Long-term effects of childbearing on mortality: evidence from pre-industrial Sweden

This paper presents an analysis of the impact of childbearing history on later-life mortality for ever-married men and women using historical micro-level data of high quality for southern Sweden. The analysis uses a Cox proportional hazards model, estimating the effects on old-age mortality of number of births and timing of first and last births. By studying the effects of previous childbearing on mortality by sex and social status, we also gain important insights into the mechanisms relating childbearing to mortality in old age. The results show that number of children ever born had a statistically significant negative impact on longevity after age 50 for females but not for males. Analysis by social group shows that only landless women experienced higher mortality from having more children, which seems to indicate that the main explanations are to be found in social or economic conditions specific to females, rather than in the strictly biological or physiological effects of childbearing.     

Long-term effects of childbearing on mortality: Evidence from pre-industrial Sweden

This paper presents an analysis of the impact of childbearing history on later-life mortality for ever-married men and women using historical micro-level data of high quality for southern Sweden. The analysis uses a Cox proportional hazards model, estimating the effects on old-age mortality of number of births and timing of first and last births. By studying the effects of previous childbearing on mortality by sex and social status, we also gain important insights into the mechanisms relating childbearing to mortality in old age. The results show that number of children ever born had a statistically significant negative impact on longevity after age 50 for females but not for males. Analysis by social group shows that only landless women experienced higher mortality from having more children, which seems to indicate that the main explanations are to be found in social or economic conditions specific to females, rather than in the strictly biological or physiological effects of childbearing.     

Association of late childbearing with healthy longevity among the oldest-old in China

Statistical analysis of a large and unique longitudinal data-set demonstrates that childbearing after age 35 or 40 is associated with survival and healthy survival among very old Chinese women and men. The association is stronger for women than for men. The estimates are adjusted for a variety of confounding factors: demographic characteristics, family support, social connections, health practices, and health conditions. Further analysis based on an extension of the Fixed-Attributes Dynamics method shows that late childbearing is positively associated with long-term survival and healthy survival from ages 80-85 to 90-95 and 100-105. This association exists among oldest-old women and men, but, again, the effects are substantially stronger for women than for men. We discuss four possible factors that may explain why late childbearing affects healthy longevity at advanced ages: (1) social factors; (2) biological changes caused by late pregnancy and delivery; (3) genetic and other biological characteristics; and (4) selection.     

Longer Life and Population Growth

Enthusiasm about the prospect of large increases in human life expectancy is often dampened by fears that lower mortality will increase population size, hence population pressure. A simple mathematical model of life-cycle stretching demonstrates that if increased longevity is accompanied by later childbearing, a trend that is already underway, future declines in mortality will not increase population size.     

Childbearing and Women's Survival: New Evidence from Rural Bangladesh

Effects of childbearing on women's mortality and the implications of family planning programs in reducing these effects are examined in a 20‐year prospective study of more than 2,000 women in Matlab, Bangladesh. Maternal mortality is defined as a death occurring in the six weeks after childbirth. But childbearing may affect women's survival beyond this brief period. Additional hypotheses considered relate to 1) cumulative exposure to childbearing, whether measured by parity or pace of childbearing, 2) age at first birth, and 3) effects beyond the reproductive ages. The results offer no support to cumulative exposure hypotheses, showing no link between parity or pace of childbearing and mortality risk. Instead, we identify an extended period of heightened mortality risk associated with each birth—the year of the birth and the two subsequent years. Family planning programs, by reducing the number of children and therefore a woman's exposure to extended maternal mortality risk, potentially increase survival. Research is needed to identify and address the specific causes of extended maternal mortality risk so that appropriate ameliorative programs may be developed.     

Determinants of Mortality at Older Ages: The Role of Biological Markers of Chronic Disease

Researchers have had a longstanding interest in understanding the determinants of mortality. This article examines the impact of a broad array of biological markers, together with self‐reports of physical and mental health status, on the probability of dying for older adults. The estimates are derived from logistic regression models based on data from a national survey in Taiwan. The analysis confirms previous studies demonstrating the effects of clinical measures related to metabolic syndrome on mortality and identifies detrimental effects of neuroendocrine and immune‐system markers. The results reveal that biomarkers provide independent explanatory power in the presence of self‐reported health measures. The associations between biomarkers and mortality found here provide new avenues for projecting future mortality and elucidating differences in longevity across populations.     

The Significance of Education for Mortality Compression in the United States

Recent studies of old-age mortality trends assess whether longevity improvements over time are linked to increasing compression of mortality at advanced ages. The historical backdrop of these studies is the long-term improvement in a population's socioeconomic resources that fueled longevity gains. We extend this line of inquiry by examining whether socioeconomic differences in longevity within a population are accompanied by old-age mortality compression. Specifically, we document educational differences in longevity and mortality compression for older men and women in the United States. Drawing on the fundamental cause of disease framework, we hypothesize that both longevity and compression increase with higher levels of education and that women with the highest levels of education will exhibit the greatest degree of longevity and compression. Results based on the Health and Retirement Study and the National Health Interview Survey Linked Mortality File confirm a strong educational gradient in both longevity and mortality compression. We also find that mortality is more compressed within educational groups among women than men. The results suggest that educational attainment in the United States maximizes life chances by delaying the biological aging process.     

Another Child? Fertility Ideals,Resources and Opportunities

Low fertility in most developed countries has prompted policy concern in relation to labour market supply, pensions, and expenditure on health and welfare services as well as policy debate about both the cost of children and the opportunity costs of parenthood. The extent to which family policy interventions can be effective in slowing or reversing fertility decline is much debated. This paper, based on a fertility module of the Scottish Social Attitudes Survey 2005, examines the current fertility, and ideal and expected fertility of a nationally representative sample of 455 parents of reproductive age and focuses on whether they plan to have another child. It compares the characteristics of those who intend to have another child with those who do not, and how parents with one child differ from those with more children. It addresses three questions about family size: (1) fertility ideals, (2) resources and the economic implications of childbearing, and (3) opportunities for childbearing and the effects of a late start on fertility expectations. It concludes that, despite a sustained period of low fertility in Scotland, childbearing ideals are robust and explanations of low fertility must derive from difficulties in realising those ideals. Difficulties in realising fertility aspirations are associated less with resources than with opportunities for childbearing, especially the timing of first birth. Those who delay their first birth are less likely to realise their ideal family size, and their lower fertility is associated with the opportunity costs of childbearing in terms of foregone qualifications, careers and earnings.     

Educational Attainment and Mortality in the United States: Effects of Degrees,Years of Schooling,and Certification

Researchers have extensively documented a strong and consistent education gradient for mortality, with more highly educated individuals living longer than those with less education. This study contributes to our understanding of the education–mortality relationship by determining the effects of years of education and degree attainment on mortality, and by including non-degree certification, an important but understudied dimension of educational attainment. We use data from the mortality-linked restricted-use files of the Panel Study of Income Dynamics (PSID) sample (N = 9821) and Cox proportional hazards models to estimate mortality risk among U.S. adults. Results indicate that more advanced degrees and additional years of education are associated with reduced mortality risk in separate models, but when included simultaneously, only degrees remain influential. Among individuals who have earned a high school diploma only, additional years of schooling (beyond 12) and vocational school certification (or similar accreditation) are both independently associated with reduced risks of death. Degrees appear to be most important for increasing longevity; the findings also suggest that any educational experience can be beneficial. Future research in health and mortality should consider including educational measures beyond a single variable for educational attainment.     

The Benefits of Educational Attainment for U.S. Adult Mortality: Are they Contingent on the Broader Environment?

The growing recognition that educational attainment is one of the strongest preventive factors for adult health and longevity has fueled an interest in educational attainment as a population health strategy. However, less attention has been given to identifying social, economic, and behavioral resources that may moderate the health and longevity benefits of education. We draw on theories of resource substitution and multiplication to examine the extent to which the education–mortality association is contingent on other resources (marriage, employment, income, healthy lifestyles). We use data on adults aged 30–84 in the 1997–2006 National Health Interview Survey Linked Mortality File and estimate discrete-time event history models stratified by gender (N = 146,558; deaths = 10,399). We find that the mortality benefits of education are generally largest for adults—especially women—who have other resources such as employment and marriage, supporting the theory of resource multiplication. Nonetheless, our results also imply that other resources can potentially attenuate the mortality disadvantages (advantages) associated with low (high) levels of education. The findings suggest that efforts to improve population health and longevity by raising education levels should be augmented with strategies that assure widespread access to social, economic, and behavioral resources.     

The Importance of Early Childhood Poverty

Most poor children achieve less, exhibit more problem behaviors and are less healthy than children reared in more affluent families. We look beyond correlations such as these to a recent set of studies that attempt to assess the causal impact of childhood poverty on adult well-being. We pay particular attention to the potentially harmful effects of poverty early in childhood on adult labor market success (as measured by earnings), but also show results for other outcomes, including out-of-wedlock childbearing, criminal arrests and health status. Evidence suggests that early poverty has substantial detrimental effects on adult earnings and work hours, but on neither general adult health nor such behavioral outcomes as out-of-wedlock childbearing and arrests. We discuss implications for indicators tracking child well-being as well as policies designed to promote the well-being of children.     

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

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

Differences in Child Health Across Rural,Urban, and Slum Areas: Evidence From India

The developing world is rapidly urbanizing, but an understanding of how child health differs across urban and rural areas is lacking. We examine the association between area of residence and child health in India, focusing on composition and selection effects. Simple height-for-age averages show that rural Indian children have the poorest health and urban children have the best, with slum children in between. With wealth or observed health environment held constant, the urban height-for-age advantage disappears, and slum children fare significantly worse than their rural counterparts. Hence, differences in composition across areas mask a substantial negative association between living in slums and height-for-age. This association is more negative for girls than boys. Furthermore, a large number of girls are “missing” in slums; we argue that this implies that the negative association between living in slums and health is even stronger than our estimate. The missing girls also help explain why slum girls appear to have a substantially lower mortality than rural girls, whereas slum boys have a higher mortality risk than rural boys. We estimate that slum conditions (such as overcrowding and open sewers), which the survey does not adequately capture, are associated with 20 % to 37 % of slum children’s stunting risk.     

Family influences on family size preferences

Several studies have demonstrated important effects of parents’ childbearing behavior on their children’s childbearing preferences and behavior. The study described here advances our understanding of these family influences by expanding the theoretical model to include parental preferences, siblings’ behavior, and changes in children’s preferences through early adulthood. Using intergenerational panel data from mothers and their children, we test the effects of both mothers’ preferences for their own fertility and mothers’ preferences for their children’s fertility. Although both types of maternal preferences influence children’s childbearing preferences, mothers’ preferences for their children’s behavior have the stronger and more proximate effects. Mothers’ preferences continue to influence their children’s preferences through early adulthood; siblings’ fertility is an additional determinant of children’s family size preferences.     

The Differential Mortality of Undesired Infants in Sub-Saharan Africa

With high rates of infant mortality in sub-Saharan Africa, investments in infant health are subject to tough prioritizations within the household, in which maternal preferences may play a part. How these preferences will affect infant mortality as African women have ever-lower fertility is still uncertain, as increased female empowerment and increased difficulty in achieving a desired gender composition within a smaller family pull in potentially different directions. I study how being born at a parity or of a gender undesired by the mother relates to infant mortality in sub-Saharan Africa and how such differential mortality varies between women at different stages of the demographic transition. Using data from 79 Demographic and Health Surveys, I find that a child being undesired according to the mother is associated with a differential mortality that is not due to constant maternal factors, family composition, or factors that are correlated with maternal preferences and vary continuously across siblings. As a share of overall infant mortality, the excess mortality of undesired children amounts to 3.3 % of male and 4 % of female infant mortality. Undesiredness can explain a larger share of infant mortality among mothers with lower fertility desires and a larger share of female than male infant mortality for children of women who desire 1–3 children. Undesired gender composition is more important for infant mortality than undesired childbearing and may also lead couples to increase family size beyond the maternal desire, in which case infants of the surplus gender are particularly vulnerable.     

Inequality and demographic response to short-term economic stress in North Orkney,Scotland, 1855–1910: Sector differences

We examine economic inequality and social differences in infant and child mortality, and fertility responses to food price changes in North Orkney, 1855–1910, using linked vital records. This small population featured a diverse occupational structure, limited land resources, and geographic isolation from mainland Scotland. Segments of Orkney’s non-agricultural working population were living so close to the margin of subsistence in normal years that an increase in food prices in bad years cost the lives of their children. Delayed childbearing, in addition to increased labour intensity, occupational diversification, and poor relief, failed to mitigate the negative effects of unfavourable prices in this group. While previous studies for Western Europe show a strong social gradient in mortality responses to food prices, and for Eastern Asia a strong household gradient, this study shows a strong sectoral gradient, indicating low standards of living for the non-agricultural working population well into the twentieth century.     

Childbearing Across Partnerships in Australia,the United States,Norway, and Sweden

This article compares mothers’ experience of having children with more than one partner in two liberal welfare regimes (the United States and Australia) and two social democratic regimes (Sweden and Norway). We use survey-based union and birth histories in Australia and the United States and data from national population registers in Norway and Sweden to estimate the likelihood of experiencing childbearing across partnerships at any point in the childbearing career. We find that births with new partners constitute a substantial proportion of all births in each country we study. Despite quite different arrangements for social welfare, the determinants of childbearing across partnerships are very similar. Women who had their first birth at a very young age or who are less well-educated are most likely to have children with different partners. The educational gradient in childbearing across partnerships is also consistently negative across countries, particularly in contrast to educational gradients in childbearing with the same partner. The risk of childbearing across partnerships increased dramatically in all countries from the 1980s to the 2000s, and educational differences also increased, again, in both liberal and social democratic welfare regimes.     

To have or not to have? Australian women’s childbearing desires,expectations and outcomes

Australia’s low fertility rate is commonly attributed to deliberate decisions by women to avoid having children. Existing theoretical explanations of fertility decision-making mostly view childbearing as a rational, voluntary process and focus on the ‘costs’ to women of having children. Although this may help explain why women do not have children, it contributes very little to understanding why women do have children. This study describes childbearing desires, expectations and outcomes in a population-based sample of 569 30–34-years-old Australian women recruited from the Australian Electoral Roll in 2005. Most women surveyed wanted to have children, and their childbearing outcomes were associated with biological, psychological and social factors including the lack of a partner and adverse health conditions. The factors and their relative importance varied by parity. Most women had fewer children than they desired, and many would have children, or more children, if their circumstances were different. These data challenge prevailing assumptions about women’s childbearing behaviour that women are able to choose when and if they have a child. Based on the findings, a conceptual framework of childbearing behaviour is proposed which builds on existing theoretical explanations to explain why women do and do not have children, differences by parity, and the role of circumstances in women’s childbearing behaviour. The findings and conceptual framework have implications for public policies, and indicate that multiple approaches are required which are sensitive to and address the barriers women face in family formation.     

The effect of number of births on women's mortality: systematic review of the evidence for women who have completed their childbearing

Mortality in women who have completed their childbearing may increase with the number of births experienced because of maternal depletion or a trade-off between reproduction and mortality. We report a systematic review of the evidence on this association. We searched Medline, Embase, Popline, and the Science Citation Index for published and unpublished studies up to September 2003, and the book catalogues of relevant London libraries. Where necessary we also contacted authors for additional information. Mortality declined with increasing numbers of births in twelve historical cohorts, but in eight contemporary cohorts the highest mortality was seen in the nulliparous and in women with more than four births. All effects seen were small and there were few statistically significant results. Studies examining the relationship in other ways (such as by linear trends or by mean number of births by age at death) found inconsistent associations. We discuss methodological, social, and biological factors that may have affected these associations.     

Interrelationships between fertility and marital dissolution: Results of a simultaneous logit model

Previous studies have failed to examine (a) the simultaneity of decisions to bear children and to dissolve a marriage and (b) the effects of the childbearing in the period just before dissolution on the likelihood of disruption. We attempted to resolve both problems by developing a simultaneous logit model of the interrelationship between the probability of separation and of having a birth during this period (when dissolution presumably is being considered). The model was estimated at successive durations of first marriage, using data for white women in the 1970 National Fertility Survey. The results indicate that childbearing patterns— number of children and age of youngest child at the beginning of the marital interval being studied and fertility during the interval—did not influence the likelihood of separation in simple or consistent ways over the marital life course, nor did marital strife (as indicated by separation) seem to affect childbearing throughout marriage.