and positively correlated with the degree of depression among the elderly (particularly rural persons aged 50–70 and older womens). (2) Elderly persons with sons had no better mental health status than those without sons, thus indicating the inapplicability of the traditional concept of “more sons are equal to more happiness” to the actual mental health situation of the elderly in China today.

Conclusion: Overall, multiple, late, and boy-oriented childbearing and overly long childbearing periods had negative effects on mental health among Chinese elderly persons. This study tested the applicability of existing theoretical inferences and empirical conclusions in China, thereby further expanding the current literature regarding the effects of fertility behaviors on depression among the elderly.

Fertility Behavior and Depression Among Women: Evidence From China

Using data from the China Labor-Force Dynamic Survey, this study employed logistic regressions to investigate the association between fertility behavior and depression among Chinese women. The empirical results show that in China, women having children were significantly less likely to have depressive symptoms (OR = 0.651) compared to childless women. We also found a U-shaped relationship between fertility levels and depression in women. The results were robust to using the propensity score matching approach to address the sample selection problem. Further, our heterogeneity analysis demonstrated that the negative relationship between fertility level and depression was more significant among women who were in their 30s, lived in urban areas, and lived in high-income households. Compared to having male children (boys) (OR = 0.874), having female children (girls) (OR = 0.795) was more significantly associated with fewer depressive symptoms among women. In the meantime, we did not find a significant relationship between the childbearing period and depression. The paper discussed possible reasons for our findings and policy implications from the perspectives of the government, society, and family.

Race Differences in Linking Family Formation Transitions to Women's Mortality

We examine how the timing and sequencing of first marriage and childbirth are related to mortality for a cohort of 4,988 white and black women born between 1922 and 1937 from the National Longitudinal Survey of Mature Women. We use Cox proportional hazard models to estimate race differences in the association between family formation transitions and mortality. Although we find no relationships between marital histories and longevity, we do find that having children, the timing of first birth, and the sequencing of childbirth and marriage are associated with mortality. White women who had children lived longer than those who had none, but the opposite was found for black women. The effects of birth timing also differed by race; delaying first birth to older ages was protective for white women but not black women. These results underscore the importance of social context in the study of life course transitions.

Reproductive Investment and Health Costs in Roma Women

In this paper, we examine whether variation in reproductive investment affects the health of Roma women using a dataset collected through original anthropological fieldwork among Roma women in Serbia. Data were collected in 2014–2016 in several Roma semi-urban settlements in central Serbia. The sample consisted of 468 Roma women, averaging 44 years of age. We collected demographic data (age, school levels, socioeconomic status), risk behaviors (smoking and alcohol consumption), marital status, and reproductive history variables (the timing of reproduction, the intensity of reproduction, reproductive effort and investment after birth), in addition to self-reported health, height, and weight. Data analyses showed that somatic, short-term costs of reproduction were revealed in this population, while evolutionary, long-term costs were unobservable—contrariwise, Roma women in poor health contributed more to the gene pool of the next generation than their healthy counterparts. Our findings appear to be consistent with simple trade-off models that suggest inverse relationships between reproductive effort and health. Thus, personal sacrifice—poor health as an outcome—seems crucial for greater reproductive success.

Female fertility history and mid-late-life health: Findings from China

China's middle-aged and older women suffer from poorer health than men. Using national baseline data from the China Health and Retirement Longitudinal Study (CHARLS), a survey conducted from 2011 to 2012, this article applies logistic models to investigate the association between female fertility history (parity, early childbearing, late childbearing) and middle-aged and late-life health. We find that parity is related to the mid-late-life health of women. Women with four children or more are more likely to suffer from activities of daily living (ADL) impairment and poorer self-rated health than those with one to three children. Early childbearing is associated with ADL impairment; however, the correlation is mediated by socioeconomic status. Early childbearing is related to self-rated health in later life by an indirect-only mediation effect via educational attainment and personal income.

Experiences of african american parents following perinatal or pediatric death: a literature review

A child's death is one of life's most difficult experiences. Little is known about the unique factors that influence the grief experience for bereaved African American parents. Through an integrative review of 10 publications, the authors describe the grief responses, outcomes, and implications for African American parents who experience the death of a child. Four themes emerged: (a) emotional response to loss; (b) factors that added to the burden of loss; (c) coping strategies; and (d) health consequences of grief. Healthcare providers, administrators, and policymakers should be sensitive to the unique needs of African American parents following a child's death.

Conversations, coping, & connectedness: a qualitative study of women who have experienced involuntary pregnancy loss

The purpose of this qualitative study was to describe processes and strategies used by women to cope after pregnancy loss. Twenty women with a history of involuntary pregnancy loss were interviewed. All of the women were in the last month of a subsequent pregnancy, married or partnered, and most were EuroAmerican or Asian American and had completed college. Taped interviews, fieldnotes, and analytical notes were transcribed then subsequently coded and developed in individual or team sessions. Construction and confirmation of the categories and related themes derived from the data was a collaborative process. Three themes were revealed that described the coping behaviors used by the women: being myself, connecting with others, and avoiding and pretending. The core concept of connectedness and coping after involuntary pregnancy loss was further validated in this study. The purpose of this study was to describe processes and strategies that facilitate coping for 20 women, pregnant subsequent to an involuntary pregnancy loss (IPL). Involuntary pregnancy loss (IPL) refers to miscarriages, ectopic pregnancies, fetal deaths, and stillbirths (Van & Meleis, 2003). This current study was designed to replicate two prior qualitative studies, with African-American women, by the author (Patterson, 2000; Van, 2001). Based on the author's previous work, a theoretical framework entitled "A Model of Living with Grief after Pregnancy Loss" was constructed (Patterson, 2000). For the current study, a more diverse sample was used to potentially expand the applicability of the Model of Living with Grief after Pregnancy Loss to women who are of races other than African American.

Childbearing history and late-life mortality: the Dubbo study of Australian elderly

OBJECTIVE

to examine the association of parity with mortality in later life.

DESIGN

a longitudinal, community-based study.

SETTING

semi-rural town of Dubbo, NSW, Australia.

SUBJECTS

a total of 1,571 women and 1,233 men 60 years and older first examined in 1988-89.

OUTCOME MEASURES

all-cause and cause-specific mortality rates analysed over 16-year follow-up. Hazard ratios obtained from proportional hazards models employing conventional predictors, potential confounders and measure of parity.

RESULTS

increasing parity in women was weakly associated with overweight, diabetes and hypertension. All-cause mortality fell progressively with increasing parity in women (hazard ratio and 95% confidence intervals): childless, 1.00; 1 child, 1.03 (0.75-1.43); 2 children, 0.83 (0.61-1.11); 3 children, 0.80 (0.60-1.08); 4 children, 0.91 (0.66-1.25); 5 children, 0.70 (0.49-1.01); 6+ children, 0.60 (0.43-0.85) (trend for parity P<0.002). This result was similar whether or not hypertension, diabetes and overweight were included in multivariate models adjusting for social variables and other confounders. The reduction in all-cause mortality was accompanied by a parallel reduction in deaths from cancer and respiratory conditions, while coronary heart disease mortality increased 60-111% in all parous women.

CONCLUSION

there was increased all-cause mortality in later life in childless women, accompanied by reduced mortality as parity increased. Underlying mechanisms are unclear but findings may have public health importance.

Racial differences in depression trajectories among older women: socioeconomic, family, and health influences

Despite recent increases in life course research on mental illness, important questions remain about the social patterning of, and explanations for, depression trajectories among women in later life. The authors investigate competing theoretical frameworks for the age patterning of depressive symptoms and the physical health, socioeconomic, and family mechanisms differentiating black and white women. Using data from the National Longitudinal Survey of Mature Women, the authors use linear mixed (growth curve) models to estimate trajectories of distress for women aged 52 to 81 years (N = 3,182). The results demonstrate that: (1) there are persistently higher levels of depressive symptoms among black women relative to white women throughout later life; (2) physical health and socioeconomic status account for much of the racial gap in depressive symptoms; and (3) marital status moderates race differences in distress. The findings highlight the importance of physical health, family, and socioeconomic status in racial disparities in mental health.

Fertility history and quality of life in older women and men

In this paper we examine associations between the fertility histories of older British women and men and their quality of life using data on a sample of 6,374 men and women born between 1923 and 1949 drawn from the British Household Panel Survey (BHPS). Quality of life in 2001 was measured using scores from the four subscales of the CASP-19 questionnaire: control, autonomy, pleasure and self-realisation. Fertility histories were derived using information on the births of children collected in all waves of the BHPS. The aspects of fertility history investigated were number of children born and parents' ages at birth of first and last child. Age, education, marital status, tenure status, smoking, co-residence with one or more children, perceived social support and health limitations were included as covariates. The results suggested that early entry to parenthood and to some extent high parity were related to poorer quality of life. These associations were mostly mediated by socio-economic, social support and health factors. Compared to women with two children, nulliparous women expressed a higher level of autonomy, and both nulliparous women and those with four or more children a higher level of self-realisation. Low parity was related to a lower level of pleasure, especially among men, but this relationship appeared weaker and among women was not significant when background factors were controlled.

Social Ties and Depression: An Intersectional Examination of Black and White Community-Dwelling Older Adults

Aging literature often links social ties to lower depression for older adults; however, research shows inconsistent findings by race and gender. Drawing from an “intersectionality” framework, this article explores whether the relationship between social ties and depression is moderated by race and gender for a nationally representative sample of diverse, community-dwelling older adults (aged 60 and older). Analysis of the most recent wave of the Health and Retirement Study (HRS) indicates that White men, Black men, White women, and Black women differ in terms of the relationship between social ties and depression. Main findings include (a) the overwhelming benefit of marriage and partnership, (b) pronounced differences between Black women’s and White women’s friend and kin ties, and (c) the potential vulnerability of older Black men. Findings highlight the importance of catering community-based elder support toward diverse aging populations. Potential community-based care solutions are discussed.

Age at first birth, parity, and post-reproductive mortality among white and black women in the US, 1982-2002

We investigate the relationship between the timing of first birth, parity, and women's risk of post-reproductive mortality over twenty-one years (1982-2002), among representative samples of black and white women in the United States. Data are taken from the National Longitudinal Survey of Mature Women. We find early childbearing to be associated with higher mortality among whites, while later childbearing is associated with higher mortality among blacks. The effect of age at first birth on white women's mortality is explained by background and mediating social, economic, and health related factors, but this effect remains robust for black women. In addition, childless white women have a higher risk of post-reproductive mortality than those with 2-3 children. High parity (6+ children) has a significant protective effect for blacks, though the effect is reduced with age. A similar protective effect of high parity becomes apparent among whites only after controlling for background and mediating characteristics. Findings are interpreted in light of the weathering hypothesis and from a life course framework that views women's fertility as adaptive to particular social and historical contexts.

Reproductive history, socioeconomic status and disability in the women aged 65 years or older in Turkey

Pregnancy and childbirth are an important physiological and emotional phenomenon in their lives for most women and studies have shown that this process may have a significant impact on their health at later ages. The objective of the study is to examine the relationship between functional disabilities in women over the age of 65 and their reproductive history and socioeconomic status. This is a cross-sectional study. The study group consisted of 543 women aged 65 or over. A general questionnaire and the Brief Disability Questionnaire (BDQ) were used to collect data with face-to-face interview in home visits. Of the women 79.2% have disability. First childbirth was experienced at the average age of 19.6+/-3.3 and the average age at which the women experienced their last delivery was 32.5+/-6.3. Parity was 4.1+/-1.7. Advanced age, being widowed and illiterate, less income, being outside of the middle class and having more than four children are important determinants for later life disability. The study highlights the importance of focusing not just on the short-term effects of childbearing and socioeconomic factors, but also of taking into account the possibility of long-term effects on disability in older women.

The Long-Term Consequences of Childbearing: Physical and Psychological Well-Being of Mothers in Later Life

Growing evidence points to relationships between patterns of childbearing and health outcomes for mothers; yet a need remains to clarify these relationships over the long-term and to understand the underlying mechanisms. Using data from the National Longitudinal Survey of Mature Women (N=1,608), I find that the long-term consequences of childbearing vary by health outcome. Early childbearing is associated with higher risk of ADL limitations at ages 65-83, though effects appear stronger among white than black mothers until SES is controlled. Early childbearing is also associated with greater levels of depressive symptomatology, though this association is mediated by SES and health. Late childbearing is associated with more depressive symptoms net of early life and current SES, child proximity and support, and physical health. Finally, I find no significant effects of high parity. These findings emphasize the need to better understand the mechanisms linking childbearing histories to later physical and psychological well-being.