Childlessness and Health Among Older Adults: Variation Across Five Outcomes and 20 Countries.

OBJECTIVES: No previous study to the best of our knowledge has examined the association between childlessness and health using a wide range of countries and health outcomes. This study improves previous literature by examining the relationship between "childlessness" (1 = childless for any reason, 0 = parent of biological, step, or adopted child) and health across 20 countries and five health outcomes. METHODS: Drawing on cross-sectional harmonized data from the family of Health and Retirement Surveys across the United States (HRS, Wave 11), Europe (SHARE, Waves 4 and 5), Mexico (MHAS, Wave 3), and China (CHARLS, Wave 2), we use logistic regression models to estimate the association between childlessness and poor health (poor self-rated health, 1 or more ADL limitations, 1 or more IADL limitations, 1 or more chronic conditions, and depression) in a sample of adults aged 50 and older across 20 countries (N = 109,648). RESULTS: Our results point to an absence of associations between childlessness and health, and suggest that childlessness may be associated with better (e.g., Mexico, Hungary) or worse health (e.g., Austria, Estonia, Netherlands, Poland) in certain contexts and for certain measures. DISCUSSION: We discuss these findings in light of the meaning of childlessness, as well as cross-national economic, social, and cultural contexts to provide suggestions for aging policy and future research.

Early marriage and early childbearing in South Asia: trends, inequalities, and drivers from 2005 to 2018.

Early marriage (EM) and early childbearing (ECB) have far-reaching consequences. This study describes the prevalence, trends, inequalities, and drivers of EM and ECB in South Asia using eight rounds of Demographic and Health Survey data across 13 years. We report the percentage of ever-married women aged 20-24 years (n = 105,150) married before 18 years (EM) and with a live birth before 20 years (ECB). Relative trends were examined using average annual rate of reduction (AARR). Inequalities were examined by geography, marital household wealth, residence, and education. Sociodemographic drivers of changes for EM were assessed using regression decomposition analyses. We find that EM/ECB are still common in Bangladesh (69%/69%), Nepal (52%/51%), India (41%/39%), and Pakistan (37%/38%), with large subnational variation in most countries. EM has declined fastest in India (AARR of -3.8%/year), Pakistan (-2.8%/year), and Bangladesh (-1.5%/year), but EM elimination by 2030 will not occur at these rates. Equity analyses show that poor, uneducated women in rural areas are disproportionately burdened. Regression decomposition analysis shows that improvements in wealth and education explained 44% (India) to 96% (Nepal) of the actual EM reduction. Investments across multiple sectors are required to understand and address EM and ECB, which are pervasive social determinants of maternal and child wellbeing.

Preferences, Partners, and Parenthood: Linking Early Fertility Desires, Marriage Timing, and Achieved Fertility.

In the United States, underachieving fertility desires is more common among women with higher levels of education and those who delay first marriage beyond their mid-20s. However, the relationship between these patterns, and particularly the degree to which marriage postponement explains lower fertility among the highly educated, is not well understood. We use data from the National Longitudinal Survey of Youth 1979 cohort to analyze differences in parenthood and achieved parity for men and women, focusing on the role of marriage timing in achieving fertility goals over the life course. We expand on previous research by distinguishing between entry into parenthood and average parity among parents as pathways to underachieving, by considering variation in the impact of marriage timing by education and by stage of the life course, and by comparing results for men and women. We find that women with a bachelor's degree who desired three or more children are less likely to become mothers relative to women with the same desired family size who did not attend college. Conditional on becoming mothers, however, women with at least a bachelor's degree do not have lower completed family size. No comparable fatherhood difference by desired family size is present. Postponing marriage beyond age 30 is associated with lower proportions of parenthood but not with lower parity among parents. Age patterns are similar for women and men, pointing at social rather than biological factors driving the underachievement of fertility goals.

Recent Trends in U.S. Childbearing Intentions.

The U.S. period total fertility rate has declined steadily since the Great Recession, reaching 1.73 children in 2018, the lowest level since the 1970s. This pattern could mean that current childbearing cohorts will end up with fewer children than previous cohorts, or this same pattern could be an artifact of a tempo distortion if individuals are simply postponing births they plan to eventually have. In this research note, we use data on current parity and future intended births from the 2006-2017 National Survey of Family Growth to shed light on this issue. We find that total intended parity declined (from 2.26 in 2006-2010 to 2.16 children in 2013-2017), and the proportion intending to remain childless increased slightly. Decomposition indicates that the decline was not due to changes in population composition but rather changes in the subgroups' rates themselves. The decline in intended parity is particularly notable at young ages and among those who are Hispanic. These results indicate that although tempo distortion is likely an important contributor to the decline in TFR, it is not the sole explanation: U.S. individuals are intending to have fewer children than their immediate predecessors, which may translate into a decline in cohort completed parity. However, the change in intended parity is modest, and average intended parity remains above two children.

Exposure to Armed Conflict and Fertility in Sub-Saharan Africa.

Changes in fertility patterns are hypothesized to be among the many second-order consequences of armed conflict, but expectations about the direction of such effects are theoretically ambiguous. Prior research, from a range of contexts, has also yielded inconsistent results. We contribute to this debate by using harmonized data and methods to examine the effects of exposure to conflict on preferred and observed fertility outcomes across a spatially and temporally extensive population. We use high-resolution georeferenced data from 25 sub-Saharan African countries, combining records of violent events from the Armed Conflict Location and Event Data Project (ACLED) with data on fertility goals and outcomes from the Demographic and Health Surveys (n = 368,765 women aged 15-49 years). We estimate a series of linear and logistic regression models to assess the effects of exposure to conflict events on ideal family size and the probability of childbearing within the 12 months prior to the interview. We find that, on average, exposure to armed conflict leads to modest reductions in both respondents' preferred family size and their probability of recent childbearing. Many of these effects are heterogeneous between demographic groups and across contexts, which suggests systematic differences in women's vulnerability or preferred responses to armed conflict. Additional analyses suggest that conflict-related fertility declines may be driven by delays or reductions in marriage. These results contribute new evidence about the demographic effects of conflict and their underlying mechanisms, and broadly underline the importance of studying the second-order effects of organized violence on vulnerable populations.

The Effects of Marital Status, Fertility, and Bereavement on Adult Mortality in Polygamous and Monogamous Households: Evidence From the Utah Population Database.

Although the associations among marital status, fertility, bereavement, and adult mortality have been widely studied, much less is known about these associations in polygamous households, which remain prevalent across much of the world. We use data from the Utah Population Database on 110,890 women and 106,979 men born up to 1900, with mortality follow-up into the twentieth century. We examine how the number of wife deaths affects male mortality in polygamous marriages, how sister wife deaths affect female mortality in polygamous marriages relative to the death of a husband, and how marriage order affects the mortality of women in polygamous marriages. We also examine how the number of children ever born and child deaths affect the mortality of men and women as well as variation across monogamous and polygamous unions. Our analyses of women show that the death of a husband and the death of a sister wife have similar effects on mortality. Marriage order does not play a role in the mortality of women in polygamous marriages. For men, the death of one wife in a polygamous marriage increases mortality to a lesser extent than it does for men in monogamous marriages. For polygamous men, losing additional wives has a dose-response effect. Both child deaths and lower fertility are associated with higher mortality. We consistently find that the presence of other kin in the household-whether a second wife, a sister wife, or children-mitigates the negative effects of bereavement.

Reproductive health challenges of male and female street beggars and use of reproductive health services by female street beggars in Ife-Ijesa, Nigeria.

OBJECTIVES: The aims of the study were to investigate the reproductive health challenges in Nigeria of male and female street beggars and the use of reproductive health services by female street beggars. METHODS: The study had a cross-sectional descriptive design. An interviewer-administered questionnaire, designed by the authors, was used to elicit information from 100 male and female street beggars recruited over a 4 week period in Ife-Ijesa zone, south-western Nigeria. Information was obtained about male and female participants' reproductive health challenges (symptoms and issues) and female participants' use of reproductive health services. RESULTS: More than a third of participants were aged ≥60 years (37%), 57% were men, 82% were from the Hausa tribe and 92% were Muslims. The main reasons given for street begging were poverty (30%) and physical handicap (66%). Although most of the street beggars were aware of the availability of reproductive health services (81%) and where to access them (89%), only a small proportion of female street beggars had given birth in hospital (9.3%) and family planning services (32.6%). CONCLUSION: Street beggars are a poor and vulnerable group with reproductive health challenges. They have difficulty accessing reproductive health services because of physical disabilities and related low socioeconomic status.

Child volunteers in a women's paramilitary organization in World War II have accelerated reproductive schedules.

Understanding how conditions experienced during development affect reproductive timing is of considerable cross-disciplinary interest. Life-history theory predicts that organisms will accelerate reproduction when future survival is unsure. In humans, this can be triggered by early exposure to mortality. Previous studies, however, have been inconclusive due to several confounds that are also likely to affect reproduction. Here we take advantage of a natural experiment in which a population is temporarily divided by war to analyze how exposure to mortality affects reproduction. Using records of Finnish women in World War II, we find that young girls serving in a paramilitary organization wait less time to reproduce, have shorter inter-birth intervals, and have more children than their non-serving peers or sisters. These results support the hypothesis that exposure to elevated mortality rates during development can result in accelerated reproductive schedules and adds to our understanding of how participation in warfare affects women.

Fertility intentions and maternal health behaviour during and after pregnancy.

This study examines associations between fertility intentions and maternal health behaviours during and after pregnancy among a nationally representative sample of 3,442 women from India. Two waves of data (2005, 2012) from the India Human Development Survey were analyzed to investigate the influence of unwanted births on women's use of antenatal care, timely postnatal care, and the delivery setting using binary and ordered logistic regression, partial proportional odds models, and propensity score weighting. Fifty-eight per cent of sample births were unwanted. Regression results show that, net of maternal and household characteristics, women with unwanted births were less likely to obtain any antenatal care and had fewer antenatal tests performed. Unwantedness was also associated with a lower likelihood of delivering in an institutional setting and of obtaining timely postnatal care. The relationships between unwantedness and antenatal care, postnatal care, and delivery setting were robust to models accounting for propensity weighting.

Declining realisation of reproductive intentions with age.

STUDY QUESTION: What is the likelihood of having a child within 4 years for men and women with strong short-term reproductive intentions, and how is it affected by age? SUMMARY ANSWER: For women, the likelihood of realising reproductive intentions decreased steeply from age 35: the effect of age was weak and not significant for men. WHAT IS KNOWN ALREADY: Men and women are postponing childbearing until later ages. For women, this trend is associated with a higher risk that childbearing plans will not be realised due to increased levels of infertility and pregnancy complications. STUDY DESIGN, SIZE, DURATION: This study analyses two waves of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. The analytical sample interviewed in 2011 included 447 men aged 18-45 and 528 women aged 18-41. These respondents expressed a strong intention to have a child in the next 3 years. We followed them up in 2015 to track whether their reproductive intention was achieved or revised. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: Multinomial logistic regression is used to account for the three possible outcomes: (i) having a child, (ii) not having a child but still intending to have one in the future and (iii) not having a child and no longer intending to have one. We analyse how age, parity, partnership status, education, perceived ability to conceive, self-rated health, BMI and smoking status are related to realising or changing reproductive intentions. MAIN RESULTS AND THE ROLE OF CHANCE: Almost two-thirds of men and women realised their strong short-term fertility plans within 4 years. There was a steep age-related decline in realising reproductive intentions for women in their mid- and late-30s, whereas men maintained a relatively high probability of having the child they intended until age 45. Women aged 38-41 who planned to have a child were the most likely to change their plan within 4 years. The probability of realising reproductive intention was highest for married and highly educated men and women and for those with one child. LIMITATIONS, REASONS FOR CAUTION: Our study cannot separate biological, social and cultural reasons for not realising reproductive intentions. Men and women adjust their intentions in response to their actual circumstances, but also in line with their perceived ability to have a child or under the influence of broader social norms on reproductive age. WIDER IMPLICATIONS OF THE FINDINGS: Our results give a new perspective on the ability of men and women to realise their reproductive plans in the context of childbearing postponement. They confirm the inequality in the individual consequences of delayed reproduction between men and women. They inform medical practitioners and counsellors about the complex biological, social and normative barriers to reproduction among women at higher childbearing ages. STUDY FUNDING/COMPETING INTEREST(S): This research was partly supported by a Research School of Social Sciences Visiting Fellowship at the Australian National University and an Australian Research Council Discovery Project (DP150104248). Éva Beaujouan's work was partly funded by the Austrian Science Fund (FWF) project 'Later Fertility in Europe' (Grant agreement no. P31171-G29). This paper uses unit record data from the HILDA Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Social Services (DSS) and is managed by the Melbourne Institute of Applied Economic and Social Research (Melbourne Institute). The findings and views reported in this paper, however, are those of the authors and should not be attributed to either DSS or the Melbourne Institute. The authors have no conflicts of interest.

Socio-demographic factors associated with delayed childbearing in Nigeria.

OBJECTIVE: Delayed childbearing is an emerging public health issue in developing countries compared with more developed countries, where it is already a major clinical and public health concern. Previous studies have mostly focused on either the health risks associated with delayed childbearing or the reasons for it with little done around the socio-demographic factors associated with it in developing countries. The objective of the study was to examine associated socio-demographic factors of delayed childbearing in Nigeria. RESULTS: The study used secondary data pooled from 2003 to 2013 Nigeria Demographic and Health Surveys. The outcome variable was delayed childbearing. The explanatory variables are selected individual socio-demographic characteristics and community characteristics. A weighted sample size of 20,550 women was analysed. Results showed a prevalence of 8.0% delayed childbearing in Nigeria. Socio-demographic factors such as higher maternal education, age at first marriage of 25 years or older, modern contraceptive use, and remarriage status were significantly associated with delayed childbearing. Significant associations were also observed with high community literacy level and high proportion of women who ever used modern contraceptive in the community.

Reproductive decisions as mediators between education and employment of women in Kyrgyzstan.

Researchers created a large body of evidence showing that education and fertility are strong determinants of women's employment. In postsocialist economies, women's reproductive decisions have become more critical to employment opportunities. Yet the issue is not well-understood. The researchers focus on the mediating roles of reproductive decisions on the relationship between education and employment among Kyrgyzstani women. The study data come from the 2012 Demographic and Health Survey (N = 2419). Consistent with other research, more education was associated with fewer number of children and being employed. An unexpected finding was that having more children was associated with increased employment.

Prevalence and associated factors of unintended pregnancy among pregnant woman in Gondar town, North west Ethiopia, 2014.

OBJECTIVE: The purpose of this study was to assess prevalence and associated factors of unintended pregnancy among pregnant women in Gondar town, North western Ethiopia, 2014. A community based cross-sectional study was conducted among pregnant women to select 325 participants for face to face interview by using simple random sampling technique from April 1-May 30, 2014. Bivariate and multivariate data analysis was performed using SPSS for Windows version 20 and level of significance of association was determined at P value < 0.05. RESULT: This study identified that 20.6% of pregnant women were unintended of which 6.8 were mistimed and 13.8 were unwanted. Unintended pregnancy was associated with family size (≥ 4) (AOR = 2.92; 95% CI 1.605, 5.31), marital status (single) (AOR = 12.59; 95% CI 5.18, 30.6) and age at first pregnancy < 18 years AOR (95% CI) 3.02 (1.522, 6.245). Therefore it is important to adequately counsel women concerning positive mind-sets about its prevention mechanism and its consequences of unintended pregnancies.

Fertility desire and associated factors among women on the reproductive age group of Antiretroviral treatment users in Jimma Town, South West Ethiopia.

OBJECTIVES: HIV remained the major cause of death in women of reproductive age worldwide. There is limited evidence regarding the fertility desire of HIV positive women receiving HIV care in the study area. Therefore, facility based cross-sectional study was conducted from March to April 2017 to assess fertility desire of HIV positive women and associated factors among mothers in receiving HIV care Jimma town, Southwest Ethiopia. Simple random sampling technique was taken to draw the sample after stratification. Data were analyzed using SPSS version 21 and statistical significance was declared at P value less than 0.05. RESULTS: This finding showed that, 175 (46.8%) of the Antiretroviral therapy users had fertility desire with those significantly associated factors; women in the age 18-29 years [AOR = 4.05, 95% CI 1.24-13.33], being married [AOR = 0.32, 95% CI (0.13-0.78)], having diploma educational level [AOR = 5.34, 95% CI 1.10, 15.60], having only boys or girls children [AOR = 2.79, 95% CI (1.24-6.25)], having 18-36$ monthly income [AOR = 1.27, 95% CI (1.56-10.67)], Partner's HIV status [AOR = 3.56, 95% CI (3.02-9.33)] and non use of contraceptives [AOR = 2.57, 95% CI (1.08-6.13)]. Fertility desire in the study area was high. Strengthening PMTCT service should consider fertility desire of mothers living with HIV.

Spacing, Stopping, or Postponing? Fertility Desires in a Sub-Saharan Setting.

A growing body of research has argued that the traditional categories of stopping and spacing are insufficient to understand why individuals want to control fertility. In a series of articles, Timæus, Moultrie, and colleagues defined a third type of fertility motivation-postponement-that reflects a desire to avoid childbearing in the short term without clear goals for long-term fertility. Although postponement is fundamentally a description of fertility desires, existing quantitative research has primarily studied fertility behavior in an effort to find evidence for the model. In this study, we use longitudinal survey data to consider whether postponement can be identified in standard measures of fertility desires among reproductive-age women in rural Mozambique. Findings show strong evidence for a postponement mindset in this population, but postponement coexists with stopping and spacing goals. We reflect on the difference between birth spacing and postponement and consider whether and how postponement is a distinctive sub-Saharan phenomenon.

Relationships of Reproductive Coercion and Intimate Partner Violence to Unintended Pregnancy.

OBJECTIVE: To examine the prevalence, correlates, and influences of male partner reproductive coercion (RC) and intimate partner violence (IPV) on unintended pregnancy (UIP). DESIGN: Retrospective cohort study using population-based data. SETTING: Six participating states contributed data from the Pregnancy Risk Assessment Monitoring System (PRAMS). PARTICIPANTS: Data were obtained for 20,252 women who gave birth between 2012 and 2015 and completed the PRAMS survey within 9 months of giving birth. METHODS: Weighted descriptive statistics and multivariate logistic regression models were used to assess the influence of RC and IPV on odds of UIP. RESULTS: Approximately 2.7% (n = 600) of participants reported physical IPV, and 1.1% (n = 285) reported RC. Participants less than 30 years of age, with low socioeconomic status, who were single and of Black or Hispanic race/ethnicity were at significantly increased risk of IPV. With the exception of Hispanic race/ethnicity, these sociodemographic characteristics were also associated with an increased risk for RC. Participants who experienced IPV had a nearly eightfold increased risk of RC (adjusted odds ratio = 7.98, 95% confidence interval [CI] [4.68, 13.59]) than their nonabused counterparts. In univariate models, RC, IPV, or RC with IPV were significantly associated with increased odds of UIP (odds ratio [OR] = 2.18, 95% CI [1.38, 3.44]; OR = 2.36, 95% CI [1.75, 3.19]; OR = 3.55, 95% CI [1.56, 8.06], respectively); however, results were nonsignificant after adjusting for sociodemographic factors. CONCLUSION: In this population-based sample, we confirmed that there were links among IPV, RC, and UIP, all factors associated with poor maternal and infant outcomes. Screening for IPV and RC is an important step toward reducing rates of UIP.

Analysis of sexual and reproductive health indicators of Brazilian adolescents, 2009, 2012 and 2015. / Análise dos indicadores de saúde sexual e reprodutiva de adolescentes brasileiros, 2009, 2012 e 2015.

OBJECTIVE: To analyze sexual and reproductive health indicators of adolescents based on data from the National School-based Health Survey (PeNSE) in 2015, comparing them to the data from 2009 and 2012. METHODS: Cross-sectional study that has analyzed data from 9th grade students from PeNSE 2015, 2012 and 2009. We estimated prevalence and 95% confidence intervals for the following indicators: sexual initiation, condom use in the last sexual intercourse, counseling for pregnancy, sexually transmitted infections and free condoms in the three rounds of the survey. Prevalence of all indicators accessed in 2015 was estimated according to sex, type of school and region. Pearson's χ2 test was used. RESULTS: The prevalence of sexual initiation reported by adolescents has decreased from 30.5%, in 2009, to 27.5%, in 2015, as well as the use of condom in the last intercourse, from 75.9 to 66.2%, respectively. In respect to counseling, there was a reduction regarding pregnancy prevention in public schools, from 81.1 to 79.3% and in relation to free condom in private schools, from 65.4 to 57.3%. About 30% reported using both condom and another contraceptive method, and 19.5% did not use any method. Boys presented greater prevalence of sexual initiation, higher number of partners and reduced prevalence of condom use. Adolescents living in North, Northeast and Central-West regions presented worse indicators. CONCLUSION: There was a reduction in sexual initiation and condom use among Brazilian adolescents, boys were more vulnerable to sexually transmitted infections, and girls from public schools were more vulnerable to pregnancy.

OBJETIVO: Analisar indicadores de saúde sexual e reprodutiva de adolescentes com base nos dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) em 2015, comparando-os aos de 2009 e 2012. MÉTODOS: Estudo transversal que analisou dados de escolares do nono ano da PeNSE 2015, 2012 e 2009. Estimou-se a prevalência com intervalos de confiança de 95% para indicadores de iniciação sexual, uso do preservativo na última relação sexual, ter recebido orientação para gravidez, infecções sexualmente transmissíveis e preservativo grátis nas três edições. Prevalências dos indicadores de 2015 foram estimadas segundo sexo, dependência administrativa da escola e região. Utilizou-se o teste do χ2 de Pearson para diferenças estatísticas. RESULTADOS: A prevalência de iniciação sexual apresentou queda, de 30,5% em 2009 para 27,5% em 2015, assim como do uso de preservativo, de 75,9 para 66,2%. Notou-se queda da orientação para prevenção de gravidez nas escolas públicas, de 81,1 para 79,3% e de preservativo gratuito nas escolas privadas, de 65,4 para 57,3%. Cerca de 30% relataram uso combinado de preservativo e outro método e 19,5% não fizeram uso de método algum. Observou-se que meninos apresentaram maior prevalência de iniciação sexual, maior número de parceiros e menor uso de preservativo. As regiões norte, nordeste e centro-oeste apresentaram pior desempenho dos indicadores. CONCLUSÃO: Evidenciou-se diminuição da iniciação sexual e do uso de preservativo entre adolescentes, maior vulnerabilidade às infecções sexualmente transmissíveis nos meninos e à gravidez entre as adolescentes de escolas públicas.

Postponing Childbearing and Fertility Preservation in Young Professional Women.

OBJECTIVES: To evaluate young women's awareness of ovarian reserve testing and oocyte cryopreservation (OC) and assess how testing ovarian reserve may affect the desire for fertility preservation. METHODS: Three questionnaire-based observational studies were conducted among female students/young professionals 20 years of age and older. The third survey was completed after participants were offered anti-Mullerian hormone (AMH) testing. The main outcomes measured included awareness that OC is available, interest in pursuing fertility preservation, and whether interest would change based on knowledge of declining fertility. RESULTS: The first tier of the study included a survey of a total of 337 women. The majority of female subjects were aware of OC (92.1%). Approximately 38.5% of the women responded that they would consider OC for future fertility purposes. This percentage increased to 60.3% if one was aware her fertility was declining. The second tier of the study included 42 resident/fellow physicians who were offered AMH testing. A survey was completed before and after testing was completed. Approximately 12% of participants stated that their AMH level altered their anticipated age of childbearing, whereas 24% would consider cryopreservation based on their results. The most common concern regarding OC was the cost. CONCLUSIONS: Women should be counseled regarding reproductive aging and options for fertility preservation. Offering ovarian reserve testing and making OC more affordable may increase the number of women who undergo elective OC.

The impact of delayed maternity on foetal growth in Spain: An assessment by population attributable fraction.

BACKGROUND: Delayed childbearing is considered a risk factor for maternal-foetal health. As in other higher-income countries, in Spain age at maternity has steadily increased during the last two decades. AIM: To quantify the impact of the delay in the age at maternity on small for gestational age (SGA) categories of <3rd, 3rd-5th and 5th-10th percentiles. METHODS: 2,672,350 singleton live births born to Spanish mothers in 2007-2015 were analysed. Adjusted relative risk was calculated to estimate the adjusted partial population attributable fractions (PAFp) for mothers aged 35-39 and ≥40 years for each category of SGA considering the interaction between age at maternity and parity. FINDINGS: Primipara 35-39 years old mothers have the highest PAFp in the three categories of SGA, with the maximum value for SGA <3rd percentile (2.57%, 95% CI 2.25, 2.88). PAFp for both primipara and multipara ≥40 years old mothers were less than 1%. PAFp for primipara older mothers increased significantly in 2007-2015 for the three categories of SGA, more clearly among those aged 35-39 years. The contribution of multipara mothers of both age groups did not increase significantly during the period. CONCLUSION: Delayed maternity is a significant adjusted risk factor for SGA, contributing to the increase of its prevalence. However, results also suggest a limited clinical impact of delayed maternity on foetal growth. Positive changes in maternal profile associated with the shift in maternal age might contribute to explain the limited impact of mothers aged 35 years and older on negative birth outcome in Spain.