Showing papers on "Fertility published in 2003"

Births: final data for 2002.

Abstract: OBJECTIVES: This report presents 2002 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race, Hispanic origin, marital status, and educational attainment; maternal characteristics (medical risk factors, weight gain, tobacco, and alcohol use); medical care utilization by pregnant women (prenatal care, obstetric procedures, complications of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, abnormal conditions, congenital anomalies, and multiple births). Also presented are birth and fertility rates by age, live-birth order, race, Hispanic origin, and marital status. Selected data by mother's State of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. METHODS: Descriptive tabulations of data reported on the birth certificates of the 4.022 million births that occurred in 2002 are presented. Denominators for population-based rates are derived from the 2000 U.S. census. Rates for 1991-2001 may differ from those published previously based on the 1990 U.S. census. RESULTS: There were 4,021,726 live births in 2002, essentially unchanged from 2001. The birth rate, fertility rate, and total fertility rates all declined 1 percent in 2002. The teenage birth rate dropped 5 percent, reaching another record low. The birth rates for women 20-24 years declined, whereas the rate for women 25-29 years was stable. The birth rate for women 30-34 years declined, but the rate for women 35-44 years continued to rise. Births to unmarried women changed very little. Smoking during pregnancy was down again. The timeliness of prenatal care continued to improve. The cesarean delivery rate climbed to the highest level ever reported in the United States (26.1 percent) and the rate of vaginal birth after previous cesarean plummeted 23 percent to 12.6 percent. Preterm and low birthweight levels both rose for 2002. The twin birth rate continued to climb, but the rate of triplet/+ births was down slightly.

The Demographic Transition: Three Centuries of Fundamental Change

Abstract: Before the start of the demographic transition, life was short, births were many, growth was slow and the population was young. During the transition, e rst mortality and then fertility declined, causing population growth rates e rst to accelerate and then to slow again, moving toward low fertility, long life and an old population. The transition began around 1800 with declining mortality in Europe. It has now spread to all parts of the world and is projected to be completed by 2100. This global demographic transition has brought momentous changes, reshaping the economic and demographic life cycles of individuals and restructuring populations. Since 1800, global population size has already increased by a factor of six and by 2100 will have risen by a factor of ten. There will then be 50 times as many elderly, but only e ve times as many children; thus, the ratio of elders to children will have risen by a factor of ten. The length of life, which has already more than doubled, will have tripled, while births per woman will have dropped from six to two. In 1800, women spent about 70 percent of their adult years bearing and rearing young children, but that fraction has decreased in many parts of the world to only about 14 percent, due to lower fertility and longer life. 1 These changes are sketched in Table 1. These trends raise many questions and controversies. Did population grow so

Role of sperm chromatin abnormalities and DNA damage in male infertility

Abstract: Sperm DNA integrity is essential for the accurate transmission of genetic information. It has a highly compact and complex structure and is capable of decondensation-features that must be present in order for a spermatozoon to be considered fertile. Any form of sperm chromatin abnormalities or DNA damage may result in male infertility. In support of this conclusion, it was reported that in-vivo fecundity decreases progressively when > 30% of the spermatozoa are identified as having DNA damage. Several methods are used to assess sperm chromatin/DNA, which is considered an independent measure of sperm quality that may yield better diagnostic and prognostic approaches than standard sperm parameters (concentration, motility and morphology). The clinical significance of this assessment lies in its association not only with natural conception rates, but also with assisted reproduction success rates. Also, it has a serious impact on the offspring and is highly prognostic in the assessment of fertility in cancer patients. Therefore, screening for sperm DNA damage may provide useful information in cases of male idiopathic infertility and in those men pursuing assisted reproduction. Treatment should include methods for prevention of sperm DNA damage.

The measurement and meaning of unintended pregnancy.

Abstract: Unintended pregnancy combines two aspects of fertility: unwanted and mistimed pregnancies. The personal partnership social and political realities of these two aspects are different and the use of separate categories may better reflect the way women think about a pregnancy. A better understanding of the multiple dimensions of unintended pregnancy also may lead to a better understanding of the consequences of these pregnancies. Likewise better knowledge of the extent of mistiming and perhaps the strength of intentions may be important in understanding health impact. Effective programs to prevent unintended pregnancy must use terms that are familiar to women and must build upon cultural understanding of the problem to be prevented. Research should focus on the meaning of pregnancy intentions to women and the processes women and their partners use in making fertility decisions. It should prospectively address the impact of pregnancy intentions on contraceptive use. Both qualitative and quantitative research have contributed to our understanding of fertility decisionmaking; both will be essential to the creation of more effective prevention programs. (excerpt)

Inequality and Growth: Why Differential Fertility Matters

Abstract: We argue that inequality and growth are linked through differential fertility and the accumulation of human capital. We build an overlapping-generations model in which dynasties differ in their initial endowment with human capital. Growth, the income-distribution, and fertility are endogenous. Due to a quantiy-quality tradeoff, families with less human capital decide to have more children and invest less in education. When initial inequality is high, large fertility differentials lower the growth rate of average human capital, since poor families who invest little in education make up a large fraction of the population in the next generation. A calibrated model shows that this fertility-differential effect is quantitatively important. We also provide empirical evidence to confirm the links between inequality, differential fertility and growth suggested by the model.

[The aging process in the Brazilian population: a demographic approach].

Abstract: Contrary to common sense, the population aging process is due to the decline in fertility rather than mortality. The aging process began around the end of the 19th century in a number of Western European countries, expanded to the rest of the so-called First World over the past century, and reached several Third World countries afterwards, including Brazil over the last decades. In the Brazilian case, a sharp and widespread fertility decline began by the end of the 1960s, and an accelerated population aging process can thus be expected. This process will necessarily be faster and with deeper structural changes, demographically speaking, than in First World countries, for two reasons: the fertility decline in Brazil was faster, and it took place in a population with a younger age structure.

Time to pregnancy: results of the German prospective study and impact on the management of infertility

Abstract: BACKGROUND: The likelihood of spontaneous conception in subsequent cycles is important for a balanced management of infertility. Previous studies on time to pregnancy are mostly retrospective and biased because of exclusion of truly infertile couples. The study aim was to present a non-parametric estimation of cumulative probabilities of conception (CPC) in natural family planning (NFP) users illustrating an ideal of human fertility potential. METHODS: A total of 346 women was observed who used NFP methods to conceive from their first cycle onwards. The couples practising NFP make optimal use of their fertility potential by timed intercourse. The CPC were estimated for the total group and for couples who finally conceived by calculating Kaplan-Meier survival rates. RESULTS: A total of 310 pregnancies occurred among the 346 women; the remaining 36 women (10.4%) did not conceive. Estimated CPC for the total group (n = 340 women) at one, three, six and 12 cycle(s) were 38, 68, 81 and 92% respectively. For those who finally conceived (truly fertile couples, n = 304 women), the respective pregnancy rates were 42, 75, 88 and 98% respectively. Although the numbers of couples in both groups were similar, the impact of age on time to conception, as judged by the Wilcoxon test, was less in the truly fertile than in the total group. CONCLUSIONS: Most couples conceive within six cycles with timed intercourse. Thereafter, every second couple is probably either subfertile or infertile. CPC decline with age because heterogeneity in fecundity increases. In the subgroup of truly fertile couples, an age-dependent decline in CPC is statistically less obvious because of high homogeneity, even with advancing age.

The emergence of Sub-Replacement Family Size Ideals in Europe

Abstract: Period fertility started to drop significantly below replacement in most Western European countries during the 1970s and 1980s, while most fertility surveys, value studies and opinion polls have found that the number of children considered ideal for society or for one's own family has remained above two children per woman. These surveys have led to the expectation that, sooner or later, period fertility would recover in Europe. The most recent data from the Eurobarometer 2001 survey, however, suggest that in the German-speaking parts of Europe the average ideal family sizes given by younger men and women have fallen as low as 1.7 children. This paper examines the consistency and the credibility of these new findings, which - if they are indeed indications of a new trend - may alter the current discussion about future fertility trends in Europe.

The World Turned Upside Down: Below Replacement Fertility, Changing Preferences and Family-Friendly Public Policy in 21 OECD Countries:

Abstract: Over the past two decades, a decline in birth rates in advanced industrialized societies to levels well below those required for population replacement has been accompanied by a major change in the cross-national incidence of fertility. This has, in turn, given rise to a massive transformation in traditional cross-national patterns of relationships between fertility and other variables. Whereas previously the countries with the highest period fertility rates were those in which family-oriented cultural traditions were most pronounced and in which women's labour market participation was least, these relationships are now wholly reversed. This study uses data for 21 OECD countries to provide a more thorough and systematic mapping of the linkages between fertility, cultural values, economic structure and social policy than has hitherto been attempted in the literature, while simultaneously addressing some of the theoretical and methodological issues that arise in explaining a reversal of this magnitude. It a...

The association of age and semen quality in healthy men

Abstract: Background Although the effect of maternal age on fertility is well known, it is unclear whether paternal age also affects fertility. This cross-sectional study sought to characterize the association between age and semen quality, a well-known proxy of fertility status. Methods A convenience sample of 97 non-smoking men (aged 22-80 years) without known fertility problems was recruited from a national government laboratory. The men provided semen samples and information relating to lifestyle, diet, medical and occupational details. Semen volume (ml), sperm concentration (x10(6)/ml), total sperm count (x10(6)), motility (%), progressive motility (%) and total progressively motile sperm count (x10(6)) were measured. Results After adjusting for covariates, semen volume decreased by 0.03 ml per year of age (95% CI: -0.05, -0.01); motility decreased by 0.7% per year (95% CI: -0.92, -0.43); progressive motility decreased by 3.1% per year (95% CI: -4.5, -1.6); and total progressively motile sperm count decreased by 4.7% per year (95% CI: -7.2, -2.2). There was a suggested decrease in sperm concentration and count. The proportion of men with abnormal volume, concentration and motility was significantly increased across the age decades. Conclusions In a convenience sample of healthy men from a non-clinical setting, semen volume and sperm motility decreased continuously between 22-80 years of age, with no evidence of a threshold.

Mortality Reductions, Educational Attainment, and Fertility Choice

Abstract: This paper explores the role of life expectancy as a determinant of educational attainment and fertility, both during the demographic transition and after its completion. Two main points distinguish our analysis from the previous ones. First, together with the investments of parents in the human capital of children, we introduce investments of adult individuals in their own education, which determines productivity in both the goods and household sectors. Second, we let adult longevity affect the way parents value each individual child. Increases in adult longevity eventually raise the investments in adult education. Together with the higher utility derived from each child, this tilts the quantity-quality trade off towards less and better educated children, and increases the growth rate of the economy. Reductions in child mortality may have similar effects -- or may only affect fertility -- depending on the nature of the costs of raising children. This setup can explain both the demographic transition and the recent behavior of fertility in ``post-demographic transition'' countries, ignored by the previous literature and incompatible with most of its results. Evidence from historical experiences of demographic transition, and from the recent behavior of fertility, education, and growth supports the predictions of the model

Laboratory semen assessment and prediction of fertility: still utopia?

Abstract: Finding a laboratory test reliable enough to predict the potential fertility of a given semen sample or a given sire for artificial insemination (AI) is still considered utopian, as indicated by the modest correlations seen between results obtained in vitro and field fertility. Male fertility is complex, and depends upon a heterogeneous population of spermatozoa interacting at various levels of the female genital tract, the vestments of the oocyte, and the oocyte itself. For this reason, laboratory assessment of semen must include the testing of most sperm attributes relevant for fertilization and embryo development, not only in individual spermatozoa but within a large sperm population as well. Strategies for the discovery of in vitro predictors of semen fertility require evaluations of low sperm doses for AI, so that differences in innate in vivo fertility can be accurately detected.

Rethinking the evolutionary theory of aging: Transfers, not births, shape senescence in social species

Abstract: The classic evolutionary theory of aging explains why mortality rises with age: as individuals grow older, less lifetime fertility remains, so continued survival contributes less to reproductive fitness. However, successful reproduction often involves intergenerational transfers as well as fertility. In the formal theory offered here, age-specific selective pressure on mortality depends on a weighted average of remaining fertility (the classic effect) and remaining intergenerational transfers to be made to others. For species at the optimal quantity–investment tradeoff for offspring, only the transfer effect shapes mortality, explaining postreproductive survival and why juvenile mortality declines with age. It also explains the evolution of lower fertility, longer life, and increased investments in offspring.

Is low fertility a twenty-first-century demographic crisis?

Abstract: Nearly half of the world’s population in 2000 lived in countries with fertility rates at or below replacement level, and nearly all countries will reach low fertility levels in the next two decades. Concerns about low fertility, fertility that is well below replacement, are widespread. But there are both persistent rationales for having children and institutional adjustments that can make the widespread intentions for two children attainable, even in increasingly individualistic and egalitarian societies.

Migration and Fertility: Competing Hypotheses Re-examined

Abstract: Competing views exist concerning the impact of geographical mobility on childbearing patterns. Early research shows that internal migrants largely exhibit fertility levels dominant in their childhood environment, while later studies find migrants’ fertility to resemble more closely that of natives at destination. Some authors attribute the latter to adaptation, others claim the selection of migrants by fertility preferences. Moreover, short-term fertility-lowering-effects of residential relocation have also been proposed and challenged in the literature. This paper contributes to the existing discussion by providing an analysis of the effect of internal migration on fertility of post-war Estonian female cohorts. We use retrospective event-history data and apply intensity regression for both single and simultaneous equations. Our analysis shows that first, the risk of birth for native residents decreases with increasing settlement size and the decrease is larger for higher-order parities. Second, it shows that migrants, whatever their origin, exhibit fertility levels similar to those of non-migrants at destination. We also observe elevated fertility levels after residential relocations arising from union formation. Our further analysis supports the adaptation hypothesis. We find no evidence on (strong) selectivity of migrants by fertility preferences.

The Changing Institutional Context of Low Fertility

Abstract: Using data for 1960–97 for 22 low fertility countries, we document a dramatic change in the association of fertility levels to women's levels of labor force participation. Until the 1980s, this association had been strongly negative. However, during the 1980s itbecame positive, and since 1990 strongly positive. We also document an emerging positive association of the country-level total fertility ratio (TFR) and nonmarital ratio (e.g., the proportion of births to unmarried women). We argue that these transformed associations reflect societal level responses that, in some contexts, have eased the incompatibility between mother and worker roles, and loosened the link betweenmarriage and childbearing. These arguments imply that societal responses to mother/worker incompatibility exert substantial influence on fertility levels in low fertility countries.

Gendering fertility: Second births in Sweden and Hungary

Abstract: With the growing prevalence of the dual-earner family model in industrialized countries the gendered nature of the relationship between employment and parenting has become a key issue for childbearing decisions and behavior. In such a context taking into account the societal gender structure (public policies, family-level gender relations) explicitly can enhance our understanding of contemporary fertility trends. In this paper we study the second birth, given its increasing importance in the developed world as large proportions of women remain childless or bear only one child. We focus on Sweden where gender equality is pronounced at both the societal and the family level and on Hungary where the dual-earner model has been accompanied by traditional gender relations in the home sphere. Our analysis is based on data extracted from the Swedish and Hungarian Fertility and Family Surveys of 1992/93. We use the method of hazard regression. The results suggest that the second-birth intensity increases as the combination of parenthood and labor-force attachment of either parent is facilitated. We see this in the effect of family policies in Sweden and in the higher second-birth intensity of couples who share family responsibilities as compared to those with traditional gender-role behavior in both countries. Also, the lack of any visible impact of men's educational attainment in both Sweden and Hungary is probably linked to public policies as state support for families with children has reduced the importance of income for second childbearing. A positive educational gradient for Swedish women and an essentially zero gradient in Hungary reflects the success of policy measures in reducing fertility cost for more educated women in both countries.

Completing the fertility transition in the developing world: The role of educational differences and fertility preferences

Abstract: This study summarizes patterns of educational differentials in wanted and unwanted fertility at different stages of the fertility transition. The data are from Demographic and Health Surveys in 57 less developed countries. As the transition proceeds, educational differentials in wanted fertility tend to decline and differentials in unwanted fertility tend to rise. An assessment of fertility patterns in developed and less developed countries with low fertility concludes that these differentials are likely to remain substantial when less developed countries reach the end of their transitions. This conclusion implies that the educational composition of the population remains a key predictor of overall fertility in late transitional countries and that low levels of schooling can be a cause of stalling fertility.

Missing the target? Correspondence of fertility intentions and behavior in the U.S

Abstract: Building on a framework suggested by Bongaarts (2001)and using data from the 1979 National LongitudinalSurvey of Youth, we describe the correspondencebetween intended family size and observed fertilityfor the 1957 to 1961 birth cohorts of US women andmen Over an 18-year period (1982–2000), we showthat while aggregate intentions are quite stable,discrepancies are very common at the individual levelWomen and men were more likely to err in predictingnumber of additional births in the period 1982–2000 thanto hit their target number A very strong predictor of over-and underachieving fertility is initial intended parity Thosewho intended more than two children tended to have fewerchildren than intended, while those who intended fewer thantwo children tended to have more children than intended Inaddition and consistent with life course arguments, thoseunmarried in 1982, childless in 1982, and (for women) stillin school in 1982 were most likely to underachieve their 2000intended parity (ie, have fewer children than intended) Weconclude by reflecting on how the circumstances that allowdiscrepancies between intentions and behavior to almost``balance'' in the US may cumulate differently elsewhere toproduce much lower fertility

Female fecundity before and after operation for familial adenomatous polyposis.

Abstract: Background: Knowledge about the fertility of women suffering from familial adenomatous polyposis (FAP) is scarce and inconclusive. The purpose of this study was to investigate the fecundity of women with FAP before and after operation, and to compare the findings with those of a general population database and women with ulcerative colitis. Methods: A questionnaire concerning reproductive experiences and waiting times to pregnancy was sent to all 230 women on the polyposis registers in Denmark, Finland, Sweden and Norway in whom primary surgery had consisted of ileorectal anastomosis or ileal pouch–anal anastomosis. Data on the general population and women with ulcerative colitis came from an existing database. Cox regression and Kaplan–Meier plots were used for analysis. Results: The fecundity of women with FAP before operation and after colectomy with ileorectal anastomosis was similar to that of the general population. However, fecundity dropped to 54 per cent (P = 0·015) following proctocolectomy with ileal pouch–anal anastomosis, although it was greater than the postoperative fecundity of women with ulcerative colitis. Conclusion: The significant reduction in female fecundity after ileal pouch–anal anastomosis should be communicated to young women with FAP before it is decided which surgical option to follow. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Explanations of the Fertility Crisis in Modern Societies: a Search for Commonalities

Abstract: Near-global fertility decline began in the 1960s, and from the 1980s an increasing number of European countries and some Asian ones achieved very low fertility (total fertility below 1.5) with little likelihood of completed cohort fertility reaching replacement level. Earlier theory aiming at explaining this phenomenon stressed the incompatibility between post-industrial society and behaviour necessary for population replacement. Recent theory has been more specific, often concentrating on the current Italian or Spanish situations or on the contrast between them and the situation in either Scandinavia or the English-speaking countries, or both. Such an approach ignores important evidence, especially that from German-speaking populations. The models available concentrate on welfare systems and family expenses, omitting circumstances that may be unique to individual countries or longer-term factors that may be common to all.

Low Fertility Rates in OECD Countries

Abstract: Fertility rates have declined in most OECD countries to levels that are well below those needed to secure generation replacement. While attitudes towards this decline in fertility rates differ across countries, several OECD governments have introduced — or are considering — specific measures aimed at countering it. Such measures are often justified by government’s wish of either reducing some of the negative consequences of population ageing for society as a whole, or of removing obstacles that discourage those women wishing to have more children from doing so, because of the negative economic consequences of childbearing and of the length of the associated responsibilities. This paper provides a comparative overview of the evidence about the size, timing and nature of this decline in fertility rate across "mature" OECD countries, and about the effects of different measures introduced to deal with it. The first chapter of this paper reviews a range of indicators of the fertility ...

The predictive value of semen analysis in the evaluation of stallion fertility.

Abstract: Pregnancy rates in managed horse populations depend on the innate fertility of the mares and stallions involved and on the quality of breeding management. Of course, because a single stallion usually mates many mares, stallion fertility is a critical factor in the overall success of a breeding program. Unfortunately, accurate evaluation of stallion fertility per se requires a large number of normal mares to be mated and is necessarily retrospective. Rather, the ideal is to predict fertility in advance of the stallion's breeding career, and this is currently attempted by way of a thorough physical examination and a routine analysis of semen quality. However, while such a 'breeding soundness examination' identifies stallions that clearly lack the capacity for adequate fertility, it is of limited use for predicting the level of fertility and fails to identify some seriously sub-fertile animals. Similarly, while various sperm function tests (e.g., sperm head morphometry, the hypoosmotic swelling test, glass wool-sephadex filtration, progesterone receptor exposure) have been shown to correlate fairly well with fertility in the field, most examine only a single or a narrow range of the attributes that a sperm must possess if it is to fertilize an oocyte in vivo, and are thus more useful for identifying specific causes of sub-fertility than for predicting the level of fertility. On the other hand, combining the results of the various sperm function tests does improve the reliability of fertility estimation and current research is therefore concentrated on identifying a range of tests that covers as many important sperm attributes as possible but that can be performed rapidly and cheaply. In this respect, flow-cytometry has proven to be an ideal tool because it allows the objective, rapid and simultaneous analysis of a number of properties in a large number of sperm. Moreover, stains are available for an increasing range of sperm characteristics including viability, capacitation and acrosome status, mitochondrial activity and chromatin integrity. Flow-cytometric analysis of sperm with appropriate probes thus offers considerable promise for the prediction of stallion fertility.

Diagnosis and Management of Female Infertility

Abstract: INFERTILITY, DEFINED AS 1 YEAR OF attempted conception without success, is one of the most prevalent chronic health disorders involving young adults Affecting 6 million or more US couples, infertility is clinically distinct from recurrent spontaneous pregnancy loss Since 1978, the management of female infertility has been transformed by in vitro fertilization (IVF) Intracytoplasmic sperm injection (ICSI), first reported as an IVF laboratory technique in 1992, has similarly changed the management of male infertility In vitro fertilization and ICSI have increased knowledge of the mechanisms of fertilization and implantation, leading to better awareness of potential fertility defects before and after fertilization, as well as possible errors in embryonic development The use of IVF and ICSI remains low, however, because of the cost and complexity of the treatment

Channels of Social Influence on Reproduction

Abstract: The article investigates the different types of social mechanisms responsible for the interdependence of couples' reproductive preferences predicted by diffusion models of fertility and family behavior. We analyze the transcripts of in-depth interviews carried out with 54 women in the northern part of Italy. The rich information on observations and conversations about fertility and family choices with relatives and peers enables us to distinguish four different ways in which social interaction influences reproductive preferences, namely social learning, social pressure, subjective obligation and contagion. Second, we show how the efficacy of each mechanism affecting fertility behavior depends on the kind and the structure of personal relationships involved in the interaction. Finally, we discuss the ways in which individual attitudes and values associated with the transition to parenthood are produced and negotiated in face-to-face interactions, and the importance of focusing on the process of preference-formationand modification for understanding fertility behavior.

Relationships between contraception and abortion: a review of the evidence.

Abstract: CONTEXT: The relationship between levels of contraceptive use and the incidence of induced abortion continues to provoke heated discussion, with some observers arguing that use of abortion decreases as contraceptive prevalence rises and others claiming that increased use of family planning methods causes abortion incidence to rise. METHODS: Abortion trends are examined in countries with reliable data on abortion and with contraceptive prevalence information from two points in time showing increases in contraceptive use. The role of changes in fertility in mediating the relationship between abortion and contraception is also explored. RESULTS: In seven countries--Kazakhstan, Kyrgyz Republic, Uzbekistan, Bulgaria, Turkey, Tunisia and Switzerland--abortion incidence declined as prevalence of modern contraceptive use rose. In six others--Cuba, Denmark, Netherlands, the United States, Singapore and the Republic of Korea--levels of abortion and contraceptive use rose simultaneously. In all six of these countries, however, overall levels of fertility were falling during the period studied. After fertility levels stabilized in several of the countries that had shown simultaneous rises in contraception and abortion, contraceptive use continued to increase and abortion rates fell. The most clear-cut example of this trend is the Republic of Korea. CONCLUSIONS: Rising contraceptive use results in reduced abortion incidence in settings where fertility itself is constant. The parallel rise in abortion and contraception in some countries occurred because increased contraceptive use alone was unable to meet the growing need for fertility regulation in situations where fertility was falling rapidly.

Frustrated Fertility: Infertility and Psychological Distress among Women.

Abstract: Using a random sample of 580 Midwestern women, we test the hypothesis that women who have experienced infertility report higher psychological distress. Approximately one third of our sample reports having experienced infertility sometime in their lives, although the majority of the infertile now have biological children. Drawing hypotheses from identity and stress theories, we examine whether roles or resources condition the effects of infertility or whether its effects are limited to childless women. Infertility combined with involuntary childlessness (including biological and social) is associated with significantly greater distress. For women in this category, the risk of distress is substantial.