Academic journal article Demographic Research

Pathways from Fertility History to Later Life Health: Results from Analyses of the English Longitudinal Study of Ageing

Academic journal article Demographic Research

Pathways from Fertility History to Later Life Health: Results from Analyses of the English Longitudinal Study of Ageing

Article excerpt

1. Introduction

Recognition of the importance of life-course influences on health and mortality at older ages has led to growing interest in the long-term consequences of reproductive pathways, particularly in the context of changing fertility patterns. Apart from the short-and long-term physiological influences of pregnancy, child birth, and lactation on women's health, broader biosocial mechanisms may link parenting trajectories with the later life health of both women and men. These include salutogenic influences of parenthood such as incentives to avoid health-damaging behaviours, role enhancement, greater community participation, and social support from children. However, parenthood also involves stresses of various kinds, including considerable economic costs, which may have health-damaging implications. In addition to the difficulty involved in unravelling effects of these countervailing influences, reproductive careers may be influenced by earlier health status and are associated with characteristics such as educational level and marital status, known to be related to health. Patterns of association observed and their interpretation may also depend on outcome measures used and age groups studied. Outcomes such as disability or death are usually sequelae of stresses, behaviours, and physiological changes accumulated over a long preceding period. Use of indicators of earlier pre-clinical changes in health may be helpful in elucidating the processes leading to these more distal outcomes. Allostatic load, conceptualised as multisystem physiological dysregulation arising from accumulated responses to multiple stressors, has been proposed as one such measure. In this paper we use path models within a structural equation-modelling framework to formally examine pathways from fertility histories to allostatic load and later life health, using longitudinal data from the English Longitudinal Survey of Ageing (ELSA). We investigate the extent to which associations are mediated by wealth, health-related behaviours, and social support and social strain in models controlling for socio-demographic characteristics and an indicator of respondents' health in childhood.

1.1 Previous research

1.1.1 Number of children

Most studies of contemporary populations have found a U- or J-shaped association between number of children born (parity) and later life mortality and health among women, and, in a few studies, among men, with both nulliparity and high parity (four, five, or more children) being associated with increased risks relative to having two children (Doblhammer 2000; Alonzo 2002; Grundy and Tomassini 2005; Hurt et al. 2006; Jaffe et al. 2009). However, in Scandinavian populations, which have generous social supports for parents, there seems to be no, or a reduced, mortality 'penalty' for high parity (Hinkula et al. 2006; Grundy and Kravdal 2008, 2010), indicating the importance of contextual factors.

Results from studies including outcomes other than or in addition to mortality show some variations that may reflect differences in measures, methodologies, and statistical power as well as contextual influences. Analyses of German survey data, for example, found that in Western Germany mothers and fathers of four or more children reported better health, but had no elevation of mortality risk, while in Eastern Germany high parity was associated with increased mortality risks among women, but not with poorer health (Hank 2010). UK studies of associations between parity and various indicators of health, like studies of mortality, generally show disadvantages associated with nulliparity, high parity, or both (Grundy and Holt 2000; Guralnik et al. 2009; Grundy and Tomassini 2005). A more recent British study including repeated health and disability measures found that childlessness was associated with faster accumulation of health limitation in women and that high parity was associated with poorer health outcomes for both women and men (Read, Grundy, and Wolf 2011). …

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