Race, Ethnicity, and the Changing Context of Childbearing in the United States

Socioeconomic and Racial/Ethnic Inequalities in Infertility Prevalence, Help-Seeking, and Help Received Since 1995

BACKGROUND

In the United States, infertility and treatment for infertility are marked by racial/ethnic and socioeconomic inequalities. Simultaneously, biomedical advances and increased public health attention toward preventing and addressing infertility have grown. It is not known, however, whether the racial/ethnic and socioeconomic inequalities observed in infertility prevalence, help-seeking, or help received have changed over time.

METHODS

Using National Survey of Family Growth data (1995 through 2017-2019 cycles), this study applied multivariable logistic regression with interaction terms to investigate whether and how racial/ethnic and socioeconomic inequalities in 1) the prevalence of infertility, 2) ever seeking help to become pregnant, and 3) use of common types of medical help (advice, testing, medication for ovulation, surgery for blocked tubes, and artificial insemination) have changed over time.

RESULTS

The results showed persisting, rather than narrowing or increasing, inequalities in the prevalence of infertility and help-seeking overall. The results showed persisting racial/ethnic inequalities in testing, ovulation medication use, and surgery for blocked tubes. By contrast, the results showed widening socioeconomic inequalities in testing and narrowing inequalities in the use of ovulation medications.

CONCLUSIONS

There is little evidence to suggest policy interventions, biomedical advances, or increased public health awareness has narrowed inequalities in infertility prevalence, treatment seeking, or use of specific treatments.

U.S. Fertility in Life Course Context: A Research Note on Using Census-Held Linked Administrative Records for Geographic and Sociodemographic Subgroup Estimation

Fertility is a life course process that is strongly shaped by geographic and sociodemographic subgroup contexts. In the United States, scholars face a choice: they can situate fertility in a life course perspective using panel data, which is typically representative only at the national level; or they can attend to subnational contexts using rate schedules, which do not include information on life course statuses. The method and data source we introduce here, Census-Held Linked Administrative Records for Fertility Estimation (CLAR-FE), permits both. It derives fertility histories and rate schedules from U.S. Census Bureau-held data for the nation and by state, racial and ethnic subgroups, and the important life course status of parity. We generate three types of rates for 2000-2020 at the national and state levels by race and ethnicity: age-specific rates and both unconditional and conditional parity- and age-specific rates. Where possible, we compare these rates with those produced by the National Center for Health Statistics. Our new rate schedules illuminate state and racial and ethnic differences in transitions to parenthood, providing evidence of the important subgroup heterogeneity that characterizes the United States. CLAR-FE covers nearly the entire U.S. population and is available to researchers on approved projects through the Census Bureau's Federal Statistical Research Data Centers.

Mental Health Distress and Delayed Contraception Among Older Adolescents and Young Adults

Background: Symptoms of mental distress increased sharply during the COVID-19 pandemic, especially among older adolescents and young adults. Mental health distress may make it more challenging for young people to seek other needed health care, including contraception. This study explored the association of symptoms of depression, anxiety, and stress with delays in getting a contraceptive method or prescription. Materials and Methods: Data from a supplementary study (May 15, 2020-March 20, 2023) to a cluster randomized trial in 29 sites in Texas and California were used. The diverse study sample included community college students assigned female at birth of ages 18-29 years (n = 1,665 with 7,023 observations over time). We measured the association of depression (CES-D [Center for Epidemiologic Studies Depression Scale]) or anxiety and stress (DASS-21 [Depression Anxiety Stress Scales]) symptoms with delayed contraceptive care-seeking with mixed-effects multivariable regression with random effects for individual and site. We controlled for age and sociodemographic factors important for access to care. Results: Over one-third of participants (35%) reported they delayed getting the contraceptive method they needed. Multivariable regression results showed increased odds of delayed contraceptive care among participants with symptoms of depression (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.27-1.96). Likewise, delays were associated with anxiety and stress symptoms (aOR 1.46, 95% CI 1.17-1.82). Adolescents were more likely to delay seeking contraception than young adults (aOR 1.32, 95% CI 1.07-1.63). Conclusions: Results showed a strong association between mental distress and delayed contraception. Interventions are needed to increase contraceptive access for young people delaying care, along with supportive mental health care services, including for adolescents who face elevated odds of delay. ClinicalTrials.gov Identifier: NCT03519685.

Women's childbearing histories and their alcohol use at midlife

There has been increased alcohol use among mid-life women in recent decades. Given the association between alcohol use and childbearing earlier in life and the centrality of childbearing for other aspects of mid-life women's health, we examined how multiple components of childbearing histories were associated with mid-life alcohol use. Our analysis included 3,826 women from the National Longitudinal Survey of Youth 1979 (NLSY79). We estimated how nine components of childbearing were associated with women's alcohol use at age 50. We investigated these components independently and also created six childbearing profiles using Mixed-Mode Latent Class Analysis (MM-LCA). The most alcohol was consumed by women without any childbirths, with older ages at first birth, with low parity, and with the same or fewer births than expected. Women with older ages at first and last birth and more childbirths were less likely to abstain from alcohol compared to women with younger ages at first and last birth and fewer childbirths. Our MM-LCA demonstrated that women with multiple childbirths over a long period of time consumed the least alcohol compared to other groups. Binge drinking at mid-life was generally not associated with childbearing histories in our models. In summary, childbearing histories mattered for women's drinking behaviors at mid-life. Given that an increasing number of women do not have children, the age at first birth continues to trend older, and parity is decreasing, we may expect mid-life women's alcohol use to continue to increase in line with these observed fertility trends.

Disruption of mitochondrial unfolded protein response results in telomere shortening in mouse oocytes and somatic cells

Caseinolytic peptidase P (CLPP) plays a central role in mitochondrial unfolded protein response (mtUPR) by promoting the breakdown of misfolded proteins and setting in motion a cascade of reactions to re-establish protein homeostasis. Global germline deletion of Clpp in mice results in female infertility and accelerated follicular depletion. Telomeres are tandem repeats of 5'-TTAGGG-3' sequences found at the ends of the chromosomes. Telomeres are essential for maintaining chromosome stability during somatic cell division and their shortening is associated with cellular senescence and aging. In this study, we asked whether the infertility and ovarian aging phenotype caused by global germline deletion of Clpp is associated with somatic aging, and tested telomere length in tissues of young and aging mice. We found that impaired mtUPR caused by the lack of CLPP is associated with accelerated telomere shortening in both oocytes and somatic cells of aging mice. In addition, expression of several genes that maintain telomere integrity was decreased, and double-strand DNA breaks were increased in telomeric regions. Our results highlight how impaired mtUPR can affect telomere integrity and demonstrate a link between loss of mitochondrial protein hemostasis, infertility, and somatic aging.

DNA methylation as a window into female reproductive aging

People with ovaries experience reproductive aging as their reproductive function and system declines. This has significant implications for both fertility and long-term health, with people experiencing an increased risk of cardiometabolic disorders after menopause. Reproductive aging can be assessed through markers of ovarian reserve, response to fertility treatment or molecular biomarkers, including DNA methylation. Changes in DNA methylation with age associate with poorer reproductive outcomes, and epigenome-wide studies can provide insight into genes and pathways involved. DNA methylation-based epigenetic clocks can quantify biological age in reproductive tissues and systemically. This review provides an overview of hallmarks and theories of aging in the context of the reproductive system, and then focuses on studies of DNA methylation in reproductive tissues.

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.

U.S. Breastfeeding Outcomes at the Intersection: Differences in Duration Among Racial and Ethnic Groups With Varying Educational Attainment in a Nationally Representative Sample

BACKGROUND

As breastfeeding rates in the United States increase, barriers persist for Black, Latine, and low-socioeconomic status household dyads when compared to White and high-socioeconomic status household dyads. Previous breastfeeding disparities research has almost exclusively considered the influence of race, ethnicity, and socioeconomic status separately, although these attributes are not randomly distributed across the population.

RESEARCH AIM

To identify breastfeeding duration patterns by race/ethnicity and educational attainment in a nationally representative U.S. National Immunization Survey sample.

METHOD

We conducted a cross-sectional, secondary analysis of the U.S. Centers for Disease Control and Prevention's 2020 National Immunization Survey-Child public-use data. To examine breastfeeding and exclusive breastfeeding durations at the intersection of race/ethnicity and educational attainment, we created a 12-item, cross-classified variable using three educational attainment groups and four race/ethnicity groups. We used linear regressions to test these associations.

RESULTS

In all, 83% of the sample breastfed. Mean durations of breastfeeding were 7.5 (SE = 1.95) months and exclusive breastfeeding duration was 4.9 (SE = 0.87) months. In adjusted models, multi-race/other high-educational attainment participants had the longest breastfeeding duration by almost 3 weeks (β: 19.53, 95% CI [5.27, 33.79]), and Black low-educational attainment participants exclusively breastfed for 1 month less than White high-educational attainment participants (β:-30.23, 95% CI [-40.87, -19.58]).

CONCLUSIONS

Examining race/ethnicity and educational attainment together provides an intersectional understanding of breastfeeding outcomes and can inform targeted, culturally appropriate interventions.

Parental sociodemographics of medically assisted reproduction births in the United States: a dyadic population-level study

Objective

To study how men's and couples' sociodemographic characteristics predict the probability of having a birth conceived using medically assisted reproduction (MAR) in the United States.

Design

Population-based study.

Setting

Not applicable.

Patients

Men and women in the National Vital Statistics Birth certificate data from 2009 to 2019.

Intervention

None.

Main Outcome Measures

Proportion of MAR births out of total births by parental sociodemographic categories and probability of having a MAR birth.

Results

Between 2009 and 2019, the overall prevalence of MAR births among men was 1.81%. Fathers of children conceived using MAR tended to be older, higher educated, and white compared with fathers of naturally conceived children. During the period of 2009-2019, these sociodemographic profiles remained largely unchanged. Controlling for maternal age and birth order only partially reduced disparities by education and race. In 2019, highly educated fathers were 2.04 percentage points (95% confidence interval, 1.97-2.12) more likely to have a MAR-conceived birth than fathers with a low educational level, and black fathers were associated with a reduction in the probability of having an MAR-conceived child by - 1.07 percentage points (95% confidence interval, -1.11 to -1.04) compared with white fathers. The dyadic analysis using parents' education and race interactions revealed that partnering with someone of a higher educational level increases the likelihood of having a MAR birth, beyond what would be observed by considering only individual-level characteristics.

Conclusions

To comprehend the environment in which MAR-conceived children are born and raised, performing dyadic analyses that examine the characteristics of both partners is essential. The findings underscore the enduring presence of substantial social disparities in MAR use in the United States, with MAR-conceived children raised in environments of relative advantage, which may impact their future health and development.

State-specific fertility rate changes across the USA following the first two waves of COVID-19

STUDY QUESTION

How did the first two coronavirus disease 2019 (COVID-19) waves affect fertility rates in the USA?

SUMMARY ANSWER

States differed widely in how their fertility rates changed following the COVID-19 outbreak and these changes were influenced more by state-level economic, racial, political, and social factors than by COVID-19 wave severity.

WHAT IS KNOWN ALREADY

The outbreak of the COVID-19 pandemic contributed to already declining fertility rates in the USA, but not equally across states. Identifying drivers of differential changes in fertility rates can help explain variations in demographic shifts across states in the USA and motivate policies that support families in general, not only during crises.

STUDY DESIGN, SIZE, DURATION

This is an ecological study using state-level data from 50 US states and the District of Columbia (n = 51). The study period extends from 2020 to 2021 with historical data from 2016 to 2019. We identified Wave 1 as the first apex for each state after February 2020 and Wave 2 as the second apex, during Fall/Winter 2020-2021.

PARTICIPANTS/MATERIALS, SETTING, METHODS

State-level COVID-19 wave severity, defined as case acceleration during each 3-month COVID-19 wave (cases/100 000 population/month), was derived from 7-day weekly moving average COVID-19 case rates from the US Centers for Disease Control and Prevention (CDC). State-level fertility rate changes (change in average monthly fertility rate/100 000 women of reproductive age (WRA)/year) were derived from the CDC Bureau of Vital Statistics and from 2020 US Census and University of Virginia 2021 population estimates 9 months after each COVID-19 wave. We performed univariate analyses to describe national and state-level fertility rate changes following each wave, and simple and multivariable linear regression analyses to assess the relation of COVID-19 wave severity and other state-level characteristics with fertility rate changes.

MAIN RESULTS AND THE ROLE OF CHANCE

Nationwide, fertility dropped by 17.5 births/month/100 000 WRA/year following Wave 1 and 9.2 births/month/100 000 WRA/year following Wave 2. The declines following Wave 1 were largest among majority-Democrat, more non-White states where people practiced greater social distancing. Greater COVID-19 wave severity was associated with steeper fertility rate decline post-Wave 1 in simple regression, but the association was attenuated when adjusted for other covariates. Adjusting for the economic impact of the pandemic (hypothesized mediator) also attenuated the effect. There was no relation between COVID-19 wave severity and fertility rate change following Wave 2.

LIMITATIONS, REASONS FOR CAUTION

Our study harnesses state-level data so individual-level conclusions cannot be inferred. There may be residual confounding in our multivariable regression and we were underpowered to detect some effects.

WIDER IMPLICATIONS OF THE FINDINGS

The COVID-19 pandemic initially impacted the national fertility rate but, overall, the fertility rate rebounded to the pre-pandemic level following Wave 2. Consistent with prior literature, COVID-19 wave severity did not appear to predict fertility rate change. Economic, racial, political, and social factors influenced state-specific fertility rates during the pandemic more than the severity of the outbreak alone. Future studies in other countries should also consider whether these factors account for internal heterogeneity when examining the impact of the COVID-19 pandemic and other crises on fertility.

STUDY FUNDING/COMPETING INTEREST(S)

L.G.K. received funding from the National Institute of Environmental Health Sciences (R00ES030403), M.C. from the National Science Foundation Graduate Research Fellowship Program (20-A0-00-1005789), and M.L. and E.S. from the National Institute of Environmental Health Sciences (R01ES032808). None of the authors have competing interests.

TRIAL REGISTRATION NUMBER

N/A.

Birth Spacing and Child Maltreatment: Population-Level Estimates for North Carolina

We examine population-level associations between birth spacing and child maltreatment using birth records and child welfare records for 1,099,230 second or higher parity children born in North Carolina between 1997 and 2013. Building upon previous research, administrative data linkages were used to address out-of-state migration and family-level heterogeneity in birth spacing and child maltreatment risk factors. Findings provide the strongest evidence to date that very short birth spacing of zero through 6 months from last birth to the index child's conception is a prenatal predictor of child maltreatment (indexed as child welfare involvement) throughout early childhood. Consequently, information about optimal family planning during the postpartum period should become a standard component of universal and targeted child maltreatment prevention programs. However, challenging previous empirical evidence, this study reports inconsistent results for benefits of additional spacing delay beyond 6 months with regard to child maltreatment risk reduction, especially for children of racial and ethnic minorities. These findings call for further inquiry about the mechanisms driving the connections between birth spacing and Child Protective Services assessments.

Under Different Roofs? Coresidence With Adult Children and Parents' Mental Health Across Race and Ethnicity Over Two Decades

Many U.S. parents share a household with an adult child in later life. However, the reasons parents and adult children coreside may vary over time and across family race/ethnicity, shaping relationships with parents' mental health. Using the Health and Retirement Study, this study investigates the determinants and mental health correlates of coresidence with adult children from 1998 to 2018 among White, Black, and Hispanic parents under age 65 and aged 65+. Findings show that the predictors of coresidence shifted with increasing odds that parents lived with an adult child, and several varied by parents' age group and race/ethnicity. Compared with White parents, Black and Hispanic parents were more likely to live with adult children, especially at older ages, and to indicate that they helped their children with household finances or functional limitations. Living with adult children was associated with higher depressive symptoms among White parents, and mental health was negatively related to living with adult children who were not working or were helping parents with functional limitations. The findings highlight increasing diversity among adult child-coresident parents and underscore persistent differences in the predictors and meaning of coresidence with adult children across race/ethnicity.

The interplay of race/ethnicity and education in fertility patterns

This study examines the interplay between race/ethnicity and educational attainment in shaping completed fertility in the United States for women born 1961-80. Using data from the National Survey of Family Growth, 2006-17, we apply multilevel, multiprocess hazard models to account for unobserved heterogeneity and to estimate (1) cohort total fertility rates, (2) parity progression ratios, and (3) parity-specific fertility timing, for non-Hispanic white, non-Hispanic Black, and Hispanic women by educational attainment. We find that compared with their white counterparts, fertility was higher among Black and Hispanic women with less than high school education. However, among college-educated women, fertility levels were lowest among Black women and highest among Hispanic women. The difference in fertility between college-educated Black and white women is driven mainly by the smaller proportion of Black mothers having second births. We find little evidence that the observed racial/ethnic disparities in fertility levels by educational attainment are driven by differences in fertility timing.

Group Normative Propensities, Societal Positioning, and Childbearing: Ethno‑linguistic Variation in Completed and Desired Fertility in Transitional Central Asia

Considerable research in western, low-fertility contexts has examined minority-vs.-majority fertility differentials, typically focusing on minority groups' cultural idiosyncrasies and on socioeconomic disadvantages associated with minority status. However, the formation and functioning of ethnic complexities outside the western world often diverge from the standard western model and so may their impact on fertility preferences, behavior, and outcomes. We expand on the previous research by analyzing ethnic variation in completed and desired fertility in the multiethnic transitional setting of Kyrgyzstan, where ethnic groups and their ethnolinguistic subparts are characterized by both different stages of the demographic transition and different positioning in the socioeconomic and political hierarchies. Using combined data from two rounds of a nationally representative survey, we find that ethnic-specific levels of completed fertility generally align with culturally shaped group-level normative propensities. In contrast, in desires to have a(nother) child, the ranking of the ethnic segments is more reflective of their collective societal positioning, with more disadvantaged segments having lower fertility desires, regardless of actual number of children and various other characteristics. We also find that ethnic homophily of respondents' social milieu and their optimism about the future of their ethnic group are positively associated with fertility desires, even though these associations are more potently present among women, compared to men. We relate our findings to the extant scholarship and reflect on their implications for a better understanding of ethno-racial fertility dynamics and differentials in transitional contexts.

How diverse are the samples used to study intimate relationships? A systematic review

The social and behavioral sciences have long suffered from a lack of diversity in the samples used to study a broad array of phenomena. In an attempt to move toward a more contextually-informed approach, multiple subfields have undertaken meta-science studies of the diversity and inclusion of underrepresented groups in their body of literature. The current study is a systematic review of the field of relationship science aimed at examining the state of diversity and inclusion in this field. Relationship-focused papers published in five top relationship science journals from 2014-2018 (N = 559 articles, containing 771 unique studies) were reviewed. Studies were coded for research methods (e.g., sample source, dyadic data, observational data, experimental design) and sample characteristics (e.g., age, education, income, race/ethnicity, sexual orientation). Results indicate that the modal participant in a study of romantic relationships is 30 years old, White, American, middle-class, college educated, and involved in a different-sex, same-race relationship. Additionally, only 74 studies (10%) focused on traditionally underrepresented groups (i.e., non-White, low-income, and/or sexual and gender minorities). Findings underscore the need for greater inclusion of underrepresented groups to ensure the validity and credibility of relationship science. We conclude with general recommendations for the field.

Does a Rising Median Income Lift All Birth Weights? County Median Income Changes and Low Birth Weight Rates Among Births to Black and White Mothers

Policy Points Policies that increase county income levels, particularly for middle-income households, may reduce low birth weight rates and shrink disparities between Black and White infants. Given the role of aggregate maternal characteristics in predicting low birth weight rates, policies that increase human capital investments (e.g., funding for higher education, job training) could lead to higher income levels while improving population birth outcomes. The association between county income levels and racial disparities in low birth weight is independent of disparities in maternal risks, and thus a broad set of policies aimed at increasing income levels (e.g., income supplements, labor protections) may be warranted.

CONTEXT

Low birth weight (LBW; <2,500 grams) and infant mortality rates vary among place and racial group in the United States, with economic resources being a likely fundamental contributor to these disparities. The goals of this study were to examine time-varying county median income as a predictor of LBW rates and Black-White LBW disparities and to test county prevalence and racial disparities in maternal sociodemographic and health risk factors as mediators.

METHODS

Using national birth records for 1992-2014 from the National Center for Health Statistics, a total of approximately 27.4 million singleton births to non-Hispanic Black and White mothers were included. Data were aggregated in three-year county-period observations for 868 US counties meeting eligibility requirements (n = 3,723 observations). Sociodemographic factors included rates of low maternal education, nonmarital childbearing, teenage pregnancy, and advanced-age pregnancy; and health factors included rates of smoking during pregnancy and inadequate prenatal care. Among other covariates, linear models included county and period fixed effects and unemployment, poverty, and income inequality.

FINDINGS

An increase of $10,000 in county median income was associated with 0.34 fewer LBW cases per 100 live births and smaller Black-White LBW disparities of 0.58 per 100 births. Time-varying county rates of maternal sociodemographic and health risks mediated the association between median income and LBW, accounting for 65% and 25% of this estimate, respectively, but racial disparities in risk factors did not mediate the income association with Black-White LBW disparities. Similarly, county median income was associated with very low birth weight rates and related Black-White disparities.

CONCLUSIONS

Efforts to increase income levels-for example, through investing in human capital, enacting labor union protections, or attracting well-paying employment-have broad potential to influence population reproductive health. Higher income levels may reduce LBW rates and lead to more equitable outcomes between Black and White mothers.

Nativity differentials in first births in the United States: Patterns by race and ethnicity

BACKGROUND

While recent decades have seen gradual convergence in ethno-racial disparities in completed fertility in the United States, differences in the age pattern of first births remain. The role of nativity has not been fully understood.

OBJECTIVE

This paper examines how first births vary by nativity, and how this variation contributes to more significant racial and ethnic differentials.

METHODS

Using data from the National Survey of Family Growth (1997-2017), we jointly estimate the correlates of the timing of first births and childlessness. We assess differences between immigrants and US-born and child-migrant women across ethno-racial groups.

RESULTS

The unique first-birth patterns among foreign-born women have a notable impact on Hispanics, reducing differences from Whites in the average age at first birth and contributing to more significant differentials in childlessness. The impact of immigrant women on White and Black first births is more modest in scope.

CONTRIBUTION

Our work shows the importance of nativity for ethnic/racial disparities in the timing and quantum of fertility in the United States. We demonstrate how the migrant population is more determinant for Hispanic fertility patterns than for Black or White. We conclude by elaborating on the implications of these results for future research as the immigrant population in the United States becomes ethnically and racially more diverse.

Multiple Perspectives on Recent Trends in Unwanted Fertility in Low- and Middle-Income Countries

The last four decades have witnessed large declines in fertility globally. This study uses data from 78 low- and middle-income countries to examine concurrent trends in unwanted fertility. Three measures of unwanted fertility are contrasted: the conventional unwanted total fertility rate, a proposed conditional unwanted fertility rate, and the percentage of births unwanted. Incidence of unwanted births and prevalence of exposure to unwanted births are both derived from answers to questions on prospective fertility preference, recognized as the most valid and reliable survey measure of preferences. Country-level trends are modeled both historically and with the decline in total fertility, with a focus on regional differentials. Results show that unwanted fertility rates-especially the conditional unwanted fertility rate-have declined substantially in recent decades. By contrast, the percentage of births unwanted has declined less, remaining stable or even increasing: from a birth cohort perspective, declines in unwanted fertility have been far more modest than the increased parental success in avoiding unwanted births. The regional patterns suggest that sub-Saharan Africa has several similarities with other major regions but also some peculiar features, including a recent stall in the decline of unwanted fertility that persists after controlling for the stage of fertility transition.

The Social Significance of Interracial Cohabitation: Inferences Based on Fertility Behavior

Interracial couples cohabit at higher rates than same-race couples, which is attributed to lower barriers to interracial cohabitation relative to intermarriage. This begs the question of whether the significance of cohabitation differs between interracial and same-race couples. Using data from the 2006-2017 National Survey of Family Growth, we assessed the meaning of interracial cohabitation by comparing the pregnancy risk, pregnancy intentions, and union transitions following a pregnancy among women in interracial and same-race cohabitations. The pregnancy and union transition behaviors of women in White-Black cohabitations resembled those of Black women in same-race cohabitations, suggesting that White-Black cohabitation serves as a substitute to marriage and reflecting barriers to the formation of White-Black intermarriages. The behaviors of women in White-Hispanic cohabitations fell between those of their same-race counterparts or resembled those of White women in same-race cohabitations. These findings suggest that White-Hispanic cohabitations take on a meaning between trial marriage and substitute to marriage and support views that Hispanics with White partners are a more assimilated group than Hispanics in same-race unions. Results for pregnancy intentions deviated from these patterns. Women in White-Black cohabitations were less likely than Black women in same-race cohabitations to have an unintended pregnancy, suggesting that White-Black cohabitations are considered marriage-like unions involving children. Women in White-Hispanic cohabitations were more likely than White and Hispanic women in same-race cohabitations to have an unintended pregnancy, reflecting possible concerns about social discrimination. These findings indicate heterogeneity in the significance of interracial cohabitation and continuing obstacles to interracial unions.

Gender and race differences in pathways out of in-work poverty in the US

Research on in-work poverty has focused on the probability of being employed while living in an impoverished household, but no studies have investigated pathways of labor market attachment and economic vulnerability following in-work poverty. We use the Panel Study of Income Dynamics (PSID) to establish a typology of employment pathways out of in-work poverty and to estimate differences by gender and race. By using the Sequence Analysis Multistate Model procedure, we identify five distinct pathways characterized by varying degrees of labor market attachment, economic vulnerability, and volatility. White men are most likely exit in-work poverty into stable employment outside of poverty, while Black men and women often experience recurrent spells of in-work poverty. Gender and race differences persist even after controlling for labor market and family demographic characteristics. Our results indicate that work-related anti-poverty strategies must be coupled with adequately high wages and employment protection legislation to effectively raise working households out of poverty.

Factors associated with condom and contraceptive use among currently and formerly homeless young adults: Does housing matter?

BACKGROUND

Young adults that experience homelessness (YAEH) are at heightened risk of unplanned pregnancy and contracting STIs, including HIV than their housed counterparts. It is unclear how exiting homelessness into Supportive Housing (SH), the most prominent intervention in homelessness, may shape sexual risk-taking.

OBJECTIVE

The goal of this study is to explore associations of condom and contraception use with particular interest in the role of partner type (i.e., casual and/or serious) and housing status.

METHODS

This study includes 143 sexually active YAEH (ages 18-27) who reported engaging in vaginal sex during the past three months: 67 "unhoused" (i.e., street-based, couch-surfers, or staying in emergency shelter), and 76 "housed" from SH programs. Multiple logistic regression examined the relationship of housing status and partner type with condom and contraceptive use.

RESULTS

Being a parent was associated with higher odds of contraceptive use regardless of housing status, while partner type (i.e., serious or casual partner) was differently associated with condom use by housing status.

DISCUSSION

Despite documented differences in condom-using behaviors by housing status, findings revealed similar patterns in contraceptive use between the two groups, indicating a possible need for enhanced and targeted service planning for YAEH, particularly among those transitioning to and residing in SH, regarding contraceptive use and prevention.

Cardiovascular Health at the Intersection of Race and Gender: Identifying Life-Course Processes to Reduce Health Disparities

OBJECTIVES

Cardiovascular health (CVH) is associated with reductions in age-related disease and later-life mortality. Black adults, particularly Black women, are less likely to achieve ideal CVH. Guided by intersectionality and life-course approaches, we examine to what degree (a) disparities in CVH exist at the intersection of race and gender and (b) CVH disparities would be reduced if marginalized groups had the same levels of resources and adversities as privileged groups.

METHODS

We used biomarker subsamples from the Midlife in the United States Core and Refresher studies (N = 1,948). Causal decomposition analysis was implemented to test hypothetical interventions to equalize the distribution of early-life adversities (ELAs), perceived discrimination, or midlife socioeconomic status (SES) between marginalized and privileged groups. We conducted sensitivity analyses to determine to what degree unmeasured confounders would invalidate our findings.

RESULTS

White women have the highest CVH score, followed by White men, Black men, and Black women. Intervening on ELAs would reduce the disparities: White men versus Black women (30% reduction) and White women versus Black women (15%). Intervening on perceived discrimination would not substantially change initial disparities. Intervening on midlife SES would yield large disparity reductions: White men versus Black men (64%), White men versus Black women (60%), and White women versus Black women (27%). These reductions are robust to unmeasured confounders.

DISCUSSION

Providing economic security in adulthood for Blacks may help reduce racial disparities in CVH. Preventing exposure to ELAs among Black women may reduce their vulnerability to cardiovascular disease, compared to White adults.

Variation in Self-Perceived Fecundity among Young Adult U.S. Women

BACKGROUND

Individuals' perceptions of their fecundity, or biological ability to bear children, have important implications for health behaviors, including infertility help-seeking and contraceptive use. Little research has examined these perceptions among U.S. women.

METHODS

This cross-sectional study examines perceptions of one's own fecundity among U.S. women aged 24 to 32 who participated in the 2009-2011 rounds of the National Longitudinal Survey of Youth (1997) cohort. Analyses were limited to 3,088 women who indicated that they or their partners never received a doctor's diagnosis regarding fertility difficulties.

RESULTS

Of the women in the sample, 67% perceived their hypothetical chances of becoming pregnant as very likely; the remainder perceived their chances as somewhat likely (13%), not as likely (15%), or provided a "don't know" response (6%). Twenty-six percent of Black women and 19% of Latina women perceived themselves as not very likely to become pregnant, compared with only 12% among non-Black/non-Latina women (p < .001). Only 6% of women with a college degree perceived their chances of becoming pregnant as not very likely, compared with 36% among women without a high school degree (p < .001). Racial/ethnic and educational differences persisted in fully adjusted models. Other factors associated with fecundity self-perceptions include partnership status, parity, fertility expectations, sexual activity, prolonged exposure to unprotected intercourse for at least 6 and/or 12 months without becoming pregnant, and self-rated health.

CONCLUSIONS

Findings indicate that self-perceived fecundity differs systematically by demographic and other characteristics. This phenomenon should be investigated further to understand how it may influence disparities in health behaviors and outcomes.

A Research Note on the Convergence of Childlessness Rates Between Women with Secondary and Tertiary Education in the United States

A gap in childlessness rates between women with and without tertiary education in low-fertility settings has been well documented by scholars. However, in the United States, high rates of childlessness are declining for women with tertiary education. Will this current trend lead to a closing of the gap in childlessness across educational subgroups in this country? We answer this question using data from the Current Population Survey from 1976 through 2018. We present population-level trends in permanent childlessness by level of education and estimate the differences in the prevalence of childlessness across educational subgroups. Our findings indicate that the rates of childlessness for women aged 40-44 with tertiary education in the United States are the lowest they have been in over three decades and that rates of childlessness are converging among women with secondary and tertiary education. The declines in childlessness rates and the convergence in childlessness rates between women with secondary and tertiary education are observed for all of the three largest race/ethnicity sub-populations of American women: non-Hispanic white, non-Hispanic black, and Hispanic women. This report contributes to the emerging literature on the convergence of childlessness rates across sub-populations of women with different levels of educational attainment, which questions the well-established observation that there is a positive relationship between education and childlessness.

Historical Trends in Children Living in Multigenerational Households in the United States: 1870-2018

Over the last two decades, the share of U.S. children under age 18 who live in a multigenerational household (with a grandparent and parent) has increased dramatically. Yet we do not know whether this increase is a recent phenomenon or a return to earlier levels of coresidence. Using data from the decennial census from 1870 to 2010 and the 2018 American Community Survey, we examine historical trends in children's multigenerational living arrangements, differences by race/ethnicity and education, and factors that explain the observed trends. We find that in 2018, 10% of U.S. children lived in a multigenerational household, a return to levels last observed in 1950. The current increase in multigenerational households began in 1980, when only 5% of children lived in such a household. Few differences in the prevalence of multigenerational coresidence by race/ethnicity or education existed in the early part of the twentieth century; racial/ethnic and education differences in coresidence are a more recent phenomena. Decomposition analyses do little to explain the decline in coresidence between 1940 and 1980, suggesting that unmeasured factors explain the decrease. Declines in marriage and in the share of White children most strongly explained the increase in multigenerational coresidence between 1980 and 2018. For White children with highly educated parents, factors explaining the increase in coresidence differ from other groups. Our findings suggest that the links between race/ethnicity and socioeconomic status and multigenerational coresidence have changed over time, and today the link between parental education and coresidence varies within racial/ethnic groups.

Individual and Environmental Predictors of Age of First Intercourse and Number of Children by Age 27

Reproductive behavior characteristics may be influenced by both social and individual factors. Recent studies have revealed that personality traits might be related to reproductive characteristics in adulthood. Little is known about potential mediators or moderators of relations between personality and reproductive behavior. The present study examines the relation between personality traits measured in early adolescence and the number of children people have by age 27, with an attempt to identify moderation and mediation effects. We used data from the longitudinal cohort (N = 585) collected as a part of the Child Development Project. Personality was measured with the use of Lanthier's Big Five Personality Questionnaire. Results from regression analyses and structural equation models showed that four of the five personality traits (except extraversion) were related to the number of children individuals had by age 27, and these associations were mediated by the age of first intercourse and participants' familial and educational plans. We also identified moderation effects of IQ and SES both on the associations of personality traits with mediators and the number of children by age 27.

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.

The Demography of Families: A Review of Patterns and Change

The authors review demographic trends and research on families in the United States, with a special focus on the past decade. They consider the following several topics: (a) marriage and remarriage, (b) divorce, (c) cohabitation, (d) fertility, (e) same-gender unions, (f) immigrant families, and (g) children's living arrangements. Throughout, the authors review both overall trends and patterns as well as those by social class and race-ethnicity. The authors discuss major strands of recent research, emphasizing emerging themes and promising directions. They close with a summary of central patterns and trends and conclude that recent trends are not as uniform as they tended to be in earlier decades, making the description of family change increasingly complex.

Unfit by Accident: Third-Party Perception of Parental Fitness Based on Childbearing Intention

Prior research has examined the impact of unintended birth on parent and child welfare. The present studies examine another potential consequence: namely, how third-party observers react to information about parenthood intention. We examine whether the act of having intended (or not) to become a parent affects people’s impressions of (1) what type of caregiver the (un)intended parent will be, (2) the type of relationship the (un)intended parent will have with the child, and (3) potential outcomes for that family. Studies 1 and 2 demonstrate that people award less custody to accidental mothers and fathers because lack of intention during birth is perceived as decreasing parental quality and closeness between parent and child. Study 3 tests potential moderators of this effect including parenthood status and controllability, highlighting the potential negative consequences of this phenomenon for families in child custody disputes where third-party judgments are especially likely to bear weight.

Exploring Experiences with Sterilization among Nulliparous Women

Although nulliparous women who are sterilized appear voluntarily "childfree," the majority report non-contraceptive reasons for their surgical procedure. Using an analytical subsample of the National Survey of Fertility Barriers, we examined 105 women's closed- and open-ended responses about the reasons for their sterilization surgeries and whether their sterilization occurred before their childbearing desires were met. We found considerable heterogeneity in the experiences and attitudes of participants. We highlight important implications of women's experiences for fertility and reproductive health research and practice, particularly by drawing a distinction between voluntarily childfree and involuntarily childless women.

The Intergenerational Transmission of Discrimination: Children's Experiences of Unfair Treatment and Their Mothers' Health at Midlife

A growing body of research suggests that maternal exposure to discrimination helps to explain racial disparities in children's health. However, no study has considered if the intergenerational health effects of unfair treatment operate in the opposite direction-from child to mother. To this end, we use data from mother-child pairs in the National Longitudinal Survey of Youth 1979 to determine whether adolescent and young adult children's experiences of discrimination influence their mother's health across midlife. We find that children who report more frequent instances of discrimination have mothers whose self-rated health declines more rapidly between ages 40 and 50 years. Furthermore, racial disparities in exposure to discrimination among children explains almost 10% of the black-white gap but little of the Hispanic-white gap in self-rated health among these mothers. We conclude that the negative health impacts of discrimination are likely to operate in a bidirectional fashion across key family relationships.

Estimating Children's Household Instability Between Birth and Age 18 Using Longitudinal Household Roster Data

Previous descriptions of the composition and stability of children's households have focused on the presence of parents and the stability of mothers' marital and cohabiting relationships. We use data available in the 2008 Survey of Income and Program Participation to expand the description of children's household composition and stability. We find that one in five children lives with nonnuclear household members. These other household members are a source of substantial household instability. In addition, during the period of observation (2008-2013), children experienced considerable residential instability. Thus, children's experience of household instability is much more common and frequent than previously documented. Moreover, levels of both residential and compositional instability are higher for children with less-educated mothers and for racial/ethnic minorities.

Gender Perspectives on Social Norms Surrounding Teen Pregnancy: A Thematic Analysis of Social Media Data

BACKGROUND

Social concern with teen pregnancy emerged in the 1970s, and today's popular and professional health literature continues to draw on social norms that view teen pregnancy as a problem-for the teen mother, her baby, and society. It is unclear, however, how adolescents directly affected by teen pregnancy draw upon social norms against teen pregnancy in their own lives, whether the norms operate differently for girls and boys, and how these social norms affect pregnant or parenting adolescents.

OBJECTIVE

This research aims to examine whether and how US adolescents use, interpret, and experience social norms against teen pregnancy.

METHODS

Online ethnographic methods were used for the analysis of peer-to-peer exchanges from an online social network site designed for adolescents. Data were collected between March 2010 and February 2015 (n=1662). Thematic analysis was conducted using NVivo software.

RESULTS

American adolescents in this online platform draw on dominant social norms against teen pregnancy to provide rationales for why pregnancy in adolescence is wrong or should be avoided. Rationales range from potential socioeconomic harms to life-course rationales that view adolescence as a special, carefree period in life. Despite joint contributions from males and females to a pregnancy, it is primarily females who report pregnancy-related concerns, including experiences of bullying, social isolation, and fear.

CONCLUSIONS

Peer exchange in this online forum indicates that American adolescents reproduce prevailing US social norms of viewing teen pregnancy as a social problem. These norms intersect with the norms of age, gender, and female sexuality. Female adolescents who transgress these norms experience bullying, shame, and stigma. Health professionals must ensure that strategies designed to prevent unintended adolescent pregnancy do not simultaneously create hardship and stigma in the lives of young women who are pregnant and parent their children.

Multiple-Partner Fertility and Cohort Change in the Prevalence of Half-Siblings

The transformation of the American family under the second demographic transition has created more opportunities for parents to have children with multiple partners, but data limitations have hampered prevalence estimates of multiple-partner fertility from the perspective of children. This study uses nationally representative data from the 1979 and 1997 cohorts of the National Longitudinal Surveys of Youth to examine cohort change in children's exposure to multiple-partner fertility. We find that one in five children in the 1979 cohort had at least one half-sibling by their 18th birthday, and the prevalence grew to more than one in four children by the 1997 cohort. A strong educational gradient in exposure to half-siblings persists across both cohorts, but large racial/ethnic disparities have narrowed over time. Using demographic decomposition techniques, we find that change in the racial/ethnic and socioeconomic composition of the U.S. population cannot explain the growth in exposure to half-siblings. We conclude by discussing the shifting patterns of fertility and family formation associated with sibling complexity and considering the implications for child development and social stratification.

Dimensions of Reproductive Attitudes and Knowledge Related to Unintended Childbearing Among U.S. Adolescents and Young Adults

Measures of attitudes and knowledge predict reproductive behavior, such as unintended fertility among adolescents and young adults. However, there is little consensus as to the underlying dimensions these measures represent, how to compare findings across surveys using different measures, or how to interpret the concepts captured by existing measures. To guide future research on reproductive behavior, we propose an organizing framework for existing measures. We suggest that two overarching multidimensional concepts-reproductive attitudes and reproductive knowledge-can be applied to understand existing research using various measures. We adapt psychometric analytic techniques to analyze two data sets: the National Longitudinal Survey of Adolescent to Adult Health (Add Health) and the Relationship Dynamics and Social Life study (RDSL). Although the specific survey measures and sample composition of the two data sets are different, the dimensionality of the concepts and the content of the items used to measure their latent factors are remarkably consistent across the two data sets, and the factors are predictive of subsequent contraceptive behavior. However, some survey items do not seem strongly related to any dimension of either construct, and some dimensions of the two concepts appear to be poorly measured with existing survey questions. Nonetheless, we argue that the concepts of reproductive attitudes and reproductive knowledge are useful for categorizing and analyzing social psychological measures related to unintended fertility. The results can be used to guide secondary data analyses to predict reproductive behavior, compare results across data sets, and structure future data collection efforts.

Childless Expectations and Childlessness Over the Life Course

Using nineteen panels of the 1979 National Longitudinal Survey of Youth (NLSY-79), we construct life-lines characterizing women's childless expectations and fertility behavior. One-quarter of women in the NLSY-79 cohort ever reported an expectation for childlessness but only 14.8 percent of women remain childless. Childless women follow two predominant life course paths: (1) repeated postponement of childbearing and the subsequent adoption of a childless expectation at older ages or (2) indecision about parenthood signaled through vacillating reports of childless expectations across various ages. We also find that more than one in ten women became a mother after considering childlessness: an understudied group in research on childlessness and childbearing preferences. These findings reaffirm that it is problematic to assign expected and unexpected childlessness labels to the reproductive experience of childless women. In addition, despite their variability over time, childless expectations strongly predict permanent childlessness, regardless of the age when respondents offer them. Longitudinal logistic regression analysis of these childless expectations indicates a strong effect of childbearing postponement among the increasingly selective group of childless women. However, net of this postponement, few variables commonly associated with childlessness are associated with reports of a childless expectation. We thus conclude that the effects of socio-demographic and situational factors on childless expectations are channeled predominantly through repeated childbearing postponement.

Family Change and Changing Family Demography

Increases in life expectancy, high rates of movement into and out of couple relationships, and increasing exposure to stepfamilies raise new questions about who is in a family, the distinction between who lives together and who is a family member, and the extent to which family members are expected to meet the long-term obligations that define kinship. These questions are important because families have traditionally served as a vital private safety net for family members. Demographic changes increase family members' uncertainty about their relationships. Family ties are less stable and more uncertain among the economically disadvantaged, and uncertainty may exacerbate these disadvantages by weakening individuals' ability to rely on family members' support to alleviate hardship. I argue that demographers should focus on individuals' family relationships to gain insight into living arrangements and family dynamics. I also outline the development of family concepts and improvements in study design to identify principles that demographers should incorporate in new research to shed light on families' support for their members.

Men's Income Trajectories and Physical and Mental Health at Midlife

Using time-varying, prospectively measured income in a nationally representative sample of Baby-Boomer men (the National Longitudinal Survey of Youth - 1979 [NLSY79]), we identify eight group-based trajectories of income between ages 25-49 and use multinomial treatment models to describe the associations between group-based income trajectories and mental and physical health at midlife. We find remarkable rigidity in income trajectories: less than 25% of our sample experiences significant upward or downward mobility between the ages of 25 to 49 and most who move remain or move into poverty. Men's physical and mental health at age fifty is strongly associated with their income trajectories, and some upwardly mobile men achieve the same physical and mental health as the highest earning men after adjusting for selection. The worse physical and mental health of men on other income trajectories is largely attributable to their early life disadvantages, health behaviors, and cumulative work experiences.

Racial and Ethnic Variation in the Relationship Between Student Loan Debt and the Transition to First Birth

The present study employs discrete-time hazard regression models to investigate the relationship between student loan debt and the probability of transitioning to either marital or nonmarital first childbirth using the 1997 National Longitudinal Survey of Youth (NLSY97). Accounting for nonrandom selection into student loans using propensity scores, our study reveals that the effect of student loan debt on the transition to motherhood differs among white, black, and Hispanic women. Hispanic women holding student loans experience significant declines in the probability of transitioning to both marital and nonmarital motherhood, whereas black women with student loans are significantly more likely to transition to any first childbirth. Indebted white women experience only a decrease in the probability of a marital first birth. The results from this study suggest that student loans will likely play a key role in shaping future demographic patterns and behaviors.

Marital Status and Mothers' Time Use: Childcare, Housework, Leisure, and Sleep

Assumptions that single mothers are "time poor" compared with married mothers are ubiquitous. We tested theorized associations derived from the time poverty thesis and the gender perspective using the 2003-2012 American Time Use Surveys (ATUS). We found marital status differentiated housework, leisure, and sleep time, but did not influence the amount of time that mothers provided childcare. Net of the number of employment hours, married mothers did more housework and slept less than never-married and divorced mothers, counter to expectations of the time poverty thesis. Never-married and cohabiting mothers reported more total and more sedentary leisure time than married mothers. We assessed the influence of demographic differences among mothers to account for variation in their time use by marital status. Compositional differences explained more than two-thirds of the variance in sedentary leisure time between married and never-married mothers, but only one-third of the variance between married and cohabiting mothers. The larger unexplained gap in leisure quality between cohabiting and married mothers is consistent with the gender perspective.

Understanding Generational Differences in Early Fertility: Proximate and Social Determinants

Although US rates of early fertility have declined, they remain high relative to other high-income countries, and disparities by population group persist. The share of the US youth population with immigrant parents has expanded greatly, yet relatively little is known about generational variations in early fertility. This study used Add Health data to investigate: (1) differences by generational status in the risk of early childbearing; (2) to what extent observed differences reflected timing of sexual onset versus post-onset proximate determinants like contraceptive use; and (3) the influence of individual-, family-, and neighborhood-level social factors. Foreign-born and second-generation young women initiated both sexual activity and childbearing later than those with US-born parents. Sequential hazard models revealed the importance of later sexual onset in explaining delayed fertility among the foreign-born, and of family attributes for their later sexual onset. Post-onset behaviors were central to the delayed childbearing observed among the second generation.

Desire for Sterilization Reversal Among U.S. Females: Increasing Inequalities by Educational Level

CONTEXT

For decades, high reliance on female sterilization in the United States has been accompanied by a high level of desire for sterilization reversal, and less-educated women have been more likely than better educated women to use the method and desire a reversal. Little is known about how levels of and educational differentials in such desire have changed in recent decades.

METHODS

Data from 4,147 women who reported being sterile from a tubal sterilization in the 1995, 2002 and 2006-2010 waves of the National Survey of Family Growth were analyzed using chi-square and Wald tests and binary logistic regression analyses. Predicted probabilities were calculated to determine the likelihood of desire for procedure reversal by wave and educational level.

RESULTS

The prevalence of desire for sterilization reversal rose by 41%, from 18% in 1995 to 23% in 2002 and 25% in 2006-2010. Overall, women with a bachelor's degree were less likely than those who had not finished high school to desire a reversal (odds ratio, 0.2), and this educational differential was larger in 2006-2010 than in earlier waves. Predicted probabilities indicate that 9% of sterilized women with less than a high school education and 8% of those with a bachelor's degree expressed a desire for procedure reversal in 1995, as did 15% and 3%, respectively, in 2006-2010.

CONCLUSION

Future research should consider how insurance coverage of all methods under the Affordable Care Act may affect use of sterilization and desire for reversal.