Dissertations and Theses

Date of Degree

1-1-2018

Document Type

Dissertation

Degree Name

Doctor of Public Health (DPH)

Department

Community Health and Social Sciences

Advisor(s)

Diana Romero

Committee Members

Barbara Katz Rothman

Mary Clare Lennon

Wendy Chavkin

Subject Categories

Community Health and Preventive Medicine | Maternal and Child Health | Public Health | Public Health Education and Promotion | Women's Health

Keywords

childbearing, maternal age, fertility intentions

Abstract

Thinking about, planning for, and having children is a deeply personal experience influenced by myriad factors at individual, intrapersonal, community and larger social levels. Examining fertility intentions is of interest to researchers from numerous social science disciplines in part because these intentions are potentially tied to larger demographic and economic shifts. In recent years in the U.S. the mean age at first birth has been increasing, with more women of older ages (age 35 and older) giving birth, due to both delays in childbearing that accompanied larger social trends such as increased educational and career opportunities and a decrease in the number of adolescent births after a concerted public health effort. As more women of older ages have children, some turn to assistance from reproductive technologies such as IVF and egg donation as these technologies become more widely available. Both the use of these technologies and the aging of motherhood as communicated both subtlety (e.g., within social circles) and more explicitly (e.g., in media stories about delayed childbearing, particularly among celebrities) may both have important implications in how we think about the norms around when and how to have children. This dissertation utilizes a three-paper approach to examine the association between age and fertility intentions, with an eye towards how an association may have changed over time. This is an issue that is not easily addressed with one approach: fertility intentions are complex, personal, and potentially fluid depending on one’s circumstances. I utilize data at three levels to try to understand this association and possible trends over time: data from a content analysis of medial sources are used to understand the social environment, data from the National Survey of Family Growth are used to understand population-level associations, and individual data from in-depth interviews with young adults (the Social Position and Family Formation study) are used to understand individual-level associations. In Chapter 1, I review the literature on fertility intentions and age and the data on age at first birth and the use of reproductive technologies and set out my rationale for the three approaches. Chapter 2 examines the media environment in which these decisions are made, examining how the media has portrayed delayed childbearing over time and how social media sources present ‘advanced maternal age’. I find that the term advanced maternal age is closely aligned with age 35 in both print and social media, but their usages vary, with social media users more commonly ‘reclaiming’ the term. I also find that over time there was not an increase in risk-framed stories (i.e., stories that portray delayed childbearing as negative and associated with risks) but rather an increase in empowerment-framed stories up until the past few years when they appear to slightly recede. In Chapter 3, I use a qualitative approach to understand how young adults think about the ideal age to have a child and what factors contribute to an age being ideal. I find that factors tend to fall in four main domains: structural/social position factors such as finances, interpersonal factors such as partner selection, fertility and health-related factors such as biological limitations, and aspirational factors, such as wanting to do things like travel before settling down and having children. The ideal age to have a child among this sample was 30 years. Interestingly, a number of individuals discuss an ideal age but their own planning around when to have a child indicates that they will likely overshoot that ideal. In Chapter 4, I use pooled cross sectional data from the National Survey of Family Growth from the period 1995-2013 to examine fertility intentions including wanting a child and desired number of children. I find that wanting a child is positively associated with being of advanced maternal age for data from 2002 and 2006-2010 compared to 1995, but this is not true in the most recent data. I do not find changes in desired number of additional children over time among women of advanced maternal age. In Chapter 5 I summarize key findings from each approach, look for areas of overlap, discuss what the findings mean for policies and future research, and speculate about where we, as a society, go from here.