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Whether, When, and How: Fertility Intentions and Age in the U.S

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Whether, When, and How: Fertility Intentions and Age in the U.S City University of New York (CUNY) CUNY Academic Works CUNY Graduate School of Public Health & Dissertations and Theses Health Policy 1-1-2018 Whether, When, and How: Fertility Intentions and Age in the U.S. Andrea Melnikas [email protected] How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/sph_etds/15 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] WHETHER, WHEN, AND HOW: FERTILITY INTENTIONS AND AGE IN THE U.S. A DISSERTATION by ANDREA J. MELNIKAS Concentration: COMMUNITY, SOCIETY, AND HEALTH Presented to the Faculty at the Graduate School of Public Health and Health Policy in partial fulfillment of the requirements for the degree of Doctor of Public Health Graduate School of Public Health and Health Policy City University of New York New York, New York DECEMBER 2017 Dissertation Committee: DIANA R. ROMERO, MA, PHD MARY CLARE LENNON, PHD BARBARA KATZ ROTHMAN, PHD WENDY CHAVKIN, MD, MPH Copyrighted By ANDREA J. MELNIKAS 2017 All rights reserved ii ABSTRACT WHETHER, WHEN, AND HOW: FERTILITY INTENTIONS AND AGE IN THE U.S. by Andrea J. Melnikas Advisor: Diana R. Romero, MA, Ph.D. 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 iii 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. iv Acknowledgments and Disclosure I am grateful for my professors, mentors, and colleagues who guided and supported me along the way. At CUNY SPH and the Graduate Center Diana Romero and Barbara Katz-Rothman have been key supporters and mentors since the beginning of this program. Mary Clare Lennon has been a shining example of how to distill complicated quantitative methods into simple concepts and I wish I had more time to learn from her in this program. Along with my impressive committee, Professors Echeverria, Freudenberg, and Gallo provided support and encouragement at key moments, whether they knew it or not. My external committee member, Wendy Chavkin, deserves special thanks for getting me interested in these topics back in 2008 as an MPH student at Columbia and teaching me something new about these topics each time we talk. My classmates and peers at CUNY SPH continue to inspire me with their commitment to public health and improving the lives of others. I am proud to be a part of the CUNY community. To my colleagues at the Population Council I specifically want to thank Peter Donaldson, Ann Blanc, Sarah Engebretsen and Sajeda Amin for being supportive and encouraging of this pursuit. The synergies between my work and education have been priceless and I look forward to using these skills to improve our work. To my friends and family I am grateful for their support over these 6 years and always believing that it was possible. Finally, to Aaron who sacrificed a lot so I could get here: thank you for the countless hours listening, reading, and encouraging. And to B and E, who make it clear that a healthier, more just and equitable society is one worth pursuing. Disclosure: The author is an employee of the Population Council and received financial support as part of an employee educational benefit program. v Table of Contents Chapter 1: Introduction and Literature Review ............................................................................................. 1 Understanding Fertility Intentions ............................................................................................................. 2 Theories Applicable to Fertility Intentions ................................................................................................. 2 Theoretical Framework ............................................................................................................................. 4 Fertility Intentions and Links to Behavior .................................................................................................. 6 Fertility Intentions, Age, and Health .......................................................................................................... 8 Fertility Knowledge and Age ................................................................................................................... 12 Research on Fertility Intentions and Age ................................................................................................ 13 Gaps in the Literature .............................................................................................................................. 18 Dissertation Summary ............................................................................................................................. 19 Tables and Figures ................................................................................................................................. 26 Chapter 2: A Content Analysis Examining the Portrayal of Delayed Childbearing and the Term “Advanced Maternal Age” in Popular Media ................................................................................................................. 32 Background ............................................................................................................................................. 32 Methods..................................................................................................................................................
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