Elsevier

Contraception

Volume 79, Issue 2, February 2009, Pages 98-104
Contraception

Original research article
Analysis why nulliparous women over age 33 wish to use contraception,☆☆

https://doi.org/10.1016/j.contraception.2008.09.005Get rights and content

Abstract

Background

In industrialized countries, the average age of first childbirth is increasing and more women are having no children. An understanding of the reasons for delay might provide strategies aimed at reversing this trend.

Study Design

A questionnaire survey of 234 nulliparous women aged 34 and over attending a family planning clinic in Scotland in 2006 for contraception to determine fertility intentions; awareness of fertility decline with age; and factors influencing the decision to delay childbearing.

Results

One hundred and sixteen women (49.6%) definitely/possibly wanted children; 118 women (50.4%) did not. Of those wanting children, 71% were concerned or very concerned about their future fertility. Most were realistic about the time it may take to conceive. Seventy-four percent of women who definitely/may want children gave reasons to do with their relationship/s as the most common reason for delay. The second most common reason was having other distractions in life. Only 34% of those wanting children, and 15% of those who did not, reported that work/training issues caused the delay.

Conclusion

Most women were aware of the risks of delaying childbirth; however, the most common reason for delay concerned lack of the ‘right’ partner, something which does not lend itself to intervention.

Introduction

The emphasis in most family planning services around the world is on preventing unwanted/unintended pregnancy. Arguably, services also have a role in preventing unintended infertility. In the industrialized world, family planning providers are aware that many women using their services are intentionally delaying pregnancy until rather late in life. In 2005, the average age at which women in the Netherlands had their first child was 29.4 years [1] and in the same year, for the first time ever, British women in their early 30s had higher fertility rates than women in their late 20s [2]. Similar trends have been observed in the United States, where in 2005 birth rates for women aged 30 and over rose to levels not seen in almost 40 years [3]. Delaying childbearing inevitably means that some couples will have fewer children than they would like, and some will not have any. In the UK, one in 10 women born in 1945 and one in five born in 1960 have no children and this figure is expected to rise to about 22% among women born in 1990 [4]. While for some women this is intentional, in a study of the fertility intentions of childless UK women, 44% of women aged 35–39 years who had intended having children remained childless [5].

Much has been written about the implications of this trend for society. Smaller families mean fewer people of working age contributing to the economy; a decrease in the capacity of informal care for the ageing population (grown-up children taking care of their parents); and rising costs to the health service of treating older couples with sub-fertility. For individuals and couples who may live to regret their decision to postpone childbirth, there are the emotional and psychological effects of involuntary childlessness.

There are, of course, many reasons for postponing childbearing and these have been widely debated in both the lay and professional press. It has been suggested that women postpone childbirth whilst they progress in their chosen careers and achieve a high standard of living [6], [7], [8]. The costs of having children and the loss of income incurred as a result of early childbearing may also play a part [8]. The average ‘mid-skilled’ UK woman is said to forego over half a million pounds in lifetime earnings if she has her first child at 24, but only around £150,000 if she waits until she is 28 [6]. A shift in the ideals and aspirations of women towards ‘post-materialist values’ in which people lead more individualistic lives and prioritize personal freedom has also been suggested by scientists and the media as a common reason for delaying childbearing [2], [9], [10]. Finally, the popular press tends to emphasize the difficulty people have in finding a suitable partner with whom to start a family [11]. Whatever the reason for delay, it is widely held that the decision to postpone childbearing is not fully informed and that women place too much confidence in the success of assisted conception technologies [2], [7]. The commercial sector has been quick to capitalize on the fuss about women delaying childbearing, and over-the-counter tests to predict future fertility are widely advertised.

A number of studies have investigated women's fertility intentions and reasons for postponing childbirth. In a survey of German university staff aged 27–61 years, 67% of women delaying childbearing cited socioeconomic reasons for doing so and only 18% lack of a partner [12]. In contrast, in an interview study of 45 childless US women in their 30s, over half cited the lack of a suitable partner, and only 11% financial reasons, as the reason for remaining childless [13].

In the light of this controversy, and aware that many nulliparous women in their mid-30s and later attend our clinics for contraception, we undertook a questionnaire survey designed to investigate their fertility intentions and the factors that had affected their decision not to have children yet. We also took the opportunity to explore their knowledge on the chances of getting pregnant relatively late in life and their interest in paying for fertility tests.

Section snippets

Methods

During May–July 2006, a self-completed questionnaire was offered to all childless women aged 34 and over attending a large community family planning clinic (FPC) in Edinburgh, Scotland, for contraceptive advice or supplies. Women attending the clinic for reasons other than contraception (such as for cervical screening or with gynecological problems) were excluded from the study.

The questionnaire comprised 21 questions, starting with seven about age, marital status, education, employment,

Results

A total of 250 questionnaires were completed. An estimated 10 women declined to complete the questionnaire, always for lack of time. Data from 11 women who were trying to get pregnant, two aged 33, two who had been sterilized and one woman who did not declare her age, were excluded leaving a total of 234 questionnaires for analysis.

Respondents were divided into two groups: women who definitely wanted (86) or may want children (30) (116 in total, 49.6%) and women who definitely did not want

Discussion

Over the last four decades, a number of surveys have investigated fertility intentions, mostly among women but at least one among men [14]. Most have surveyed respondents in a wide age range [14], [15] and many have been undertaken in academic settings [15], [16]. The more detailed qualitative research has focussed on pregnant women or women attending infertility clinics [13], [17], [18], [19]. To our knowledge, this is the only study undertaken among older women still actively trying to avoid

Acknowledgments

We thank Dr Rob Elton, Honorary Fellow, Public Health Sciences Section, Community Health Sciences, University of Edinburgh, for his statistical analysis and interpretation of data.

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    Conflict of interest: None of the authors have any conflict of interest with this work.

    ☆☆

    This study was funded by NHS Lothian.

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