Who are the late mothers?

BACKGROUND: The frequency of late births (to mothers aged 35 or above) has increased since the 1980s, because the number of women over this age has increased (baby-boomer generation) and above all because their fertility has increased. The characteristics of late mothers have changed in the last 20 years: more primiparous women, more women in second unions, more women with a high educational level etc. Some of these trends are related to a general shift in the characteristics of the population, whereas others are the consequence of a change in women's fertility after 35 for some specific categories of women. METHODS: We compared the characteristics of "late births" with those of births to mothers aged below 35 and with those of all women aged over 35. Fertility among several groups of women over 35 and the proportion of "late births" among different groups of births offer different insights into trends according to birth order, mother's marital history, level of education and occupation. RESULTS: Late births are more often of order 1 because the fertility of childless women over 35 has increased substantially. Conversely, more births are to women living in a second union, mostly because second unions are becoming more common. Late mothers are more educated than before. On the one hand, the overall level of education has increased. On the other hand, highly educated women are more likely to be childless and without a partner at age 35, and fertility after 35 is now highest for childless women living in a couple. Late mothers are increasingly likely to have middle-level or higher-level occupations, because they rarely have children before reaching such positions. CONCLUSION: Late mothers are now more numerous than 40 years ago and their mean social status has improved. This may change the way in which age is considered to be a risk factor for pregnancies: late mothers are more often primiparous, but their pregnancies are now more planned than before.

Contraceptive practices and trends in France.

CONTEXT: Contraceptive use has been legal in France for the past 30 years, and patterns of use changed substantially from the 1960s to the 1980s. Given the rapidity with which use patterns change and the possible impact of rising concern about infection with HIV and other sexually transmitted diseases, it is important to determine trends of contraceptive practice into the 1990s. METHODS: A total of 5,900 French households were selected in 1994 for inclusion in the Fertility and Family Survey. Respondents were questioned about their contraceptive use patterns and family formation status. The results were compared with those of comparable surveys conducted in 1978 and 1988. RESULTS: Two-thirds of French women used some form of reversible contraceptive method in 1994. Oral contraceptive use has grown steadily in France: About 40% of women aged 20-44 reported using the pill alone or combined with another method in 1994, compared with 34% in 1988 and 28% in 1978. Condom use has also been on the rise: Nearly 8% of women were using condoms alone or combined with another method in 1994, up from 5% in 1988 and 6% in 1978. IUD use has declined from 19% in 1988 to 16% in 1994, and both male and female sterilizations remain rare. CONCLUSIONS: Contraceptive behavior in France appears unique among developed countries, with fairly high levels of oral contraceptive use--even among older women--relatively high levels of IUD use and little reliance on either male or female sterilization. As with other countries, however, condom use has climbed in recent years, and is especially common at first intercourse.

PIP: This study describes current contraceptive practices in France over the past 30 years, by method, among single men and women, for dual method use, for pregnancy or sexually transmitted disease (STD) prevention, and at 1st intercourse. Data were obtained from the 1994 Fertility and Family Survey and previous fertility surveys. In 1994, 69% of women aged 20-49 years used contraceptives. Most women relied on the pill (about 36%), followed by the IUD (16%). 7% of women were sterilized. About 5% used condoms, and 6% used abstinence or withdrawal. 31% reported not using contraceptives, of whom 3% were sterile. 4% were infertile. 4% were pregnant. 4% desired pregnancy, and 11% had no ongoing sexual relationship. 5% were determined to be at risk for unintended pregnancy. About 83% of women reported ever use of the pill, and 58% had ever used condoms. Typical patterns of use during the 1980s include 10 years of pill use followed by IUD use. Contraceptive behavior only differed among single men and women not in a union. Some men and women reported multiple method use, especially pills and condoms. During 1988-94, pill use increased, IUD use decreased, and condom use increased. Condom use was higher among singles, among the well educated, and in large cities. During 1978-94, natural method use and sterilization declined. Women tended to identify condom use with pregnancy prevention. Men tended to include STD/AIDS prevention. Contraceptive use at 1st intercourse increased over time. Even though contraceptive use increased, the number of induced abortions remained constant, suggesting lower use-effectiveness.

Very few couples remain voluntarily childless.

"The secular decline of fertility, which reached its bottommost level between the two world wars, went together with a rise in permanent infertility that was sometimes, in the ideological atmosphere of the time, ascribed to physiological factors, but obviously indicated that some couples were refusing to have children. The signs of a similar pattern in present-day France are much more discreet. Having emerged relatively recently, it is difficult to quantify, but the main problem is that sterility therapy now makes it more difficult to define once and for all a level of infertility beyond which we can speak of ¿refusal to have children'. In an attempt to do so, [the author] uses an impressive range of tools: analysis of vital registration and census data, of ad hoc and general surveys, methods of estimation to fill in the many gaps, fertility models and so on. It is a useful reminder that the understanding of fertility behaviour goes beyond the mere interpretation of individual intentions."

[The standardization of revised rates]. / La standardisation des quotients instantanes.

PIP: The author examines some questions concerning the standardization of revised rates in demography. This is done with particular reference to their application to data on divorce in Sweden in recent articles by Jan Hoem and Gunnar Andersson.^ieng

[Contraceptive practices in France]. / Les pratiques contraceptives en France.

Between 20 and 44 years of age, in France, two women out of three use contraception; 41% use oral contraception, and 16% the IUD; 5% use condoms, and sterilization remains uncommon. Since 1988, when some information was made about the AIDS epidemics, condoms have become widely used, as a temporary method, especially by young people and people not living as a couple; 59% of women and 83% of men aged 20-24 ever used condom, and half of the women who had their first sexual intercourse during the two last years used condoms.

PIP: In France, about 66% of women aged 20-44 use a contraceptive method. The remaining women have no need to protect themselves against the risk of unwanted pregnancy. The most common contraceptive method used in France is oral contraceptives (41%), followed by the IUD (16%). Nonmedical methods comprise only 15% (5% for condoms). Since 1988, condom use has increased greatly (8% vs. 45% in 1993), especially among youth and persons not in a union and as a temporary method. Its increased use is largely due to its ability to protect against sexually transmitted diseases, including AIDS. In the 20-24 year old age group, 59% of women and 83% of men have already used condoms. In the last 2 years, condoms were used in almost 61% and 46% of first sexual relationships for men and women, respectively. Condom use declines thereafter.

The place of children in the history of couples.

"Does the multiplication of families outside wedlock increase poverty and aggravate the 'social problems' that emerge during adolescence, or does it normalize the position of children brought up in nontraditional families?...[The author] observes the place of children in the history of couples [in France].... The increase in the risk of breakdown of unions corresponds to a logic that is independent of fertility behaviour. Children are increasingly conceived by parents who already live [together], and the time of their birth is more and more often planned, but the presence of children thereafter has only a weak influence on the solidity of the union, except when the children are very young; children are no stronger a guarantee of the solidity of a union now than [they were] in the past."

Period fertility measures: the construction of different indices and their application to France, 1946-89.

PIP: The conventional summary measure of period fertility, the total fertility rate, is but one of a family of synthetic indicators. When detailed information is available, more complete period indices can be calculated, which provide greater consistency and are devoid of certain flaws often considered inherent to the principle of period measure. To interpret period indices which summarize the performance of a hypothetical, or synthetic, cohort whose members would live each age of their lifetime in the fertility conditions of the specified year, it is necessary to assume that fertility depends only upon the conditions in that particular year, and not at all on past fertility. The authors consider this assumption, then apply it to the construction of five period fertility indices. The indices are eventually used to measure total fertility and its parity components in France since 1946.^ieng

[Difficulties in conceiving. Discussion about methodology concerning the INED-INSERM survey carried out in France in 1988 on 3,181 women aged between 18 and 49]. / Difficultés à concevoir. Discussion méthodologique à propos de l'enquête INED-INSERM réalisée en France en 1988 sur 3 181 femmes âgées de 18 à 49 ans.

Different types of enquiries can be carried out in the field of infertility: descriptive ones (to find out the "frequency" of difficulties in conceiving and their causes) or analytical ones (to show and quantify the risk factors). A descriptive one was conducted on a representative national sample of women ages 18 and 49 years by INED and INSERM in 1988. The results shown here deal with the proportions of women who had had difficulties in conceiving as well as those who had consulted doctors for this reason. One notes that 27% of the women who were questioned had had difficulties and of those who had been waiting for more than one year, 62% had consulted a doctor. On the other hand, from the knowledge that has been gained from this enquiry, some methodological points are discussed, as far as the precise definition of infertility, the sample on which the study is carried out as well as the measured variable (prevalence, annual incidence and cumulative incidence). A particular reference is made to another enquiry carried out on patients who consulted because of infertility in three departments of France in 1988-89.

Historical overview of fertility and age.

PIP: Since the early 1980s, the number of births to women over age 35 has been increasing in most European countries. Consequently, the period of highest fertility shifted from the 20-25 to the 25-30 age range. During the baby boom after World War II in France, the annual number of births rose from 610,000 in 1938 to 870,000 by the end of the 1940s. In 1964 when the baby boom children reached reproductive age, annual births were close to 850,000. The number of births in mothers over 35 increased from 47,000 in 1980 to 70,000 in 1985. The total fertility ratio was 3 children/woman by the end of the 1940s, then it declined to 1.8 between 1964 and 1976, below the replacement level up to the present time. The proportion of the ratio attributable to women over 35 age declined during the 20th century from 25% to the current 9%. Between 1964 and 1976, all the age-specific birth rates fell. In France in 1978, unwanted births dropped from 21% to 13.5% between the periods 1963 and 1967, and 1973 and 1977, respectively. In 1976, fertility in the 25-39 and the 30-34 age ranges started to increase. The main reason for the increase in fertility beyond age 35 was the decrease in nuptiality at younger ages due to more efficient birth control. Illegitimate fertility rates also rapidly increased along with single women at all ages. In Sweden, the illegitimacy ratio is currently close to 1 out-of wedlock birth in every 2 births. The illegitimacy ratio nearly doubled between 1976 and 1985 to reach 17% in the UK and 20% in France. It is not close to 6% in Switzerland, 8.5% in the Netherlands, and 9% in West Germany. On the one hand, the increase in the number of births at maternal ages over 35 occurred because the baby boom cohorts are not 25-40 year old. New cohorts will marry later and often get divorced, while out-of-wedlock fertility continues to increase. These changes will bring about the decline in fertility before age 25 and an increase between ages 25 and 35. Late fertility after age 35 will probably increase to a much smaller extent than mid-period fertility.^ieng

[Use of IUD in France (1976-1985)]. / L'usage du sterilet en France (1976-1985).

PIP: The conversion of sales statistics for IUDs into number of users requires assumptions about their average duration of use, which may have changed over the past few years. 308 responses to a mail questionnaire sent to physicians regularly prescribing IUDs were analyzed to obtain an up-to-date estimate of average duration of use. The response rate of 30% was reasonable for a mail questionnaire. The geographic and sex distribution of respondents were on the whole very similar to those of all obstetrician-gynecologists in France, but there were fewer than expected respondents under age 40. The respondents inserted an average of 20 IUDs per month. In 1978, over 3/4 of physicians who responded to a National Institute of Demographic Research survey reported removing IUDs after 24 months, and the average duration of use of an IUD was 26-27 months. By 1985, only 1/3 of physicians planned to remove IUDs after only 24 months. The average duration of use increased to 33-34 months. Female doctors and those under 45 were particularly likely to remove IUDs after longer periods of use. Different formulas for estimating the number of IUD users were compared. The 1st formula, which requires sales data for 3 consecutive years and assumes an average duration of use of 1.9 years, with no variation over the 3 years, yielded estimates of 120,000 users in 1971 and 912,000 in 1978, values in agreement with survey estimates for those years. The number of users for 1985 according to the formula would be about 1.8 million. Another formula allowing for fluctuation of sales figures over 5 years and a progressive lengthening of the duration of use of each device assumed an average duration of use of about 1.95 years. This formula and a simplified version yielded estimates of the number of users in 1985 of about 2.2 million, or 16-17% of all French women aged 15-49 years. Still another formula, which differentiates between users who have their IUDs removed almost immediately, users leaving their devices in place as long as possible, and users who are regularly followed, yields an estimate of 1.95 million users + or - 10%. The number of new users of IUDs in France appears to have stabilized after 1981. About 13-15% of fertile aged women are estimated to use IUDs.^ieng