Psychosocial experiences of involuntary definitive childless women: a comparative study based on reproductive status.

STUDY QUESTION: Do involuntary definitive childless women have lower psychosocial adjustment levels than women with infertility diagnoses actively trying to conceive and presumably fertile women? SUMMARY ANSWER: Involuntary definitive childless women have lower levels of sexual functioning than infertile women actively trying to conceive and presumably fertile women, and higher levels of depression than presumably fertile women. WHAT IS KNOWN ALREADY: Involuntary definitive childless defines those who wanted to become parents but were unable to do so. Studies have provided evidence about infertility and its psychosocial consequences, but there is a lack of knowledge about the impact of involuntary definitive childlessness, namely on sexual function, social support, marital satisfaction, and psychological adjustment. STUDY DESIGN, SIZE, DURATION: This associative study was conducted between July 2021 and January 2022 for involuntary definitive childless women and between July 2016 and February 2018 for women with an infertility diagnosis actively trying to conceive as well as presumably fertile women. An online questionnaire announced in social media and gynaecology and fertility clinics was used. The inclusion criteria for all participants were being childless, in a heterosexual relationship and cohabiting for at least 2 years. Specific inclusion criteria for involuntary definitive childless women were: trying to conceive for at least 2 years; not achieving pregnancy because of biological and medical constraints; and not undergoing fertility treatment or being a candidate for adopting a child at time of the study. For women with an infertility diagnosis the inclusion criteria were: actively trying to conceive (naturally or through fertility treatments); having a primary fertility diagnosis; and aged between 22 and 42 years old. For presumably fertile women, the inclusion criteria were: having a parenthood wish in the future; and not knowing of any condition that could prevent them from conceiving. PARTICIPANTS/MATERIALS, SETTING, METHODS: Out of 360 women completing the survey, only 203 were eligible for this study (60 involuntary definitive childless women, 78 women with an infertility diagnosis actively trying to conceive, and 65 presumably fertile women). All participants completed a questionnaire including sociodemographic and clinical data, the Female Sexual Function Index, the 2-Way Social Support Scale, the Relationship Assessment Scale, and Hospital Anxiety and Depression Scale. Binary logistic regression was performed to assess the relation between sexual function, social support, marital satisfaction, anxiety, depression, and reproductive status, adjusting for age, and cohabitation length. Presumably fertile women were used as a reference group. MAIN RESULTS AND THE ROLE OF CHANCE: Women were 34.31 years old (SD = 5.89) and cohabited with their partners for 6.55 years (SD = 4.57). The odds ratio (OR) showed that involuntary definitive childless women had significantly lower sexual function than infertile women actively trying to conceive (OR = 0.88, 95% CI = 0.79-0.99) and presumably fertile women (OR = 34.89, 95% CI = 1.98-614.03), and higher depression levels than presumably fertile women (OR = 99.89, 95% CI = 3.29-3037.87). Women with an infertility diagnosis actively trying to conceive did not differ from presumably fertile women in sexual function, social support, marital satisfaction, anxiety, and depression. LIMITATIONS, REASONS FOR CAUTION: The majority of childless women underwent fertility treatments, and childlessness for circumstantial reasons owing to lack of a partner was not included, therefore these results may not reflect the experiences of all women with an involuntary childless lifestyle. There was a time gap in the recruitment process, and only the definitive childlessness group filled out the questionnaire after the coronavirus disease 2019 pandemic. We did not ask participants if they self-identified themselves with the groups' terminology they were assigned to. WIDER IMPLICATIONS OF THE FINDINGS: Our results emphasize the importance of future research to provide a more comprehensive understanding of the adjustment experiences of childless women and an awareness of the poor adjustment they might experience, highlighting the need to keep following women after unsuccessful treatments. Clinical practitioners must attend to these dimensions when consulting involuntary definitive childless women who might not have gone through treatments but also experience these adverse outcomes. STUDY FUNDING/COMPETING INTEREST(S): This study was partially supported by the Portuguese Foundation for Science and Technology. The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.

Fatherhood timing and men's midlife earnings: A within-family study of Finnish cohorts born in 1938-50.

Fathers tend to achieve higher earnings than childless men, but there is limited evidence on the associations between fatherhood timing and men's later earnings. Using a longitudinal census-based sample of Finnish men, including a subsample of brothers, we investigated fatherhood timing and men's midlife earnings using both between- and within-family models. Earnings around age 50 were lower among adolescent and young fathers than for men who became fathers at ages 25-29 or later, but these associations became negligible after accounting for measured confounders and unobserved familial confounding. Overall, our findings highlight the important roles of selection into early childbearing and into childlessness. At the population level, early fatherhood was associated with clear negative distributional shifts in fathers' midlife earnings. However, among all men, any influence of fatherhood timing on men's midlife earnings distribution paled in comparison with that of childlessness.

Infertility as Trauma: Understanding the Lived Experience of Involuntary Childlessness.

Infertility, to those who are affected by it, is much more than whether one manages (or not) to have a child: it can be a traumatizing experience. Based on a clinical case study that involved one-to-one psychotherapy sessions and semi-structured interviews with six involuntarily childless women living in Norway, this article develops the argument that there is a need to treat infertility as trauma, both conceptually and from the perspective of therapeutic practice. The analysis contributes to our understanding of trauma as a disruptive event that erodes a person's moral agency. It does so by outlining conceptual and therapeutic tools that illuminate what happens in the psyche as a result of the trauma: they help explaining why the moral agency of different individuals is damaged to different extents, and how therapy can repair it. In relation to the issue of involuntary childlessness, the analysis shows where infertility fits within one's traumabiography-a map of the way adverse experiences over the life-course have affected one's psyche and behavior-both as traumatizing in itself and connected to previous traumas. This understanding enables more effective therapeutic support and better care for many individuals whose long-term suffering would otherwise remain unacknowledged and untreated.

Diverse pathways to permanent childlessness in Singapore: A latent class analysis.

The proportions of adults reaching midlife without having children have been rising rapidly across the globe, particularly in Asia. However, little is known about the pathways to permanent childlessness within the region's childless population. This study utilized latent class analysis (LCA) to typologize pathways to childlessness based on dynamic characteristics of multiple life domains (i.e., partnership, education, and occupation) among 489 childless Singaporeans aged 50 and above from a 2022 nationwide survey. Additionally, we utilized multinomial logistic regressions to examine the sociodemographic correlates of pathway profiles and Shannon's entropy index to assess the heterogeneity in pathways to childlessness among successive cohorts. Results revealed five distinct profiles of pathways to childlessness: the Never-Married Semi-Professionals, the Low-Flex Blue-Collars, the Highly Educated Professionals, the Ever-Married Semi-Professionals, and the Flexible Blue-Collars. These pathway profiles were significantly associated with sociodemographic characteristics such as gender and family background. Women's pathways to childlessness were more standardized and heavily influenced by partnership characteristics, compared to those of men. The childless from privileged family background were less likely to follow pathways characterized by disadvantageous education and occupational status. There were also rising trends of voluntary childlessness among married childless individuals and increasing heterogeneity in pathways to childlessness across successive birth cohorts. In sum, our findings are consistent with some of the predictions of the Second Demographic Transition theory, suggesting that Singapore may be experiencing a demographic transition characterized by rising childlessness, decoupling of marriage and childbearing, and de-standardization of the life course.

How do people story their experience of miscarriage? A systematic review of qualitative literature.

Literature surrounding miscarriage is broad in scope, yet narrative constructions following miscarriage are significantly under-researched. Few studies have sought to understand sense-making processes following miscarriage, including how and why people story their experience. Consequently, the complexities and nuances of these processes have not been adequately explored. This review aimed to gain insight into what is already known about how people story their experience of miscarriage, as well as research gaps and limitations. A systematic literature review of qualitative literature was conducted across four databases to identify relevant research related to miscarriage narratives and sense-making. Eligibility criteria was applied to a staged screening process to identify the highest quality, peer-reviewed research. Ten studies were included in the review and presented as a narrative synthesis. The literature was divided into five collective themes: women's perspectives, male partner's perspectives, couples' perspectives, healthcare professional's perspectives, and cultural perspectives. The literature review summarises existing knowledge about narrative processes in relation to miscarriage, as well as highlighting research gaps, clinical implications, and directions for future research. When working with those who have experienced involuntary child loss and infertility, there is a need for professionals to have appropriate training to support the provision of compassionate, individualised care and decision-making. The role of language requires consideration as there is a need to address over-medicalised systems of knowledge, and it is important that there is understanding regarding the need for expression, and the various ways that individuals might express their feelings and loss.

Associations between factors in childhood and young adulthood and childlessness among women in their 40s: A national prospective cohort study.

BACKGROUND: While the risk factors for infertility are well-established, research on factors associated with voluntary childlessness is limited and mainly focused on adulthood factors. Thus, we examined the associations between factors in childhood and young adulthood and different types of childlessness. METHODS: The analysis included 4653 women from the Australian Longitudinal Study on Women's Health from 1996 to 2021. Childlessness was categorised as: voluntary, due to infertility issues, or due to other reasons. The associations between factors in childhood and young adulthood and childlessness were assessed using multinomial logistic regression models. RESULTS: In their 40s, 4.8 % of women were voluntarily childless, 6.7 % were childless due to infertility issues, and 7.8 % were childless due to other reasons. Regardless of types of childlessness, being childless was associated with poorer self-rated health during childhood and having been unpartnered and obese in young adulthood. Ex-smokers in young adulthood had lower odds of childlessness. Childhood physical abuse was associated with childlessness due to infertility issues and other reasons. Voluntary childlessness and childlessness due to infertility issues were associated with having identified as non-exclusively heterosexual in early adulthood. Lower social support in early adulthood was associated with voluntary childlessness and childlessness due to other reasons. LIMITATIONS: The direction of the associations could not be determined and using self-reported data may introduce recall bias. CONCLUSIONS: Factors in childhood and young adulthood were associated with different types of childlessness, highlighting the importance of adopting a life course perspective when studying childlessness.

Depression after pregnancy loss: the role of the presence of living children, the type of loss, multiple losses, the relationship quality, and coping strategies.

Background: Pregnancy loss (PL) is a common, yet rarely examined public health issue associated with an increased risk of impaired mental health, particularly depression.Objective: Previous research shows childlessness to be a correlate of depression after PL. First studies also indicate associations of the type of loss, multiple losses, relationship quality, and coping strategies with depression after the loss of a pregnancy. However, results are inconsistent and the few existing studies show methodological deficits. Therefore, we expect higher depression scores for women without living children, and we exploratively examine the associations between the type of loss, the number of losses, relationship quality, and coping strategies with depression scores for women who suffered a PL.Method: In an online setting, N = 172 women with miscarriage (n = 137) or stillbirth (n = 35) throughout the last 12 months completed the Patient Health Questionnaire (PHQ-D), Brief-COPE, and Partnerschaftsfragebogen (PFB), a German questionnaire measuring relationship quality.Results: In a multiple hierarchical regression analysis, stillbirth, ß = 0.15, p = .035, presence of living children, ß = -0.17, p = .022, and self-blame/emotional avoidance, ß = 0.34, p < .001, are predictors of depression scores. However, there was no association between depression symptoms and other coping strategies, relationship quality, and multiple losses.Conclusions: Especially with regard to women who have no living children, have suffered a stillbirth, or are affected by self-blame/emotional avoidance, health care providers should monitor the presence of depressive symptoms. Our results indicate the need for specific instruments measuring coping style and relationship quality after PL, since the standard items of the PFB and the Brief-COPE seem inappropriate for this setting.

Stillbirth is associated with higher maternal depression scores than miscarriage.Women with living children show lower depression scores after pregnancy loss than childless women.Self-blame and emotional avoidance are associated with higher maternal depression scores after pregnancy loss.

Las trayectorias de las mujeres sin hijos en Uruguay / Life-course trajectories of childless women in Uruguay / As trajetórias das mulheres sem filhos no Uruguai

El objetivo de este trabajo es analizar la población de mujeres uruguayas que finalizan su vida reproductiva sin hijos. Además de cuantificar el fenómeno, se busca responder las siguientes preguntas: ¿qué rasgos socioeconómicos las caracterizan?; ¿cuáles son las trayectorias típicas que conducen a la nuliparidez?; ¿en qué medida es el resultado de aspiraciones reproductivas frustradas o de la voluntad de no tener hijos? Para responder estas preguntas, se utiliza una estrategia de métodos combinados que integra datos cuantitativos y cualitativos. Los resultados muestran que la proporción de nulíparas descendió aproximadamente de 25% a 10%, entre las nacidas entre 1900 y 1960, y que en los datos más recientes se detecta un incipiente incremento. Además, hay una mayor proporción de nulíparas entre las mujeres de nivel educativo alto. Finalmente, la tipologización de trayectorias hacia la nuliparidez definitiva reafirma la heterogeneidad de caminos y atributos: aunque se identificaron trayectorias guiadas por la intención de no tener hijos, un conjunto importante de mujeres llega a la nuliparidez como una consecuencia no buscada de la postergación de la maternidad.

O objetivo deste artigo é estudar as mulheres uruguaias que terminam sua vida reprodutiva sem filhos. Além de quantificar o fenômeno, procura-se responder às seguintes questões: quais são seus principais traços socioeconômicos? Quais são as trajetórias típicas que levam essas mulheres a não se tornarem mães? Até que ponto essa situação é o resultado de aspirações reprodutivas frustradas e até que ponto da vontade de não ter filhos? A estratégia metodológica é baseada na combinação de informações quantitativas e qualitativas, utilizando métodos mistos. Os resultados evidenciam que a proporção de mulheres nulíparas, ao final do ciclo reprodutivo, diminuiu de aproximadamente 25% para 10%, entre as nascidas em 1900-1960, sendo que nos dados mais recentes é detectado um aumento incipiente. Além disso, há uma maior proporção de mulheres sem filhos entre as mulheres de alto nível educacional. Por fim, a tipologização das trajetórias que levam à nuliparidade definitiva reafirma a heterogeneidade de caminhos e atributos: embora tenham sido identificadas trajetórias guiadas pela intenção de não ter filhos, um importante grupo de mulheres chega ao final da vida reprodutiva como uma consequência não intencional do adiamento da maternidade.

This paper aims to analyze Uruguayan women who end their reproductive life span without having children. In addition to quantifying the phenomenon, it seeks to answer the following questions: Which are their main socioeconomic traits? What are the typical trajectories that lead to childlessness? To what extent is it the outcome of unsatisfied reproductive aspirations and to what extent of the will to not have any children? We use a mixed methods approach integrating quantitative and qualitative data. Our results show that the proportion of childless women dropped from approximately 25% to 10% among those born in 1900-1960, and that the most recent data show an incipient increase. In addition, there is a higher proportion of childless women among those with a high level of education. Finally, our typology of trajectories towards definitive childlessness confirms the diversity of paths and traits: although trajectories guided by the intention of not having children were identified, a significant number of women reach childlessness as an unintended consequence of the postponement of motherhood.

A não maternidade na contemporaneidade: um estudo com mulheres sem filhos acima dos 45 anos / The childlessness in contemporary times: a study with non-child women above 45 years old

Na contemporaneidade, um número crescente de mulheres tem vivenciado a não maternidade, constituindo um fenômeno recente e ainda pouco estudado. Nesse contexto, este estudo investigou os motivos apontados por mulheres associados à vivência da não maternidade, as características desse processo e desdobramentos em suas vidas. Esta pesquisa teve âmbito exploratório e descritivo, com método de análise de dados qualitativo. Participaram cinco mulheres acima dos 45 anos, que declararam ter optado por não serem mães, com as quais foram realizadas entrevistas semiestruturadas. Os dados foram analisados por meio de análise de conteúdo e os resultados apontam que a carreira profissional é indicada como principal motivo associado à vivência da não maternidade. Também se constatou como desdobramento desta escolha que essas mulheres sofrem pressões da sociedade, que culminam em ambivalência dos seus sentimentos. Destaca-se a característica de todas terem vivenciado relacionamentos amorosos conflituosos no percurso de suas vidas, por outro lado, elas declaram contar com expressiva rede social de apoio.(AU)

In contemporary times an increasing number of women have opted for non-motherhood, which has constituted a recent phenomenon that has yet to be thoroughly studied. Therefore, this study investigated the alleged reasons associated by woman to their non-motherhood, characteristics of this process and developments in theirs live. The scope of this research is both exploratory and descriptive, and uses qualitative data analysis. Semi-structured interviews were conducted with five women over age 45, who declared by choice decided not to be mothers. The data was analyzed using content analysis and the results indicated that career choice was the main reason for the option of non-motherhood. It was also discovered as a development that these women suffer society pressures regarding this choice culminating ambivalence in their feelings. It stands out the characteristic that all women have experienced loving and conflicting relationships during the course of their lives, however they declare to have significant social support network.(AU)

Casamento contemporâneo: revisão de literatura acerca da opção por não ter filhos / Contemporary marriage: a review of literature concerning voluntary childlessness

Em meio às diversas transformações sofridas pelo casamento e pela família ao longo da história, várias configurações familiares convivem na contemporaneidade: nuclear, monoparental, homoparental, recomposta, entre outras possibilidades. Nesse contexto, aumenta, em vários países, e mais recentemente no Brasil, o número de casais que escolhem não ter filhos. O objetivo deste trabalho foi realizar uma revisão bibliográfica sobre o tema, incluindo publicações nacionais e internacionais. A busca foi feita em bases de dados (Web of Science, PsycINFO, Medline, SciELO, Lilacs, Psicodoc, BVS-Psi, Dedalus), e foram levantados artigos completos em periódicos indexados e resumos de teses e dissertações produzidas nos últimos dez anos. Os resultados coletados abordam diversas facetas do fenômeno da escolha contemporânea por não ter filhos: motivações declaradas, associação entre esse tipo de escolha e a situação profissional, relação com fatores de história de vida e família de origem, satisfação de vida e conjugal, preconceito e estereótipos negativos.

Marriage and family have undergone several transformations throughout history. Nowadays many family structures coexist: nuclear, monoparental, homoparental, recomposed, amongst others. In this context, in many countries, and most recently in Brazil, there is an increasing number of couples who are voluntarily childless. The aim of this article is to perform a bibliographical research on this theme, including Brazilian and international publications. The search was conducted of a variety of databases (Web of Science, PsycINFO, Medline, SciELO, Lilacs, Psicodoc, BVS-Psi, Dedalus) and included complete articles published in indexed periodicals and dissertation abstracts, from the last ten years. The collected results take into account various aspects of this phenomenon - the contemporary choice to remain childless: Declared motivations, the association between this type of choice and professional status, the relationship with factors in the life history and family origins, marital adjustment and satisfaction with life, prejudice and negative stereotypes.