Factors Influencing Childbearing Decisions and Knowledge of Perinatal Risks among Canadian Men and Women

Background: Women age 35 and older account for an increasing proportion of births and are at increased risk of having difficulties conceiving and of delivering a multiple birth, low birth weight infant, and/or preterm infant. Little is known about men’s and women’s understanding of the maternal age related risks to pregnancy.Objectives: 1) To determine the factors influencing the timing of childbearing for non-parenting men and women, 2) to determine knowledge among non-parenting men and women about maternal age-related reproductive risks, the consequences of low birth weight and multiple birth, and issues related to infertility, and 3) to determine characteristics associated with limited knowledge of these reproductive risks.Methods: An age-stratified random sample of individuals, aged 20–45 years and without children, completed a computer-assisted telephone interview from two urban regions of Alberta, Canada (1006 women and 500 men).Results: Factors that influenced timing of childbearing for both men and women included: financial security (85.8%) and partner suitability to parent (80.2%). Over 70% of men and women recognized the direct relationship between older maternal age and conception difficulties. Less than half knew that advanced maternal age increased the risk of stillbirth, caesarean delivery, multiple birth and preterm delivery.Conclusions: Poor understanding of the links between childbearing after age 35, pregnancy complications and increased risk of adverse infant outcomes limits adults’ ability to make informed decisions about timing of childbearing.     

Defining Early Adolescent Childbearing

OBJECTIVES: This study determined the age group for the case definition of early adolescent childbearing based on rates of adverse clinical outcomes. METHODS: We examined rates of infant mortality, very low birthweight (<1500 g), and very preterm delivery (<32 weeks) per 1000 live births for all US singleton first births (n = 768 029) to women aged 12 to 23 years in the 1995 US birth cohort. RESULTS: Rates of infant mortality, very low birthweight, and very preterm delivery were graphed by maternal age. In all 3 cases, the inflection point below which the rate of poor birth outcome is lower and begins to stabilize is at 16 years; therefore, mothers 15 years and younger were grouped together to determine the case definition of early adolescent childbearing. The inflection points were similar when outcomes were stratified by the 3 largest US racial/ethnic groups (non-Hispanic White, non-Hispanic Black, and Mexican American). CONCLUSIONS: From this population-based analysis of birth outcomes, we conclude that early adolescent childbearing is best defined as giving birth at 15 years or younger.     

The Educational Consequences of Adolescent Childbearing and Union Formation in Brazil

While Brazil has high rates of adolescent fertility for its below‐replacement total fertility rate, we know little about the causal effects of adolescent childbearing and adolescent union formation for women's education. In this paper, we examine unique data from the 2013 School‐to‐Work Transitions Survey to address the consequences of adolescent childbearing and adolescent union formation on educational outcomes of Brazilian young women. We apply several analytical strategies to address the endogeneity between adolescent childbearing and educational outcomes. Our findings suggest that childbearing during the teenage years is detrimental to the educational attainment of Brazilian women, and that educational disadvantages persist once we take into account mother's selection into adolescent childbearing. The penalty for adolescent mothers ranges from −1.66 to −1.80 fewer years of schooling and from 41 to 35 percent difference in the probabilities of graduating from high school. Additional findings show that marital unions among adolescent mothers have a compounding role at further hindering women's educational progress. Combined, our findings suggest that young mothers, particularly those in a marital union, face additional layers of disadvantages, demonstrating that early family formation is a meaningful stratifier for women in an already highly‐stratified society.     

Unplanned childbearing in Kenya: the socio-demographic correlates and the extent of repeatability among women

Unplanned pregnancies account for a substantial proportion of births in Kenya and can have a variety of negative consequences on individual women, their families, and the society as a whole. This paper examines the correlates of mistimed and unwanted childbearing in Kenya, with special focus on the extent of repetitiveness of these events among women. A multilevel multinomial model is applied to the 1993 Kenya Demographic and Health Survey data. The results show that unplanned childbearing in Kenya is associated with a number of factors, including urban/rural residence, region, ethnicity, maternal education, maternal age, marital status, birth order, length of preceding birth interval, family planning practise, fertility preference and unmet need for family planning. In addition to these factors, women who have experienced an unplanned birth are highly likely to have a repeat occurrence.     

Vital Signs: Repeat Births Among Teens — United States, 2007–2010

Background

Teen childbearing has potential negative health, economic, and social consequences for mother and child. Repeat teen childbearing further constrains the mother’s education and employment possibilities. Rates of preterm and low birth weight are higher in teens with a repeat birth, compared with first births.

Methods

To assess patterns of repeat childbearing and postpartum contraceptive use among teens, CDC analyzed natality data from the National Vital Statistics System (NVSS) and the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2007–2010.

Results

Based on 2010 NVSS data from all 50 states and the District of Columbia, of more than 367,000 births to teens aged 15–19 years, 18.3% were repeat births. The percentage of teen births that represented repeat births decreased by 6.2% between 2007 and 2010. Disparities in repeat teen births exist by race/ethnicity, with the highest percentages found among American Indian/Alaska Natives (21.6%), Hispanics (20.9%), and non-Hispanic blacks (20.4%) and lowest among non-Hispanic whites (14.8%). Wide geographic disparities in the percentage of teen births that were repeat births also exist, ranging from 22% in Texas to 10% in New Hampshire. PRAMS data from 16 reporting areas (15 states and New York City) indicate that 91.2% of teen mothers used a contraceptive method 2–6 months after giving birth, but only 22.4% of teen mothers used the most effective methods. Teens with a previous live birth were significantly more likely to use the most effective methods postpartum compared with those with no prior live birth (29.6% versus 20.9%, respectively). Non-Hispanic white and Hispanic teens were significantly more likely to use the most effective methods than non-Hispanic black teens (24.6% and 27.9% versus 14.3%, respectively). The percentage of teens reporting postpartum use of the most effective methods varied greatly geographically across the PRAMS reporting areas, ranging from 50.3% in Colorado to 7.2% in New York State.

Conclusions

Although the prevalence of repeat teen birth has declined in recent years, nearly one in five teen births is a repeat birth. Large disparities exist in repeat teen births and use of the most effective contraceptive methods postpartum, which was reported by fewer than one out of four teen mothers.

Implications for Public Health Practice

Evidence-based approaches are needed to reduce repeat teen childbearing. These include linking pregnant and parenting teens to home visiting and similar programs that address a broad range of needs, and offering postpartum contraception to teens, including long-acting methods of reversible contraception.     

A perspective on adolescent fertility in developing countries

While the best data at present indicate that adolescent fertility is declining in the developing world, it is still very high relative to the developed world. Access by teenage women to family planning information does not seem to be restricted (except in the cases of abortion and sterilization), if only because much of adolescent fertility takes place in marriages or other sanctioned unions, nor is there much evidence that they are proportionally underrepresented as family planning acceptors. However, services are rarely designed to meet the special needs of young clients. The health and social consequences of adolescent childbearing are a major cause of concern. High maternal, neonatal, and infant mortality have been documented, and U.S. studies show that teenage mothers suffer education and income deficits. Future trends toward urbanization seem likely to exacerbate these problems, and the large number of people entering adolescence in the developing world could have a major demographic effect. In the U.S., recognition of the need for special services to teenagers only became a high priority when teenage fertility had reached 20% of total births. It appears that reassessment of the low priority now being given to adolescent fertility in the developing countries is in order.     

Delayed Childbearing by Education Level in the United States, 1969–1994

Objectives. Advanced maternal age at first birth, but not at subsequent births, may have detrimental health implications for both mother and child, such as a poor birth outcome and an increased risk of maternal breast cancer. However, positive outcomes may also result such as an improvement in economic measures and offspring's performance on cognitive tests. Research has indicated that women increasingly are delaying their first births beyond the early twenties, but the recent trends in socioeconomic disparity in age at first birth, and the implications for public health, have not been well described. Method. This study used national birth certificate data for 1969–1994 to examine age at first birth by maternal education level. Current Population Survey data were also used to examine changes over time in age and educational distribution among women of childbearing age. Results. Age at first birth increased during the time period. Median age at first birth increased from 21.3 to 24.4 between 1969 and 1994, and the proportion of first-time mothers who were age 30 or older increased from 4.1% to 21.2%. Age at first birth increased rapidly among women with 12 or more years of education; nearly half (45.5%) of college graduate women who had their first birth in 1994 were age 30 or older, compared with 10.2% in 1969. However, little change was observed among women with fewer than 12 years of education; among those with 9–11 years of education, only 2.5% of first births in 1994 occurred at age 30 or older. Conclusions. The trend toward postponed childbearing has occurred primarily among women with at least a high school education. Health services use, such as infertility treatment and cesarean section, may increase as a result of delayed childbearing among higher educated women. Future examinations of the association between maternal age at first birth and health outcomes may need to take greater account of socioeconomic differentials.     

Risk factors for childbearing during adolescence in a population-based birth cohort in southern Brazil.

OBJECTIVE: To use a case-control study to analyze risk factors associated with teenage childbearing among adolescents who were in a birth cohort study that began in 1982 in the city of Pelotas, Rio Grande do Sul, Brazil. METHODS: Adolescent mothers in Pelotas who gave birth between January 1995 and March 2001 and who had been born in 1982 were identified through the local birth information system. These subjects from the 1982 birth cohort were compared to adolescents from the same cohort who had not given birth before March 2001. Standardized interviews were used in 2001 to obtain information about socioeconomic, maternal reproductive, demographic, and lifestyle characteristics. This information was combined with data obtained in earlier phases of this 1982 birth cohort study. Unconditional logistic regression was used to analyze the risk factors associated with childbearing during adolescence. RESULTS: A total of 420 parous adolescents from the 1982 birth cohort were identified and then compared with 408 cohort adolescents who had not given birth by March 2001. Higher family income in 1982 and more parental schooling in 1982 were inversely related to childbearing among the birth cohort adolescents. Cohort girls whose mothers were under age 20 when they gave birth in 1982 had a higher risk of becoming pregnant while still an adolescent. Cohort girls who, during childhood, lived with siblings from different fathers were twice as likely to become an adolescent mother. Compared to cohort adolescents who had not failed during the first four years of school, those girls who had done so had twice the risk of giving birth during adolescence. Among the cohort girls a positive association was found between younger age at first intercourse and childbearing in adolescence. CONCLUSIONS: The results indicate that the educational level of the adolescent mothers must be considered in planning policies that attempt to disrupt successive cycles of socioeconomic deprivation. Early interventions to improve sex education and to increase the motivation of young girls to achieve higher levels of education are needed. The interventions should aim for a reduction in the risk of long-term poverty and poorer educational achievements of teenage mothers and their children.     

The effects of early childbearing on schooling over time.

CONTEXT: In recent studies, the effects of teenage childbearing on the schooling of young women have been smaller than those in earlier research. The discrepancy has been attributed to the use in the later studies of controls for unmeasured differences between young women who start childbearing early and those who do not, but could instead reflect changes in the effect of early childbearing over time. METHODS: Data from the National Longitudinal Survey of the Labor Market Experience of Youth and the Panel Study of Income Dynamics are used to identify the reasons for this difference. Logistic regression, ordinary least-squares regression and fixed-effects models examine the impact of early childbearing on rates of high school graduation and college attendance, and number of years of schooling completed through age 29. RESULTS: The two data sets show a significant negative impact of a teenage birth on rates and years of completed schooling. For example, teenage mothers complete 1.9-2.2 fewer years of education than do women who delay their first birth until age 30 or older. Moreover, compared with women who give birth at age 30 or older, teenage mothers have odds of high school completion 10-12% as high and odds of postsecondary schooling 14-29% as high. Unobserved differences between young mothers and their childless peers reduce, but do not eliminate, the effects of early births. Effects on high school completion declined in recent periods because more young women completed high school, regardless of the timing of their first birth. However, the gap between early and later childbearers in postsecondary school attendance widened from 27 to 44 percentage points between the early 1960s and the early 1990s. CONCLUSIONS: Given the current importance of a college education, teenage childbearers today are at least as disadvantaged as those of past generations.     

The children of teenage mothers: patterns of early childbearing in two generations

Twenty years after a mostly black group of Baltimore women became adolescent mothers, the majority of their first-born children had not become adolescent parents, a finding that challenges the popular belief that the offspring of teenage mothers are themselves destined to become adolescent parents. Almost all of the offspring had had intercourse by age 19. About half of the young women had experienced a pregnancy before that age, and approximately one-third of the young men reported having impregnated a partner before age 19. The Baltimore youths were just as likely to have had a live birth before age 19 as were the children of teenage mothers in a national sample of urban blacks, and both of these groups were more likely to have done so than were the children of older mothers in the national sample. In the Baltimore sample, maternal welfare experience only increased a daughter's likelihood of early childbearing if welfare was received during her teenage years. Within the Baltimore sample, a direct comparison of the daughters who became adolescent mothers with their own mothers at a comparable age reveals that the daughters have bleaker educational and financial prospects than their mothers had, and are less likely to ever have married. These results suggest that today's teenage parents may be less likely than were previous cohorts of adolescent mothers to overcome the handicaps of early childbearing. This trend could portend the growth of an urban underclass, even though only a minority of the offspring of teenage mothers go on to become adolescent parents.     

Teenage childbearing and welfare: preventive and ameliorative strategies

The results of seven computer simulations suggest that strategies to prevent teenage childbearing may be more effective in reducing the number of young women who require welfare assistance than are strategies to improve the circumstances of teenagers who have already given birth. The first simulation constitutes a baseline projection, in which current levels and patterns of adolescent childbearing are assumed to continue to 1990. Three "preventive" simulations assume that no births or fewer births occur among teenagers during the projection period; and three "ameliorative" simulations assume that changes occur in the completed family size, marriage rate and educational attainment of teenage childbearers. Compared with the baseline projection, the three preventive strategies are estimated to reduce by 22-48 percent the number of adolescent childbearers who, as 20-24-year-olds in 1990, will be receiving welfare payments; the three ameliorative strategies cause only a 6-12 percent drop. The strategy with the least impact is the education scenario, in which adolescent mothers are assumed to be no more likely to drop out of school than are other comparable teenagers. The primary reason for the surprisingly small effect appears to be the relatively low earnings of women--even when they are high school graduates. All of the experimental scenarios tested, however, bring about at least some reduction in projected government spending for the three major public assistance programs considered (Aid to Families with Dependent Children, Medicaid and Food Stamps).     

The Impact of Food Insecurity on the Home Emotional Environment Among Low-Income Mothers of Young Children

Objectives Household stressors, such as food insecurity, contribute to the home emotional environment and negatively affect child development. Little research on this topic has been conducted among very young children. This study aimed to examine the relationship between food insecurity and the home emotional environment, as well the extent to which the relationship may be mediated by maternal symptoms of depression. Frequency of praise, affection, and discipline of young children by mothers were examined as markers of the home emotional environment. Methods Data were collected in a cross-sectional study of mothers of children under the age of five (N?=?4231). Logistic regression was used to assess the relationship between level of food security and frequency of praise and discipline of children. Mediation analysis using the KHB method was conducted to test whether maternal mental health mediated the relationship between food insecurity and each outcome. Results Low and very low food security were significantly associated with higher odds of disciplining children with high frequency. Controlling for all covariates, frequency of praise was not significantly associated with level of household food insecurity. Differences in praise and discipline frequency were found by language of interview, maternal education, and employment. Conclusions for Practice Parent–child interactions, specifically related to discipline, are related to food insecurity. Further research should consider cultural patterns and mechanisms behind the relationship between food insecurity and the home environment. Household stressors begin affecting children at young ages, and early intervention is essential to prevent further negative sequelae as children grow older.     

Home Deliveries in Indonesia: Who Provides Assistance?

Indonesia has set an ambitious target of reducing its maternal mortality rate to 125 maternal deaths per 100,000 live births by the year 2010. This poses formidable challenges in a geographically diverse country where the majority of births occur at home. One option for the Indonesian government in order to reduce its maternal mortality would be to increase rates of skilled assistance for home deliveries. In order to design appropriate policies to achieve this, it is imperative to understand the determinants of use of birth attendants by mothers delivering at home. We use the Andersen Behavioral Model as a theoretical framework to understand the determinants of the use of a trained provider, traditional birth attendant, or no trained assistance during home deliveries in Indonesia. The 1997 Indonesia Demographic and Health Survey (IDHS) was used, and data from the most recent home delivery was abstracted for analysis. Out of a total sample of 10,692 home deliveries, a majority (53%) used the services of a TBA, 40% had a doctor, nurse or midwife in attendance, and only 7% delivered with the help of family and/or friends. A multinomial logit model was used to predict determinants of use. Our results indicate that maternal education, religion, asset index quartile and number of antenatal visits are significant determinants among all choice sets.     

Adolescent Pregnancy and Parenthood in South Africa

South Africa's total fertility rate is estimated to be one of the lowest in sub-Saharan Africa, fewer than three births per woman nationally and declining. At the same time, adolescent childbearing levels remain high: More than 30 percent of 19-year-old girls are reported to have given birth at least once. Evidence from focus-group discussions conducted in urban and rural areas in South Africa with young black women and men, and with the parents of teenage mothers, is used to consider the experience of early parenthood, including the role of paternity, education, work opportunities, and subsequent fertility. In South Africa, in contrast to many other settings, teenage mothers may return to school once they have given birth, and this opportunity is strongly related to a long delay before the birth of a second child. Educated girls also tend to bring more bridewealth, which may encourage parents to support their daughters' schooling, and perhaps their return to school following childbirth. The support of the child, however, is often subject to paternal recognition and commitment, even though boys are unwilling to admit paternity because it jeopardizes their educational and employment opportunities.     

The pace of repeated childbearing among young American mothers

Women who first give birth at ages 16 and younger are more likely to bear a second child within the next two years (26 percent) than are women who have their first child at ages 17-18 (20 percent) or at ages 19-22 (22 percent). However, there are important racial and ethnic differences in the likelihood of rapid repeated childbearing: Among whites, age at first birth has little effect on the proportions who have a second birth quickly; but among blacks, it has a significant inverse effect, with younger women more likely than older women to have a second child quickly. At nearly all ages at first birth, Hispanic mothers are more likely than either whites or blacks to have a second birth soon after the first. While the youngest black mothers (those 16 and under) are more likely than the youngest whites to have a rapid second birth, the oldest white mothers (those 19-22) are more likely than the oldest blacks. Socioeconomic background (represented by level of parental education), marital status at first birth and wantedness of the first birth also affect the pace of repeated childbearing. Compared with young mothers whose own mothers are high school graduates, those whose mothers are dropouts are more likely to have a second child within two years. Teenage mothers who are married at their first birth appear somewhat more likely than their unmarried counterparts to bear another child quickly; and mothers who wanted their first child at the time of conception are generally more likely to do so than are mothers whose first births were unwanted.(ABSTRACT TRUNCATED AT 250 WORDS)     

Individual Characteristics and Use of Maternal and Child Health Services by Adolescent Mothers in Niger

Despite high rates of early childbearing, maternal mortality, and under-five mortality, little is known about factors that affect access of teenage mothers to maternal and child health (MCH) services in Niger. This paper explores potential factors associated with the utilization of MCH care services by adolescent mothers. Using the third wave of the Niger demographic and health survey (NDHS) 2006, we estimate three multivariate logistic regression models to assess individual characteristics associated with the utilization of antenatal care (ANC) and safe delivery care services among adolescent women, as well as full immunization received by children born to adolescent mothers. The analytical sample includes 934 adolescent mothers out of 1,835 respondents aged 15–19, and within this group, 493 mother–child dyads for children aged 12–59 months. Possessing any level of education was found associated with the increased use of all three selected MCH services, while urban residence and higher income were associated with the increased use of two of three MCH services studied. Higher birth order plus a birth interval more than 2 years for the most recent birth appeared associated with the lower probability of antenatal care visits and safe delivery care. This study finds that women who attended at least four ANC visits were more likely to experience safe delivery care, and the children whose mothers had safe delivery care were more likely to receive full immunization. Therefore, an effective program should be designed to promote a continuum of MCH care with special attention to adolescent women who are uneducated, poor and residing in rural areas.     

Association of parental characteristics with adverse outcomes of adolescent pregnancy

BACKGROUND: It is well-known that pregnancy in adolescence has an increased risk of adverse reproductive outcomes. It remains unclear whether this association is due mainly to the unfavourable sociodemographic status or due solely to biological immaturity of pregnant adolescents. OBJECTIVE: The purpose of this study was to determine the association of parental sociodemographic characteristics with the adverse outcomes of adolescent pregnancy. METHOD: Data from certificates of live births in Taichung County, Taiwan in 1994 of 7994 singleton, first-born babies whose mothers were 15-34 years of age were analysed. The relative risk of having adverse pregnancy outcomes for adolescent subgroups was obtained as compared with that among mothers 20-34 years of age with the same characteristics. The adjusted relative risk of having adverse pregnancy outcomes for each covariate was calculated by a multiple logistic regression analysis. RESULTS: Of 7994 babies born to mothers of 15-34 years of age, 8.3% were born to adolescent mothers. In all age groups, the younger adolescent mothers (15-17 years of age) had the highest percentage of both infants with low birth weight (10.6%) and preterm births (7.1 %). Younger adolescent mothers in almost all sociodemographic categories had higher risks of having both low-birth-weight and preterm births than those of older adolescent mothers. Multiple logistic regression analysis showed that a younger maternal age is the only significant risk factor for having infants with low birth weight (adjusted RR = 2.5, 95% Cl 1.8-4.5 and adjusted RR = 1.7, 95% Cl 1.2-2.6 for younger and older adolescent mothers, respectively) or preterm birth (adjusted RR = 1.9, 95% Cl 1.1- 3.4 and adjusted RR = 1.5, 95% Cl 1.0-2.3 for younger and older adolescent mothers, respectively). CONCLUSIONS: Adolescent pregnancy carries an increased risk of having low-birth-weight and preterm births, and a younger maternal age is causally implicated.      

Pathways to adolescent childbearing among Kaqchikel women in Guatemala

Abstract

One-in-five children in Guatemala is born to a mother aged 15–19 years, which poses social, economic and health risks to both mother and child. In Guatemala, adolescent childbearing is directly associated with education, ethnicity and poverty, which increases vulnerability among Indigenous young women living in poverty. This study examines the context and experiences of adolescent childbearing from the perspectives of young mothers in the Kaqchikel Indigenous ethnic group of Sololá, Guatemala. Data were collected in 19 qualitative in-depth interviews with women who had given birth to one or more children when aged 15 to 19 years. Grounded theory and narrative analysis were used to develop a conceptual framework of the process and influences on childbearing. Four distinct pathways were identified, which were influenced by gender expectations, limited communication about sex and stigma around sex. The study identifies key sociocultural influences that lead to adolescent childbearing and reveals variability within these. Identifying distinct pathways to early childbearing and their influences enables a clearer understanding of potential opportunities to interrupt these pathways with culturally relevant policies and programmes, in particular those that promote gender equality and intergenerational communication about sex.     

Repeat adolescent pregnancy and low birth weight: Methods issues

Longitudinal studies of the relationship between birth order and birth weight suggest that mean birth weight increases with parity among women of all ages. In contrast, national birth statistics and other cross-sectional studies of these relationships suggests a decrease in mean birth weight and an increased incidence of low-weight births with parity among adolescent mothers. We examine the potential reasons for these strikingly different conclusions. Our aim is to determine whether multiparity itself is a low-birth-weight risk factor among adolescent mothers or whether it is a marker for other adolescent maternal conditions that increase the risk of a low birth weight, independent of parity.