Adolescent Fertility Attitudes and Childbearing in Early Adulthood

Assessing Parenting Attitudes Among Adolescents Seeking Healthcare with a Brief Pregnancy and Parenting Attitudes Questionnaire

PURPOSE

To use modified Parenthood/Pregnancy Attitude, Timing and How important is pregnancy prevention (PATH) questions to assess parenting attitudes and reproductive desires in adolescents and young adults (AYAs).

METHODS

Between November 2020 and January 2022, we recruited participants 13-22 years old via a convenience sample from an Adolescent Medicine outpatient clinic at an urban children's hospital to participate in a cross-sectional survey. The survey was self-administered on a tablet and was adapted from the original PATH questions.

RESULTS

300 adolescents completed the survey. Median age 17 years, 87.3% identified their assigned sex at birth as female, 43.0% identified as Black, and 55.3% had public insurance. 61.3% reported ever being sexually active. 62.7% reported a desire for future children, 70.2% listed a time frame or specific age when they would like children. Those who had ever had sexual activity were more likely to desire future children. Most participants (68.5%) reported pregnancy prevention was very important or important.

CONCLUSIONS

To our knowledge, this is the first study assessing parenting attitudes and reproductive desires of AYA patients assigned sex female at birth and assigned sex male at birth in a clinical setting. Most AYAs reported they were sexually active, had a desire for future children, had a certain time frame in mind for having children, and would want to prevent pregnancy until that time. Assessing AYA's parenting attitudes and reproductive desires supports the use of shared decision making and the provision of reproductive health counseling aligned with patients' preferences and priorities.

Willingness to bear the first child among the Chinese childless population: a national survey study

BACKGROUND

Having a first child is a contributing factor to having a second or third child; however, current research focuses on second and third children, and the present study aims to investigate the intention to have a first child and its main influencing factors among the childless population aged 15-49 in China, as well as analysing the influencing factors by age group.

METHOD

As part of the 'Survey on the Psychology and Behaviour of Chinese Residents', this survey was conducted on 6941 residents aged 15-49 in 32 provinces across China. The survey was conducted from 20 June to 31 August 2022.

RESULT

Out of 6941 respondents, the mean score of willingness to have a first child (score range: 0-100) was 42.51. 17.33% of the respondents had no willingness to have a child (0), while 9.54% had a high willingness to have a child (100). Intention to have a first child seems to peak in the age group 30-34 years (p < 0.0001). Being male (p < 0.000, OR = 0.178), having siblings (p1 < 0.035, OR1 = 1.324; p2 < 0.000, OR2 = 1.995) and good family communication (p < 0.003, OR = 1.023), and high self-efficacy (p = 0.001, OR = 1.558) were associated with higher fertility intentions. Influential factors in the lower age group (15-24 years) were mainly related to family and social support, in the 25-29 years age group they were more related to personal, family and social, while in the 30-39 years age group they were related to economic stability such as property and marital status.

CONCLUSIONS

The willingness to have a child is at a low to medium level among those of childbearing age who have not had children in China. There is a need to adopt a staggered policy for the younger age group to reduce perceived economic pressure, reduce occupational pressure on the age group, and increase childcare and occupational fertility friendly environments. In addition, there is a need for multisectoral economic compensation and educational district planning to alleviate the "don't want to save" and solve the "don't dare to give birth" problem. People who have had one child are more likely to want to have a second child, so the government and society need to do more to support the desire to have a child, thereby increasing the national fertility rate.

Transgender persons' view on previous fertility decision-making and current infertility: a qualitative study

STUDY QUESTION

How do adult transgender and gender diverse (TGD) people, who are infertile due to prior gender-affirming treatment, view their current infertility and their reproductive decisions made in the past?

SUMMARY ANSWER

In a time where sterilization was mandatory, transgender adolescents prioritized gender-affirming treatment over their future fertility and would make the same choice today despite emotional challenges related to infertility experienced by some.

WHAT IS KNOWN ALREADY

Under transgender law in the Netherlands, sterilization was required for legal gender recognition until 2014, resulting in permanent infertility. The long-term consequences of this iatrogenic infertility in transgender adolescents who have now reached adulthood remain underexplored.

STUDY DESIGN, SIZE, DURATION

Qualitative study design based on 21 in-depth one-on-one semi-structured interviews.

PARTICIPANTS/MATERIALS, SETTING, METHODS

TGD people in a stage of life where family planning may be a current topic were eligible for participation. They all received gender-affirming treatment in adolescence prior to the legislation change in 2014. A purposeful sampling technique was used from participants of another ongoing study. Eleven people assigned female at birth and ten people assigned male at birth were included. Interview transcripts were thematically analysed using a modified version of Braun and Clarke's six steps theory.

MAIN RESULTS AND THE ROLE OF CHANCE

Six main themes were generated: (i) personal considerations regarding fertility and fertility preservation in the past; (ii) external considerations regarding fertility and fertility preservation in the past; (iii) current vision on past considerations and decisions; (iv) Current experiences and coping with infertility; (v) future family building; (vi) advice regarding fertility and fertility preservation decision-making.

LIMITATIONS, REASONS FOR CAUTION

Selection, recall, and choice supportive bias may play a role in interpreting our results.

WIDER IMPLICATIONS OF THE FINDINGS

This study highlights the importance of tailored counselling and comprehensive information on fertility preservation for transgender individuals, especially adolescents, undergoing gender-affirming treatment.

STUDY FUNDING/COMPETING INTEREST(S)

N/A.

TRIAL REGISTRATION NUMBER

N/A.

Associations between factors in childhood and young adulthood and childlessness among women in their 40s: A national prospective cohort study

BACKGROUND

While the risk factors for infertility are well-established, research on factors associated with voluntary childlessness is limited and mainly focused on adulthood factors. Thus, we examined the associations between factors in childhood and young adulthood and different types of childlessness.

METHODS

The analysis included 4653 women from the Australian Longitudinal Study on Women's Health from 1996 to 2021. Childlessness was categorised as: voluntary, due to infertility issues, or due to other reasons. The associations between factors in childhood and young adulthood and childlessness were assessed using multinomial logistic regression models.

RESULTS

In their 40s, 4.8 % of women were voluntarily childless, 6.7 % were childless due to infertility issues, and 7.8 % were childless due to other reasons. Regardless of types of childlessness, being childless was associated with poorer self-rated health during childhood and having been unpartnered and obese in young adulthood. Ex-smokers in young adulthood had lower odds of childlessness. Childhood physical abuse was associated with childlessness due to infertility issues and other reasons. Voluntary childlessness and childlessness due to infertility issues were associated with having identified as non-exclusively heterosexual in early adulthood. Lower social support in early adulthood was associated with voluntary childlessness and childlessness due to other reasons.

LIMITATIONS

The direction of the associations could not be determined and using self-reported data may introduce recall bias.

CONCLUSIONS

Factors in childhood and young adulthood were associated with different types of childlessness, highlighting the importance of adopting a life course perspective when studying childlessness.

Agency and role models: do they matter for adolescent girls' sexual and reproductive health?

Despite recent declines in early childbearing in Ethiopia, improved sexual and reproductive health continues to elude many adolescent girls, partially due to constrained agency and role models. This study examined the relationship between agency, role models and two sexual and reproductive health outcomes, ideal age at childbirth and attitude towards gender-differentiated parental control, among adolescent girls in Ethiopia. Agency and role model presence were positively associated with ideal age at childbirth (β = 0.23, p < .01 and β = 0.77, p < .001, respectively). Having family members, friends or famous individuals as role models was significantly associated with an increase of 1.45 years (p < .01), 1.32 years (p < .05) and 1.01 years (p < .01) in ideal age at childbirth, respectively, compared to having no role model. Agency was positively associated with attitude towards gender-differentiated parental control of adolescent behaviors (OR = 1.18, p < .001). This study highlights the need for interventions aimed at increasing agency and providing role models for adolescent girls.

A Latent Class Analysis: Identifying Pregnancy Intention Classes Among U.S. Adolescents

PURPOSE

Few studies have captured the multidimensionality of pregnancy intentions for adolescents on a national level, particularly missing the perspectives of male adolescents. Therefore, this study aimed to identify and describe pregnancy intention profiles among U.S. adolescents.

METHODS

Latent class analysis was conducted using data from two cycles of the National Survey of Family Growth (2015-2017 and 2017-2019) among U.S. adolescents 15-19 years old (N = 3,812). Stratified by sex, six National Survey of Family Growth indicators around desires, feeling, timing, and social acceptability were included. Multinomial logistic regression was used to identify the correlates of class membership.

RESULTS

Three latent classes of pregnancy intention were identified for each sex, which were distinguished by immediate and future desires, feelings, timing, and social acceptability. For both females and males, Delayed Pro-pregnancy (53% vs. 82%) and Near Pro-pregnancy (28% vs. 8%) were identified. Ambivalent-pregnancy (14%) and Anti-pregnancy (10%) were specific to females and males, respectively. Near Pro-pregnancy females and Anti-pregnancy males were more likely to be sexually active, older, of Hispanic descent, report receiving public assistance, and have a teen mother than adolescents classified as Delayed Pro-pregnancy. Females with a pregnancy history were more likely to be classified as Ambivalent than Delayed Pro-pregnancy.

DISCUSSION

While most adolescents intend to delay or avoid childbearing, there are subsets of adolescents whose pregnancy intentions are in favor of early childbearing, which is often dismissed in adolescent sexual and reproductive health. Current efforts can use these distinct pregnancy intention classes to tailor sexual and reproductive health services specifically for diverse adolescent populations.

Adolescent reproductive attitudes and knowledge effects on early adult unintended and nonmarital fertility across gender

Theory and evidence suggest strong short-term effects of attitudes toward, and knowledge about, reproduction on women's fertility. Adolescent attitudes and knowledge may also have longer-term implications about the contexts women perceive as appropriate for childbearing and their capacity to manage their preferences. Although previous research on men's fertility is limited, theory would suggest the links between adolescent attitudes and knowledge and subsequent fertility would also exist for men (though perhaps in different ways given the gendered meanings of sex, contraception, and reproduction). We analyze the relationship between reproductive attitudes and knowledge in adolescence and unintended and nonmarital first and second births in early adulthood, using the National Longitudinal Study of Adolescent to Adult Health (N = 9,431). Adolescent reproductive attitudes, especially life course consequences of early childbearing, predict the intendedness and marital status of first and second births. Adolescent reproductive knowledge is more often linked to the context of second births than first births. These associations vary by gender, but the overall results suggest that fertility schemas developed during adolescence predict behavior into early adulthood.

Association between socioeconomic status and fertility among adolescents aged 15 to 19: an analysis of the 2013/2014 Zambia Demographic Health Survey (ZDHS)

Background

Adolescents face significant barriers to access and utilization of sexual and reproductive health services in many low-income settings, which in turn may be associated with adverse consequences such as early pregnancy, sexually transmitted infections, unsafe abortion and mortality. There is evidence suggesting that limited access to sexual and reproductive health information and services among adolescents contributes to these outcomes. We aimed to find out the factors that affect the fertility of adolescents aged 15 to 19 years in Zambia and to identify possible drivers of adolescents’ fertility.

Methods

Secondary analysis of the ZDHS 2013/14 data was carried out to find out the factors that affect the fertility rate of adolescents aged 15 to 19 years using multivariate logistic regression (n = 3666).

Results

Overall, 23.1% of adolescents had given birth at least once in the 5 years leading to the survey (n = 3666, 99.4% response), and 49.8% were rural-based while 50.2% were urban-based. The median number of schooling was 8 years (IQR 6–10). About 52% of the adolescents were in the poorer, poor and medium wealth quintiles while the other 48% were in the rich and richer quintiles. Factors found to affect fertility include residence, wealth status, educational attainment, marriage and abortion. An urban-based adolescent with a lower socioeconomic status was 2.4 times more likely to give birth compared to rural-based poorer adolescents (aOR = 2.4, 95% CI: 1.5, 3.7, p < 0.001). Although odds of giving birth were much higher among rural-based married adolescents (aOR = 8.0, 95% CI: 5.4, 11.9, p < 0.001) compared to urban married adolescents (aOR = 5.5, 95% CI: 8.3, 16.0, p < 0.001), and these relationships both statistically significant, higher educational attainment (aOR = 0.7, 95% CI: 0.6, 0.8 p < 0.001) and abortion (aOR = 0.3, 95% CI: 0.1, 0.8, p = 0.020) reduced these odds, particularly for rural-based adolescents.

Conclusion

Despite response aimed at reducing adolescent fertility, low wealth status, low educational attainment and early marriage remain significant drivers of adolescent fertility in Zambia. There is a need to address sexual and reproductive health needs of urban-based adolescents with a lower socioeconomic status.

Adolescents go through serious challenges related to accessing and using sexual and reproductive health services in many low-income settings, and may also be related to negative consequences such as early pregnancy, sexually transmitted infections and unsafe abortion and death. Research has revealed that limited access to sexual and reproductive health information and services among young people contributes to these negative consequences. This analysis aimed to find out the factors that affect the fertility of 3666 adolescents aged 15 to 19 years in Zambia and to identify possible drivers of adolescents’ fertility, using the Zambia Demographic and Health Survey conducted in 2013/2014. A little over a quarter of the adolescents had given birth at least once in the five years leading to the survey. About half of the young people were rural-basedwhile the other half were urban-based, with an average of about 8 years in school. The rural-based adolescents had slightly lower average years in school compared to the urban-based; 7 years and 9 years respectively. Living in a rural area, residing in a home with a low wealth status and being married were all linked to higher chances of giving birth, while terminating a pregnancy and having more years of education were linked to lower chances of giving birth among the adolescents. Urban-based adolescents with lower wealth status were also linked to higher chances of giving birth compared to urban-based adolescents with higher wealth status. These results suggest that while residing in rural areas and being married increase the chances of higher fertility, the adolescents in urban areas but with lower wealth status also need interventions aimed at reducing their fertility.

Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis

INTRODUCTION

In low-and middle-income countries, pregnancy-related complications are major causes of death for young women. This study aimed to determine the prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa.

METHODS

We undertook a secondary analysis of cross-sectional data from Demographic and Health Surveys conducted in 32 sub-Saharan African countries between 2010 and 2018. We calculated the prevalence of first adolescent (aged 15 to 19 years) pregnancy in each country and examined associations between individual and contextual level factors and first adolescent pregnancy.

RESULTS

Among all adolescents, Congo experienced the highest prevalence of first adolescent pregnancy (44.3%) and Rwanda the lowest (7.2%). However, among adolescents who had ever had sex, the prevalence ranged from 36.5% in Rwanda to 75.6% in Chad. The odds of first adolescent pregnancy was higher with increasing age, working, being married/cohabiting, having primary education only, early sexual initiation, knowledge of contraceptives, no unmet need for contraception and poorest wealth quintile. By contrast, adolescents who lived in rural areas and in the West African sub-region had lower odds of first adolescent pregnancy.

CONCLUSION

The prevalence of adolescent pregnancy in sub-Saharan African countries is high. Understanding the predictors of first adolescent pregnancy can facilitate the development of effective social policies such as family planning and comprehensive sex and relationship education in sub-Saharan Africa and can help ensure healthy lives and promotion of well-being for adolescents and their families and communities.

Do Adolescent Sexual and Reproductive Attitudes and Knowledge Predict Men and Women's Adult Sexual Partnerships?

PURPOSE

Adolescence is a key stage for forming knowledge and attitudes about sex and reproduction that may have long-term implications for adult sexual behaviors. Gender differences in experiences and socialization processes may affect the links between adolescent characteristics and adult behaviors.

METHODS

By following adolescent virgins aged 15 years and older from wave I through wave IV of the National Longitudinal Study of Adolescent to Adult Health (n = 4,152), we test whether adolescent boys' and girls' knowledge about, and attitudes toward, sex and reproduction influence the number of lifetime different-sex sexual partners and the likelihood of having concurrent sexual partners in adulthood, using negative binomial regression and logistic regression, respectively. Models are run separately by gender.

RESULTS

Men and women who reported greater physical benefits of sex as adolescents reported more lifetime different-sex sexual partners and were more likely to have concurrent sexual partners in adulthood. For women, adolescent perceptions of more social costs to sex were linked to fewer lifetime sexual partners, whereas greater birth control confidence was linked to more sexual partners. Women who more strongly felt that avoiding sexually transmitted infections was a hassle during adolescence were less likely to have concurrent sexual partners as adults, and men who were more knowledgeable about condoms during adolescence were more likely to have concurrent sexual partners.

CONCLUSIONS

Adolescent knowledge and attitudes about sex, contraception, and reproduction have implications for adult sexual behavior, but different aspects emerge as salient for men and women.

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

OBJECTIVE

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Teen Girls' Reproductive Attitudes and the Timing and Sequencing of Sexual Behaviors

PURPOSE

Teen girls consider not only health outcomes, such as pregnancy or contracting a sexually transmitted infection (STI), but also social outcomes, such as guilt or embarrassment, when making decisions about sexual behaviors.

METHODS

Following a sample of female virgins aged 15-18 years from wave I through wave IV of the National Longitudinal Study of Adolescent to Adult Health (N = 2,376), we tested whether adolescent girls' attitudes toward sex, contraception, pregnancy, and STIs influence the timing of coital debut, using discrete time event history logistic regression, and whether oral sex precedes coital debut, using logistic regression.

RESULTS

Concerns about negative social consequences of sex were associated with later coital debut (adjusted odds ratio [AOR]=.79, p = .000), whereas perceived physical benefits of sex and positive attitudes toward contraception were associated with earlier coital debut (AOR = 1.09, p = .049 and AOR = 1.17, p = .002, respectively). Worries about pregnancy were not associated with the timing of coital debut but did predict having oral sex before vaginal sex (AOR = 1.33, p = .007). Favorable birth control attitudes and positive attitudes toward sex also increased the odds of oral sex before vaginal sex (AOR = 1.38, p = .008 and AOR = 1.47, p = .000, respectively).

CONCLUSIONS

Teen girls' worries about the emotional and social consequences of sex may be a more salient predictor of the timing of coital debut than concerns about the risk of pregnancy or STIs. Teen girls' fears coexist with positive views about sex and contraception, which are associated with earlier sex and sexual sequencing.