Short summary

Danish women's age at the birth of their first child has increased significantly over the past decades, and a rising number of women do not establish a family before the age of 30, where women's reproductive capacity has dropped considerably. Although there can be many other causes when couples experiencing fertility problems, age is by far the biggest reason why women experience difficulties in becoming pregnant, are not getting the number of children they want or never fulfill their wishes to have children. Therefore, health preventive initiatives is needed to meet age-related fertility challenges and support women in the timing of motherhood.

Rationale

An increasing number of Danish women are in their mid or late 30's before they try to conceive their first child, and at the same time a rising number of Danish women have to undergo fertility treatment to become mothers. For some of these women, they never succeed in getting the children they want. Throughout the last 50 years, the age of birth of the first child has risen significantly in Denmark. In the 1960s Danish women were 22.7 years old at the time of birth of their first child, but over the past decades this age trend has risen steadily to 29.5 years in 2019. Denmark is one of the countries in the world with the largest number of fertility treatments per year per resident. In 2015 almost 5,000 children (corresponding to 8% of the birth rate) came into the world by assisted fertilization. Approximately 10-15% of Danish couples aged 25-45 who try to conceive, are affected by fertility challenges, which makes infertility the most common disease among men and women in the reproductive age. Although female fertility problems can have many causes, age is the indispensable reason why otherwise healthy women need fertility treatment. The higher age at the time the women are trying to conceive, also means that they are in increased risk of other risk factors, such as sexually transmitted diseases, cancer or endometriosis that may affect female fertility, as well as the risk of spontaneous abortion increases with age. 

On average, Danish women wish to have 2.4 children, but only get 1.7 children. When women postpone motherhood, there is not always enough time to get the number of children desired, why postponing of motherhood also influence on family size. Infertility, regardless of its causes, is associated with lower quality of life and lower health-related quality of life, reflected in the fact that infertile women experience a higher incidence of anxiety, depression and stress. Fertility treatment is often seen as stressful for the relationship, and if the couple remains childless, it can pose a serious threat to the relationship and for the couple's and the individuals quality of life. In order for Denmark to maintain the population size, every woman in the reproductive age should have an average of 2.1 children. Over the last couple of years this number of children has been an average of 1.67-1.71 per. woman, and despite a slight progress in birth rates for the last two years, Denmark is still below reproduction level. However, this development is not unique to Denmark but also characterizes other Western and Northern European countries. 

In Denmark, pregnancy planning is only offered to a very limited extent. Women are not offered reproductive counselling with their doctor, and Danish women seem to be left alone and making important decisions about their fertility and timing of motherhood on their own. At the time the women become aware of the desire to have children they are in the mid 30s, their fertility is already severely impaired by their age, and many couples do not seek fertility advice until they experience challenges of achieving pregnancy, a tendency that could be avoided if they had a greater knowledge of the age's importance to fertility and/or had sought advice in time. Several studies show that both men and women's knowledge regarding the age's importance to fertility is inadequate, as 40% are underestimating the importance of age for fertility and 50% are overestimating the chance of having a child through fertility treatment. In 2016, the Danish Welfare Prevention Council published the report 'Prevention of Fertility Reduction' in which it is concluded: 'There is a great need for efforts that increase the awareness of young people and adults on risk factors for reduced fertility and we recommend further research into risk factors for reduced fertility and research involving the development, implementation and evaluation of a variety of prevention efforts to reduce the incidence of reduced fertility'. Instead of investing in expensive fertility treatment, health prevention offers should be established to inform and support Danish women in the reproductive age, so they can maintain a healthy fertility, plan to have children while they are still fertile and decide on timing of motherhood on a well-informed basis. 

AIM AND OBJECTIVES: The purpose of this project is to elucidate Danish women's reflections on timing of motherhood, and the considerations behind when women choose to postpone motherhood. The project aims to initiate a health prevention initiative through the design and development of a technological solution in collaboration with the users that can increase the knowledge of fertility and reproduction among Danish women, support women in timing of motherhood, and allow them to actively act on their own fertility. Furthermore, the project aims to discuss experiences using online focus group interview on social media as a data collection method in health research. 

Description of the cohort

Women of reproductive age (18-45 years) who has not yet had any children

Data and biological material

Qualitative data (online focusgroups, in-depth interviews, workshops)

Collaborating researchers and departments

Odense University Hospital, HCA

• Professor, Jane Clemensen                           

University of Copenhagen and Hvidovre Hospital, Dept of Medicine

• Professor, Henriette Svarre Nielsen 

VivaNeo

• CEO, Medical Director, Kathrine Birch Petersen

University College AbsalonDept of Nursing

• Docent, Heidi Myglegaard Andersen