His & Her biological clock: Reproductive decision-making and reproductive success in the 21st century

Lead Research Organisation: Cardiff University
Department Name: Sch of Psychology

Abstract

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Description Starting families in the 21st century is a complex affair. In our systematic review there were >25 determinants of childbearing (e.g., mainly demographic) but there remained a lack of clarity about the degree of influence of these factors on starting families. Our online survey (International Fertility Decision-Making Study [IFDMS], N=10,045) and literature review concurred that people require increasingly more time to feel ready to conceive. This body of work led to the proposal of a multi-factorial model for childbearing.

People do not seem to be aware that their behaviour jeopardises their parenthood goals. Our pilot work on the planning fallacy suggested that people might not realise that a long deliberation period comes at the potential cost of not achieving parenthood. A pilot study on fertility awareness using FertiSTAT (n=612) showed that young people were not behaving optimally in regards to their fertility (e.g., smoking) suggesting a need for fertility policies directed at tackling the causes of sub-optimal fertility behaviour, which led to a new collaboration with the WHO. Further international work showed that in some countries fertility knowledge was so poor that fertility was indeed jeopardised (e.g., Japan).

Our feasibility/acceptability work indicated that all recruitment methods for research on childbearing (e.g., media, social research panels, Facebook, Google Adwords) presented some biases. One needs to be mindful of these biases but having done so; data quality was high, costs reasonable and methods effective in generating cross-cultural comparisons of people currently trying to conceive (which is a typically difficult population to reach) including low resource countries.

From an ethics perspective nudging people in the right direction to increase their likelihood of achieving parenthood good is acceptable, provided people know they are being nudged. If policies are not transparent and people denied certain options to increase adherence to politically valued positions (e.g., at home mothers highly valued so childcare not publicly funded before the age of 5 years) then one can argue that such nudging infringes on individual rights.
Exploitation Route Related to the principal network goals:

Starting families is a complex and protracted process, very dissimilar to family building experiences in past decades. The model building work started a dialogue aimed at disentangling biological, individual, couple, social, societal and environmental influences and organises key indicators into a working model. However, future research needs to test the direct and indirect explanatory links proposed. This work also made clear a dearth of research on planning for parenthood in some groups, for example families from low resource countries or individuals in non-traditional groups (e.g., gay and lesbian). A further gap is lack of fertility awareness, people know very little about fertility which means decision about whether and when to conceive are not informed decisions. Several of the studies part of the grant were related to fertility awareness but more needs to be done on how fertility knowledge impacts childbearing goals.

The methodological work done for the network made more salient the difficulty of identifying people trying to conceive spontaneously because these people are not always aware that they are trying to conceive, do not belong to groups that could be targeted and often change status too quickly for practical research follow-up (i.e., triers become pregnant quickly). The large scale survey did show however, a catchment period from about age 28 (near median age of first birth) where people (men and women) can become more interested in research on planning for childbearing.

The ethical review identified that most of the ethical review in this research is around (direct, indirect) financial policies to incentivise fertility, with much of it not evidence based. However, policies often miss their mark of encouraging those prevaricating on parenthood goals and instead reinforcing further behaviour of those already on parenthood tract.

Related to starting a network (as per UIBEN PI recommendations):
• the importance of choosing participants (co-investigators, other members) carefully, covering, for example, those with complementary skills, those whose work is familiar, those with genuine interdisciplinary interests and capability (avoiding topic 'ownership' by one discipline), and having a good mix of experienced and earlier career researchers
• the importance of 'getting away', especially early on in a project, in an informal, social setting to help bring down barriers and aid communication
• the benefit of clear objectives and expected outcomes for and from meetings, and the value of building in small 'projects' or tasks as a way of focusing activity and encouraging smaller groups of participants to work together (including on grant proposals)
Sectors Other
 
Description In February 2011 I presented results of the network research (IFDMS) showing poor fertility knowledge among Japanese people to Yuko Obuchi, Minister of State for Social Affairs and Gender Equality, whose responsibility it is to address the declining birth rate in Japan. This research was subsequently used to support a recommendation by The Task Force for Tackling the Crisis of Falling Birth Rate by Dr. Hidekazu Saito, a member of the Cabinet Office committee, to fund the creation and distribution of a leaflet to improve fertility knowledge. The WHO (Department of Reproductive Health Research and HRP Document team) is also adapting the fertility awareness tool based on the evidence from the IFDMS survey in low resource countries showing low levels of fertility awareness. Several publications have arisen from the research.
First Year Of Impact 2011
Sector Other
Impact Types Societal
 
Description Influence on Japanese policy about increasing fertility knowledge
Geographic Reach Europe 
Policy Influence Type Implementation circular/rapid advice/letter to e.g. Ministry of Health
 
Description Daiwa Anglo Japanese Foundation
Amount £3,000 (GBP)
Organisation Daiwa Anglo-Japanese Foundation 
Sector Charity/Non Profit
Country United Kingdom
Start 09/2013 
End 09/2015
 
Description Joint interdisciplinary studentship MRC-ESRC
Amount £35,686 (GBP)
Funding ID ES/1031790/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 09/2010 
End 10/2014
 
Description World Health Organization
Amount £25,000 (GBP)
Organisation World Health Organization (WHO) 
Department Department of Reproductive Health and Research
Sector Academic/University
Country Global
Start 09/2013 
End 12/2015
 
Description ESHRE Reproduction and Society Task Force 
Organisation University of Copenhagen
Country Denmark 
Sector Academic/University 
PI Contribution The ESRC Fertility Pathways facilitated the collaboration between Lone Schmidt and Tomas Sobotka, who are members of the pathway.
Collaborator Contribution The review of the consequences of delayed parenthood, in support of the aims of the ESRC Fertility Pathways.
Impact 10.1093/humupd/dmr040
Start Year 2009
 
Description Fertility knowledge and the timing of first childbearing in Japan 
Organisation University of Tokyo
Country Japan 
Sector Academic/University 
PI Contribution Current reproductive trends in Japan show declining total fertility rates (1.41 in 2012) and increasing parental age at first birth (30.1 and 32.1 years for women and men, respectively). Concerted government effort has already been deployed to introduce policies that address work-life balance and deficits in childcare, considered to be important causes of delayed childbearing. However, our recent international survey of 79 countries showed that fertility knowledge of Japanese participants was the poorest among developed countries (Bunting, Tsibulsky, Boivin 2013, from ESRC Network). It was proposed that this lack of fertility knowledge could also play a role in low fertility in Japan. The project was to support the adaptation of the Cardiff Fertility Knowledge Scale for Japan and carry out a public health survey to document in greater depth fertility knowledge in Japan.
Collaborator Contribution Partners provided funding (in addition to Daiwa-Anglo grant), and carried out the survey in Japan.
Impact The study is ongoing but preliminary findings have been presented at: Fertility knowledge and the timing of first childbearing: a cross sectional study in Japan. American Society for Reproductive Medicine, 2014, Hawaii, October 18 to 22, 2014. Authors: Eri Maeda, Fumiaki Nakamura, Jacky Boivin, Hiroki Sugimori, Hidekazu Saito
Start Year 2013
 
Description Planning for a healthy pregnancy 
Organisation University of Southampton
Country United Kingdom 
Sector Academic/University 
PI Contribution Professor Nick Macklon was a member of the ESRC Fertility Pathways Network. His interest in childbearing related to how people planned for a healthy pregnancy and we had the opportunity to work with him on this topic with an industrial partner. With Bethan Fulford (student member of the network, awarded an ESRC studentship) we developed a perspective on mental models of pregnancy which influenced whether or not women were willing to take healthy actions when planning for a pregnancy.
Collaborator Contribution Prof Macklon provided input about periconceptional healthcare and Merck Consumer Health Care paid for the survey in four countries.
Impact 10.1016/j.ejogrb.2014.02.011
Start Year 2012
 
Description Sheryl van der Poel, World Health Organization 
Organisation World Health Organization (WHO)
Country Global 
Sector Public 
PI Contribution The goal is to adapt a fertility awareness tool for low resource countries. The School of Psychology is contributing stipend fees for a doctoral student to carry out the prototype research in the Sudan and I am supervising the student.
Collaborator Contribution The WHO has provided a Work Performance Package (funding) to support the work.
Impact Collaboration has started in September 2014, no outputs yet.
Start Year 2014
 
Description Fertility knowledge and fertility awareness 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The ESRC Fertility Pathways group made clear that one reason why people were postponing childbearing was because of a lack of knowledge about risks to fertility and ways of safeguarding fertility. Our international survey (IFDMS, 10,045 participants in low and high resource countries) made clear that this lack of knowledge was particularly apparent in low resource countries. The WHO, a member of the fertility Pathways group, was particularly interested in addressing this disparity in knowledge. My role on the 'Consultation group on the development of a country assessment tool for integration of infertility care services' concerns how best to integrate 'fertility knowledge and awareness' activities as per the initial research within the country assessment tool. Once developed this tool will be distributed internationally.

The rapid assessment tool is in development, impacts not yet determined.
Year(s) Of Engagement Activity 2013
URL http://www.who.int/reproductivehealth/topics/infertility/assessment_tool/en/
 
Description Participation in a documentary on postponement of childbearing 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact In June 2012 my research showing poor fertility knowledge among Japanese people of childbearing age led the Japanese national television channel NHK to broadcast a documentary featuring me discussing this research.

Greater awareness of the effect of poor fertility knowledge on delaying or postponing childbearing, and knock on effects in other domains as associated with delayed childbearing.
Year(s) Of Engagement Activity 2011
 
Description Talk to Japanese Diet 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact In February 2011 I presented results of our research showing poor fertility knowledge (IFDMS survey) among Japanese people to Yuko Obuchi, Minister of State for Social Affairs and Gender Equality, whose responsibility it is to address the declining birth rate in Japan. This was a scheduled talk to the Japanese Diet (parliament).

The research was subsequently used to support a recommendation by The Task Force for Tackling the Crisis of Falling Birth Rate by Dr. Hidekazu Saito, a member of the Cabinet Office committee to fund the creation and distribution of a leaflet to improve fertility knowledge.
Year(s) Of Engagement Activity 2011