January 31, 2022
Fertility Awareness in the UK and Denmark: A Review of Research
By Antonella Rodríguez Santana
Editor’s Note: This is a review of research published in 2016 by Vassard et al in the UPSALA Journal of Medical Sciences titled, “A population-based survey on family intentions and fertility awareness in women and men in the United Kingdom and Denmark.” Antonella Rodríguez Santana summarized the study while on the FACTS elective. The research results affirm the need for fertility awareness education in Western developed countries.
Introduction
A new trend is unfolding in developed countries: people are waiting to have children. For first-time mothers, a higher mean age of 28-30 years is being seen in Western countries. Studies show that most people who do not have children desire to have children at some point in the future, with most people wanting two to three children. Since parenthood is being delayed, another trend is that people start planning their families at an age when female fertility has greatly declined. This results in many women who are either unable to achieve pregnancy or do not reach their goals of having two to three children. This is supported by studies that show many women and men underestimate the effects of age on fertility decline, which results in them making uninformed family planning decisions. This leads to difficulty having children and the need for fertility assistance in the future.
Methodology
An internet survey was advertised electronically and physically in the United Kingdom (UK) and Denmark from September 2012 to September 2013. A total of 1,237 participants made up of 1,000 women and 237 men completed the survey. Forty percent of participants were from the UK and 60% were from Denmark. The survey included questions about family formation: number of children they had, if they desired more children, and at what age they began trying to have children. Participants who did not have children were asked whether they wanted children, how many children they desired, and the age at which they wanted the first and last child. The survey also included questions about the participants’ awareness of women’s fertility and its age-related decline. Socio-demographic information was also obtained. The data was statistically analyzed using chi-square test to determine associations.
Results
Survey results established that participants from Denmark had a higher education status compared to those from the UK. Female responders from both countries had higher education than male participants. Most participants wished to have children in the future, and the majority wanted two to three children. It was found that 20% of women and 33% of men wanted a last child at the age of 40.
The survey also showed differences in fertility awareness between genders. Men were more likely than women to answer that women’s fertility starts to decline at age 35, making it difficult for a woman to have a child at age 40 or older. Participants who overestimated a woman’s likelihood of having children at age 30 were more likely to delay parenthood.
Discussion
Most participants wanted to have around two to three children, which has been supported by studies from several Western countries. The population-based survey by Vassard et al found that one-fifth of women and one-third of men wanted to have children after age 35, with a last child around the age of 40. These proportions were similar and correlated with those found in other studies.
Habbema et al performed simulations on fertility which show that women should start trying to conceive between ages 28 and 31 to have a 90% chance of having two to three children. Studies show that IVF treatment only makes up for half the births that would be achieved if parenthood was not postponed, yet participants seem to think IVF treatments could restore their fertility.
A similar knowledge of female fertility was reported between the United Kingdom and Denmark, with men in both countries knowing significantly less about female fertility than women. The study proposes that aspects other than fertility awareness, such as career plans and available paternity leave, were decisive factors on when to start having children.
The study also suggests that better education on the topics of fertility and family planning is needed so people can make informed decisions. These results are reinforced by a Canadian study reporting that women are more likely to start having children earlier if they know delaying parenthood will affect their chances of achieving pregnancy. Further education on fertility awareness and a shift towards making family formation a priority would assist parents in having more time, support, and benefits to feel comfortable balancing their careers and family planning.
References
[1] Vassard, D., Lallemant, C., Andersen, A., Macklon, N., Schmidt, L. “A population-based survey on family intentions and fertility awareness in women and men in the United Kingdom and Denmark”. Upsala Journal of Medical Science. 2016, https://www.tandfonline.com/doi/full/10.1080/03009734.2016.1194503?src=recsys.
[2] Cooke, A., Mills, TA., Lavender, T. “Informed and uninformed decision making’- Women’s reasoning experiences and perceptions with regard to advanced maternal age and delayed childbearing: a meta-analysis. Int J Nurs Studies. 2010. https://pubmed.ncbi.nlm.nih.gov/20580363/.
[3] Habbema, JDF., Eijkemans MJC., Leridon H., te Velde E. “Realizing a desired family size: when couples should start”. Human Reprod. 2015. https://pubmed.ncbi.nlm.nih.gov/26185187/.
[4] Daniluk, JC., Koert, E., Cheung, A. “A Childless women’s knowledge of fertility and assisted human reproduction: identifying the gaps”. Fertil Steril. 2021. https://pubmed.ncbi.nlm.nih.gov/22192349/.
[5] Daniluk JC., Koert, E. “Fertility awareness online: the efficacy of a fertility education website in increasing knowledge and changing fertility beliefs”. Hum Reprod. 2015. https://pubmed.ncbi.nlm.nih.gov/25480922/.
About the Author
Antonella Rodríguez Santana
Antonella Rodríguez Santana is a fourth-year medical student from the Universidad Central del Caribe in Puerto Rico. She participated in the FACTS online elective, which allowed her to expand her knowledge about female fertility and natural family planning methods.
