Elizabeth Hervey Stephen

Impaired fecundity in the United States: 1982-1995.

CONTEXT The 1995 National Survey of Family Growth (NSFG) provides new nationally representative data to test the accuracy of the commonly held assumption that impaired fecundity has been rising in the United States over the past decade. METHODS Using data from the 1982, 1988 and 1995 rounds of the NSFG, trends in both the proportions and numbers of women with impaired fecundity and of those who received infertility services were examined. Multiple logistic regressions were carried out to estimate the effects of demographic characteristics on the likelihood of currently having impaired fecundity and of ever having received medical help for infertility. RESULTS The proportion of U.S. women aged 15-44 who reported some form of fecundity impairment rose from 8% in 1982 and 1988 to 10% in 1995, an increase in absolute numbers from 4.6 million to 6.2 million women. Although the proportion of fecundity-impaired women who had ever sought medical help did not change between 1988 and 1995 (44%), the absolute numbers of such women grew by nearly 30%, from 2.1 million to 2.7 million. Women who had ever sought help for fertility problems were older and had a higher income than those who had not, and were more likely to be married. CONCLUSION The dramatic increase in the numbers of U.S. women with impaired fecundity occurred because the large baby-boom cohort, many of whom delayed childbearing, had reached their later and less fecund reproductive years. This increase in both rates and numbers occurred across almost all age, parity, marital status, education, income, and race and ethnicity subgroups.

Updated projections of infertility in the United States: 1995–2025

OBJECTIVE To project the number of infertile women aged 15-44 every 5 years from 2000 to 2025. DESIGN Data are used from Cycle 5 of the National Survey of Family Growth conducted by the National Center for Health Statistics. Population projections prepared by the U.S. Bureau of the Census are used as the base population for 2000-2025. Prospective demographic projections are used to estimate the number of infertile women. PARTICIPANTS The National Survey of Family Growth (Cycle 5) interviewed 10,847 women aged 15-44 in 1995. MAIN OUTCOME MEASURE(S) Number of infertile women. RESULT(S) The number of women experiencing infertility will range from 5.4-7.7 million in 2025, with the most likely number to be just under 6.5 million. CONCLUSION(S) This is a substantial revision (upward) in the number of infertile women, largely a result of the increase in the observed percentage of infertile women in 1995. This is the base population of concern to providers; of particular interest is the percentage of infertile women who seek medical treatment.

Assimilation disruption and the fertility of Mexican origin women in the United States.

This research uses 1970 and 1980 Census data to test hypotheses about the effects of adaptation, assimilation and disruption on the fertility of Mexican-origin women. In the absence of longitudinal or life history data, the kinds of forces affecting immigrant group fertility can be inferred by: 1) examining the degree to which Mexican-origin women disaggregated by nativity or generational groups differ in fertility behavior from non-Hispanic Whites; 2) analyzing both current and cumulative fertility; 3) comparing the fertility of nativity or generational groups disaggregated by age of women and period of immigration; and 4) conducting cohort analyses between more than one time period. The findings show evidence of both assimilation and disruption effects on reproductive behavior. Fertility is found to decline the greater the length of familial exposure to the United States and, in the case of younger groups of immigrant women, to fall below the level of U.S.-born Mexican-origin and non-Hispanic White women when other variables are held constant. These results illustrate why assimilation effects on immigrant group fertility have often not emerged in previous research. They also imply that the fertility behavior of the Mexican-origin population is likely to come to resemble that of the rest of the population the longer this group resides in the United States.

Marital Noncohabitation: Separation Does Not Make the Heart Grow Fonder.

There are a variety of situations which arise such that husbands and wives live in separate households temporarily or permanently for reasons other than marital discord. Such living arrangements may have far-reaching implications and perhaps the most important question is whether living apart from ones spouse leads to divorce. The percentage of currently married persons living apart in the US is highest for ages 18-24 and for blacks. The 2 most common identifiable reasons for husbands and wives not living together are military service and incarceration. The authors found that those living apart from their spouses in 1976 were nearly twice as likely to experience a marital dissolution within 3 years as were persons cohabiting with their spouses. (authors)

Language Usage and Fertility in the Mexican-Origin Population of the United States

This article examines the effects of English proficiency and female education on cumulative and recent fertility within the Mexican-origin population in the U.S. To ascertain whether the cultural or the human capital aspects of linguistic variables have the greater salience for fertility behavior, fertility patterns of bilingual women are compared with those of monolingual women speaking English or Spanish. Using the 1980 U.S. Census 5 percent Public Use Micro data Sample for ever-married Mexican-origin women aged 15–44, we find that for almost all age cohorts, thee effects of English proficiency are negative and increase with rising education. The strength of the interaction is greater in younger age groups. Greater English proficiency is also associated with a more negative impact of education for native- than foreign-born women. Overall, the influence of “opportunity cost,” asopposed to cultural factors, is more important in shaping the fertility behavior of these women.

Racial Differences in Contraceptive Choice: Complexity and Implications

Previous research has failed to generate consensus about why black fertility has persistently exceeded that of whites in the United States. In an effort to shed light on this question, this article examines black/white differences in sociodemographic factors affecting contraceptive choice. Using data from the 1976 and 1982 National Surveys of Family Growth, we find a complex pattern of black/white differences. Not only does contraceptive choice vary by race, but the effects of such variables as age, marital status, and education also differ between blacks and whites. For example, compared with whites, black married women avoid coital methods, and compared with blacks, white women shift contraceptive behavior more as they change marital status. The complex nature of the racial differences in contraceptive choice are interpreted as reflecting differences in marriage patterns and trends.

Projections of impaired fecundity among women in the United States: 1995 to 2020 *

OBJECTIVE To determine the number of women aged 15 to 44 years with impaired fecundity every 5 years from 1995 to 2020. DESIGN Data are used from cycle IV of the National Survey of Family Growth conducted by the National Center for Health Statistics. Population projections prepared by the U.S. Census Bureau are used for the expected population base for 1995 to 2020. Prospective demographic projection analysis is used to estimate the number of women with impaired fecundity. PARTICIPANTS The National Survey of Family Growth interviewed 8,450 women aged 15 to 44 years as of March 15, 1988. MAIN OUTCOME MEASURE Number of women with impaired fecundity. RESULTS The number of women with impaired fecundity may drop from 5.1 million in 1995 to 4.7 million in 2015 and then rise to 4.8 to 5.9 million in 2020. CONCLUSION The age structure of the population will cause the absolute number of women with impaired fecundity in the United States to increase slowly, if at all, over the next 25 years.

Supply of and demand for assisted reproductive technologies in the United States: clinic- and population-based data, 1995-2010.

OBJECTIVE To study national-level trends in assisted reproduction technology (ART) treatments and outcomes as well as the characteristics of women who have sought this form of infertility treatment. DESIGN Population-based study. SETTING Not applicable. PATIENT(S) For CDC: All reporting clinics from 1996-2010. For NSFG: for the logistic analysis, sample comprising 2,325 women aged 22-44 years who have ever used medical help to get pregnant, excluding women who used only miscarriage prevention services. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) CDC data (number of cycles, live birth deliveries, live births, patient diagnoses); and NSFG data (individual use of ART procedures). RESULT(S) Between 1995 and 2010, use of ART increased. Parity and age are strong predictors of using ART procedures. The other correlates are higher education, having had tubal surgery, and having a current fertility problem. CONCLUSION(S) The two complementary data sets highlight the trends of ART use. An increase in the use of ART services over this time period is seen in both data sources. Nulliparous women aged 35-39 years are the most likely to have ever used ART services.

Demographic implications of reproductive technologies

Medical advances in the infertility field are coming at a rapid pace. This paper examines four areas of demography that are being affected by the delivery of infertility services in the United States, or have the potential to be affected. The greatest effects are currently seen in the rapid increase in the rate of multiple deliveries, with smaller effects evident in delayed childbearing. To date the sex ratio at birth in the United States has not been affected by reproductive technologies. The experience from Asian countries such as Korea and China indicates that massive societal change coupled with reproductive technologies could bring about changes in the sex ratio at birth in the United States. The last area examined is the intergenerational transmission of infertility which to date has not been largely affected by reproductive technologies, but has the potential to affect a larger proportion of the population.

Korean unification: a solution to the challenges of an increasingly elderly population?

South Korea experienced below replacement fertility for the first time in 1983, which also marked the point from which fertility rates continued to decline over the next 20 years to reach a low of 1.2 in 2003. In spite of recent pronatalist policies, the fertility rate has remained near this level and has not increased appreciably. The reasons for sustained low fertility in South Korea are complex and solutions remain elusive. One option that has been suggested is reunification with North Korea, which could address the eventual decline in the population and mitigate the increasing proportion of the elderly. Although the conditions surrounding the German reunification experience were vastly different than what Korea will likely undergo, it is informative to look at Germany as a guide to the demographic parameters of reunification. Three projection models for 2015–2050 are presented; even the highest fertility models show that reunification will not be the answer to population restructuring already underway in South Korea as a result of sustained low fertility.