Trends in fertility and abortion in Czechia.

The assessment of the development of fertility and abortion rates over the last three decades shows that Czechia has reached the top position in Europe with a total fertility rate of 1.83 children per woman in 2021. The postponement of fertility to women's older age, which was behind the sharp drop in fertility to 1.1, has been gradually slowed down and halted between 2015 and 2021. In recent years, there has been an increase in fertility rates for women aged 30 and older as well as a balanced increase for women under 30. In the European context Czechia has maintained its position as a country with lower rates of reproductive ageing. The favourable demographic position of Czechia among European countries is also illustrated by the relatively low level of the abortion rate. The postponement of female fertility to older ages has not been accompanied by an increase in the abortion rate among young women, but on the contrary a decline in fertility has been accompanied by a decline in the abortion rate. Given the year-on-year increase in total fertility (from 1.71 in 2020 to 1.83 in 2021), the initial effect of the COVID-19 pandemic on fertility can be assessed positively. However, the subsequent decline to 1.62 in 2022 is already the result of a combination of adverse effects stemming from the consequences of antipandemic measures and worsening economic conditions, to which new security risks associated with the war in Ukraine have subsequently been added. This has created the conditions for a further postponement of fertility until women are older.

Changes in contraceptive behavior in Czechia.

The rapid increase in the proportion of women using hormonal contraception in the 1990s was positively reflected in a rapid decline in the number of abortions. Czechia was unique not only among Eastern European countries, but also worldwide. At the same time the decline in the prevalence of hormonal contraception from a peak of almost 50 % in 2007 to 30 % in 2021 meant a slowing and gradual halt in the further decline in abortions. The results of the GGP 2020-2022 survey in Czechia showed that the lower use of hormonal contraception among women was only partly offset by the increased use of other reliable methods of protection against unintended pregnancy (e.g. condom use). The largest decline in the use of hormonal contraceptives in the form of the pill occurred among the youngest women aged 18-27 years, from 76 to 37 %, which was partly reflected in the more intensive use of condoms (an increase from 21 to 35% in the 18-27 age group), but is worrying, that this age group saw the largest increase in the use of less reliable methods (withdrawal from 11 to 22 % and an increase in the use of the barren days method from 1 to 6 %) and also the largest increase in the proportion of women using neither method (from 7 to 17 %). The lowest proportion of female hormonal pill users was found among female with higher education. However an important finding is that when less reliable methods are used, there is an effort to combine at least two methods. Women have a more important role in determining how to protect themselves from unintended pregnancy.

The relation between age at menopause and age at first childbirth.

Analysis of data from the representative "GGP - Contemporary Czech Family Survey" (2020-2022) on the population of women aged 40-69 years showed that the age of onset of menopause is associated with a low age at the birth of the first child. Women who had their first child before their 20th birthday, a pattern of reproductive behaviour common among generations of women before 1989, have an earlier onset of menopause than older first-time mothers. Conversely, the effect of higher age at first birth (35 years or more) on the delay of menopause has not been proved. However, this issue requires further investigation, as the sample analysed suggests certain tendencies. A larger sample size would be needed to make a conclusive finding.

The fertility timing gap: the intended and real timing of childbirth.

The fertility gap, which indicates the difference between the planned and actual number of children born, can be explained by the shift in parenthood to older ages and is associated with the non-attainment of one's intended reproductive plans. This paper focuses on the gap in the timing of entry into parenthood, i.e. between the planned and actual age at the birth of the first child. The study is based on data from the Women 2016 survey which re-interviewed women of fertile age from the second wave of the Czech Generations & Gender Survey conducted in 2008. At the population level, the fertility timing gap differs across generations. While for Czech women born between 1966 and 1971 the planned age exceeded the actual observed age by one year, the realisation of fertility occurred two years later than planned for the youngest generation (1983-1990) included in the study. At the individual level, the later-than-planned realisation of fertility was found to be related primarily to partner-related factors.

The influence of the increasing use of assisted reproduction technologies on the recent growth in fertility in Czechia.

This study aims to enhance the understanding of how the increasing use of assisted reproductive technologies (ART) has contributed to the increase in the total fertility rate (TFR) and to further delaying childbearing. Moreover, it addresses the gap in the methodology concerning the quantification of the effect of ART on fertility postponement. Czechia is one of few countries that are able to serve for the study of the demographic impacts of ART. ART and non-ART fertility rates were calculated using unique data on all children born in Czechia. Excluding mothers who received cross-border reproductive care, the proportion of ART live births in Czechia has not exceeded 4%. However, without ART the TFR would have stood at just 1.65 instead of 1.71 in 2020. ART significantly contributed to a reduction in childlessness and to the increase in fertility rates at ages over 35. Applying the decomposition method, the contribution of the use of ART to delaying childbearing between 2013 and 2020 was 4%. The findings have important policy implications. ART has the potential to support fertility recovery in the context of delayed childbearing. The findings served to alleviate concerns about the contribution of ART to the further undesired delay of childbearing.

Does advanced maternal age explain the longer hospitalisation of mothers after childbirth?

BACKGROUND: Fertility postponement, which has comprised the most significant reproductive trend in developed countries over the last few decades, involves a number of social, personal and health consequences. The length of stay (LOS) in hospital following childbirth varies considerably between countries. Czechia, where the fertility postponement process has been particularly dynamic, has one of the longest mean LOS of the OECD member countries. OBJECTIVE: We analyse the influence of the age of mothers on the LOS in hospital associated with childbirth. DATA AND METHODS: We employed anonymised individual data provided by the General Health Insurance Company of the Czech Republic on women who gave birth in 2014. Kaplan-Meier survival plots and binary logistic regression were employed to identify factors associated with long stays (> = 7 days for vaginal births, > = 9 days for CS births). RESULTS: The impact of the maternal age on the LOS is U-shaped. A higher risk of a longer hospitalisation period for young mothers was identified for both types of birth (OR = 1.58, 95% CI 1.33-1.87, p˂0.001 for age less than 20, OR = 1.31, 95% CI 1.20-1.44, p˂0.001 for age 20-24 compared to 30-34). The risk of a longer stay in hospital increases with the increasing age of the mother (OR = 1.23, 95% CI 1.13-1.35, p˂0.001 for age 35-39, OR = 2.05, 95% CI 1.73-2.44, p˂0.001 for age 40+ compared to 30-34), especially with concern to vaginal births. CONCLUSION: The probability of a long LOS increases significantly after the age of 35, especially in the case of vaginal births. Thus, the fertility postponement process with the significant change in the age structure of mothers contributes to the increase in health care costs associated with post-birth hospitalisation.

Has the cesarean epidemic in Czechia been reversed despite fertility postponement?

BACKGROUND: Although the percentage of cesarean sections (CS) in Czechia is below the average of that of other developed countries (23.6%), it still exceeds WHO recommendations (15%). The first aim of the study is to examine the association between a CS birth and the main health factors and sociodemographic characteristics involved, while the second aim is to examine recent trends in the CS rate in Czechia.  METHODS: Anonymized data on all mothers in Czechia for 2018 taken from the National Register of Expectant Mothers was employed. The risk of cesarean delivery for the observed factors was tested via the construction of a binary logistic regression model that allowed for adjustments for all the other covariates in the model. RESULTS: Despite all the covariates being found to be statistically significant, it was determined that health factors represented a higher risk of a CS than sociodemographic characteristics. A previous CS was found to increase the risk of its recurrence by 33 times (OR = 32.96, 95% CI 30.95-35.11, p<0.001). The breech position increased the risk of CS by 31 times (OR = 31.03, 95% CI 28.14-34.29, p<0.001). A multiple pregnancy increased the odds of CS six-fold and the use of ART 1.8-fold. Mothers who suffered from diabetes before pregnancy were found to be twice as likely to give birth via CS (OR = 2.14, 95% CI 1.76-2.60, p<0.001), while mothers with gestational diabetes had just 23% higher odds of a CS birth (OR = 1.23, 95% CI 1.16-1.31, p<0.001). Mothers who suffered from hypertension gave birth via CS twice as often as did mothers without such complications (OR = 2.01, 95% CI 1.86-2.21, p<0.001). CONCLUSIONS: The increasing age of mothers, a significant risk factor for a CS, was found to be independent of other health factors. Accordingly, delayed childbearing is thought to be associated with the increase in the CS rate in Czechia. However, since other factors come into play, further research is needed to assess whether the recent slight decline in the CS rate is not merely a temporal trend.

Does Advanced Maternal Age Comprise an Independent Risk Factor for Caesarean Section? A Population-Wide Study.

OBJECTIVE: To investigate the association between a mother's age and the risk of caesarean section (CS) when controlling for health factors and selected sociodemographic characteristics. METHODS: Binary logistic regression models for all women who gave birth in Czechia in 2018 (N = 111,749 mothers who gave birth to 113,234 children). RESULTS: An increase in the age of a mother significantly increases the odds of a CS birth according to all of the models; depending on the model, OR: 1.62 (95% CI 1.54-1.71) to 1.84 (95% CI 1.70-1.99) for age group 35-39 and OR: 2.83 (95% CI 2.60-3.08) to 3.71 (95% CI 3.23-4.27) for age group 40+ compared to age group 25-29. This strong association between the age of a mother and the risk of CS is further reinforced for primiparas (probability of a CS: 11% for age category ≤ 19, 23% for age category 35-39, and 38% for age category 40+). However, the increasing educational attainment of young women appears to have weakened the influence of increasing maternal age on the overall share of CS births; depending on the model, OR: 0.86 (95% CI 0.80-0.91) to 0.87 (95% CI 0.83-0.91) for tertiary-educated compared to secondary-educated women. CONCLUSIONS: The age of a mother comprises an independent risk factor for a CS birth when the influence of health, socioeconomic, and demographic characteristics is considered.

The realization of fertility intentions in the context of childbearing postponement: comparison of transitional and post-transitional populations.

Childbearing postponement is a key demographic change that has been experienced by most European countries. It leads to a late-fertility pattern, with women realizing their reproductive plans preferentially after the age of 30. This may result in a lower fertility level. Since the ideal family size has not changed in most European countries, it has been argued that the end of the postponement transition further depends on the extent to which the lower fertility of younger women is compensated for by an increase in that of older women. Thus, the completion of the transition depends not only on the formation of a late childbearing pattern, but also on the capability of women to realize their reproductive plans if they commence childbearing later in their lives. This study employed a new approach to assess postponement transition based on analysis of the realization of the fertility intentions of women at later childbearing ages using survey panel data. A method that enables the differentiation between transitional and post-transitional cohorts was applied. The investigation was based on a comparison of the postponement transition in Czechia and France, the former being a post-communist and the latter a Western European country. It was found that despite having a similar pattern of fertility timing, Czechia and France underwent differing phases of postponement transition. The Czech population was identified as being transitional since only the 'transition' cohorts had completed their fertility during the period under study. These cohorts did not show a significant increase in realization of fertility intentions in later age. In contrast, the post-transitional French population is characterized by higher completed cohort fertility rates amongst women who entered motherhood at the age of 30 and over and by the significantly higher realization of fertility intentions for women aged 30-34 years.

Impact of the mothers age at childbirth on the birth weight of new-born children.

The various health risks associated with the increasing age of mothers at childbirth include the low birth weight of new-born children. The aim of the article is to verify the relationship between the birth weight of new-born children and the age of mothers at childbirth employing data on new-born children from the General Health Insurance Company of the Czech Republic. The data also allow take into consideration other characteristics such as the gender of the child, the frequency of childbirth, complications during hospitalisation and the type of conception (spontaneous or following IVF treatment). It was found that the proportion of new-born children with birthweights of 2500+ g exceeded 93% for women aged 25-39 and that the proportion is only slightly lower for women aged 40 and over. The lowest proportion (less than 88 %) was determined for women below the age of 20, while the proportion for women aged 20-24 years stood at 92 %. No relationship was proved between a higher proportion of children born with low weights and the higher age of women with respect either to single or multiple births. However, the research did reveal the significantly higher proportion of children from single births with lower birth weights most likely born following IVF treatment. Moreover, the proportion of new-born children hospitalised due to health complications increases with the increasing age of mothers at childbirth with respect to both normal and lower birth weights.

Reproduction ageing in Czechia in the European context.

The shift in fertility to higher ages over the last few decades represents one of the most distinctive features of reproductive behaviour in Czechia. The aim of this article is to provide an overview of the process of fertility postponement in the European context and assessment of the Czech situation. While the fertility postponement is a universal trend in developed countries, significant differences are evident between European countries in terms of both the commencement and speed of postponement concerning the mean age of mothers at first birth. The article also discusses the main factors that influence the fertility postponement. While at the beginning of the 1990s Czech first-time mothers were among the youngest in the worlds developed countries, during the 1990s Czech women experienced one of the most rapid increases in the mean age of first birth. Nevertheless, in the European context Czechia continues to have slightly younger first-time mothers (28.2 years in 2016, 0.8 years younger than the EU average). It also appears that currently no direct correlation is evident with concern to the mean age of mothers at first birth and the total fertility rate.

Relationship between abortion and contraception: A comparative socio-demographic analysis of Czech and Slovak populations.

Before 1990, abortions were highly prevalent in Eastern Europe, including Czechoslovakia. After 1990, the Czech and Slovak populations experienced a significant decrease in the abortion rate. Because both states have complete statistics on abortion and identical histories of abortion legislation, trends in abortion rates between 1988 and 2008 can be compared in detail using standard and decomposition methods. Binary logistic regression with odds ratios and 95% confidence intervals were used to identify the variables associated with changes in attitudes toward abortion between 1991 and 2008. First, a convergence in abortion rates was confirmed, although a higher abortion rate among unmarried Czech women remained in 2008. In contrast, a divergence in contraceptive practices was found; Slovaks have significantly lagged behind Czechs in the use of modern contraceptives. Differentials in attitudes toward abortion significantly increased (p < .001). Additionally, although a decline in the abortion rate was achieved without legal restrictions to access to abortions, various factors were responsible for this outcome. In the Czech Republic, improvements in family planning and increasing awareness of reproductive health have played key roles in promoting responsible sexual behavior, whereas in Slovakia, the stronger influence of the Catholic Church has contributed to the prevention of abortions.

How old is too old? A contribution to the discussion on age limits for assisted reproduction technique access.

In 2012, the Czech Republic established the women's age limit for access to assisted reproduction techniques at age 49 years. In this paper, the acceptability of this age limit from the children's perspective in the Czech Republic is assessed. Although the necessity of balancing the interests of parents and children is acknowledged, little research has taken children's interests into account. We have attempted to map out 'children's interests', asking older children and adolescents (aged 11-25 years) how old they would prefer their parents to be: Czech respondents would prefer to have younger parents. This finding is consistent with the optimal biological childbearing age rather than with the current postponement to a later age. So far, assisted reproduction techniques have been largely regarded as a medical treatment justifying the current women's age limit of 49 years. Had the children's perspective been taken into account, this age limit might have been lower than 49 years. We propose that reproductive health policy should adequately reflect multiple perspectives as an integral part of a multi-layered support system of a society.

Demographic relevancy of increased use of assisted reproduction in European countries.

BACKGROUND: Delayed childbearing in European countries has resulted in an increase in the number of women having children later in life. Thus more women face the problem of age-related infertility and cannot achieve their desired number of children. Childbearing postponement is one of the main reasons for the increasing use of assisted reproductive technology (ART) and conversely, the latter may be one of the factors contributing to the rise in female childbearing age. The research goal of our article is to evaluate the demographic importance of ART increased use and to examine its impact on both the fertility rate and birth timing. METHODS: Comparative analysis based on demographic and ART data collected by the European IVF-monitoring (EIM) Consortium for the European Society of Human Reproduction and Embryology (ESHRE). RESULTS: Most countries with a higher total fertility rate (TFR) also registered a higher number of treatment cycles per 1 million women of reproductive age. Despite the positive relationship between the postponement rate and the demand for ART among women aged 35 and older, the highest share of children born after ART was not found in countries characterized by a "delayed" fertility schedule. Instead, the highest proportion of ART births was found in countries with fertility schedules concentrated on women aged between 25 and 34. Accordingly, the effective use of ART can be expected in populations with a less advanced postponement rate. CONCLUSIONS: ART can have a demographic relevancy when women take advantage of it earlier rather than later in life. Furthermore it is suggested that the use of ART at a younger age increases women's chance of achieving their reproductive goals and reduces the risk of age-related infertility and failed ART. Based on a demographic approach, reproductive health policy may become an integral part of policies supporting early childbearing: it may keep women from delaying too long having children and increase the chance of diagnosing potential reproductive health problems requiring a timely ART application.

Changes in contraceptive practice and the transition of reproduction pattern in the Czech population.

OBJECTIVES: To analyse changes in contraceptive practice among Czech women, during the last two decades, and to evaluate the associated demographic impacts. METHODS: Recent trends in fertility and abortion are presented and compared with earlier survey data on contraceptive use. Data from four Czech surveys carried out as part of international projects in 1993, 1997, 2005, and 2008 were used to document changes in contraceptive practice among Czech women. RESULTS: Greater availability and greater acceptance of new birth control methods have resulted in increased contraceptive use and in the replacement of traditional methods with more effective alternatives. While only 42% of women in union (married and cohabiting) used condoms, the pill or an intrauterine contraceptive in 1993, 75% of all women with a partner currently use effective contraceptives. The fertility transition towards delayed childbearing has not resulted in additional requirements in terms of family planning as no increase in the abortion rate among young women is observed. CONCLUSION: The shaping of a new reproduction pattern in the Czech Republic has been accompanied by significant improvements in contraceptive practice. Despite the fact that the Czech population cannot be considered to perform outstandingly in terms of use of contraception, any remaining unmet need for modern contraception is marginal.

Can increased use of ART retrieve the Czech Republic from the low fertility trap?

OBJECTIVE: The aim of the study was to evaluate the importance of increased use of assisted reproduction technologies (ART) for the fertility trends in the Czech Republic. DATA AND METHODS: Comparative analysis based on demographic and ART data was used. Demographic data have been published by EUROSTAT and the Czech Statistical Office. ART data have collected by ESHRE. FINDINGS: In the 1990s a trend towards later childbearing contributed greatly to the decline in total fertility rate (TFR) in the Czech Republic. Recently, recuperation of delayed births has resulted in the increase of TFR to 1.5 children per woman which is considered to be a critical minimum level. The highest increase in fertility rates occurred in the age group of 35-39, in which the contribution of ART treatments usually is greatest. Moreover, a substantial increase of multiple births has been registered. In 2005 the estimated share of children born after ART in the Czech Republic (3%) was close to countries with the highest share (Nordic countries, Belgium or Slovenia). However, the Czech Republic registered only half the number of ART cycles per million inhabitants than in those countries. Contrary to Nordic countries the Czech Republic faced an extremely low TFR of 1.28 children per woman. As the estimation of average number of cycles suggests, the need for fertility treatment has not been met in the Czech Republic yet. Moreover, due to the continuous postponement of childbearing to higher women s age, demand for ART treatment will be even higher in the near future and will probably result in the need of more than 2 500 cycles per million inhabitants in the Czech Republic. CONCLUSIONS: Spreading of ART is particularly relevant in the countries caught in the low fertility trap as higher impact on fertility trends could be expected. In the Czech Republic there is a chance to get over the critical level of TFR if comprehensive population policy including the improved access to ART based on well-considered strategy with explicit aim to optimize the quality of health care was accepted. However, from the demographic perspective the risk of further delay of childbearing encouraged by ART treatment should be taken into account while making these decisions.

Suicidal behavior in children and adolescents: does a history of trauma predict less severe suicidal attempts?

OBJECTIVES: The aim of this study was to identify risk factors and possible predictors of severity of suicidal behavior of children and adolescents. METHODS: Seventy-seven patients (15 boys and 62 girls) aged 15.5+/-1.6 years on average, hospitalized due to a suicidal attempt in the department of pediatric psychiatry, were examined. Structured interviews with patients and their parents were used to clinically assess circumstances of suicidal behavior, relevant risk factors and severity of suicidal behavior. RESULTS: The results indicated that patients with any previous traumatic experience tended to have somatically less severe suicidal attempts (p=0.050). Intensity of suicidal intent was associated with a history of depression (p=0.014) and anxiety disorders (p=0.004), and the current stress from a mental disorder (p=0.014). Somatic severity of suicidal behavior was significantly associated with intensity of suicidal intent (p=0.014). A history of any trauma (previous traumatic experience predicted less severe suicidal behavior, p=0.053) and the current stress from sexual problems (p=0.067) were identified as predictors of somatic severity of suicidality. These two predictors showed only a trend level of significance. The only significant predictor of intensity of suicidal intent was the current stress from a mental illness (p=0.017). CONCLUSIONS: Several risk factors of somatic severity of suicidal behavior and intensity of suicidal intent were described. The most important finding of the study was the association between a history of psychological trauma and a tendency to have less somatically severe suicidal behavior.

Induced abortions: still important reproduction loss in the Czech Republic?

OBJECTIVES: The aim of study was to evaluate the importance of induced abortions for reproduction medicine in Czech Republic. DESIGN: Demographic analysis of data published by EUROSTAT and Czech statistical office. SETTING: Department of Demography and Geodemography Faculty of Science, Charles University Prague. RESULTS: Widespread use of the liberal abortion law in socialist countries contributed to the decline of fertility rates only to the replacement level. In the Czech Republic total fertility rate dropped below 1.3 in 1995 and it did not increase above 1.5 children per woman till 2007. The increased use of modern contraceptive methods that results in a sharp decline in fertility and in a significant decrease of induced abortions can be documented. The total abortion rate fell from 1.54 abortions per a woman in 1990 to 0.34 in 2007. The proportion of women aged 15-49 years who were prescribed oral contraception increased from 4 percent in 1990 to 48 percent in 2007. An induced abortion is still used largely as a way to avoid birth of additional children by women who already have the number of children they want. This is in sharp contrast with the situation in the majority of Western European countries in which abortion is used mainly by teen-age girls whose attempts to avoid pregnancy have failed. CONCLUSION: In contrast to other demographic characteristics which classify the Czech Republic to Eastern Europe, the level of induced abortion rate is comparable with the levels observed in some Western European countries.