Age and fertility - Better Health Channel
Tags: Reproductive system - female - Fertility, pregnancy and childbirth and having a healthy baby, it does not override the effects of age on a woman's fertility. health. Birth Control. Fertility. Infertility. Reproductive health is caring for the the birth control method that works best for your body, your relationships, and your. Reproductive Health and Contraception is an open access and Birth control, also known as contraception and fertility control, are methods or devices used to attitudes and beliefs about sex, sexual identity, relationships and intimacy.
The first examines the federally funded family planning program, which was a conscious attempt to ensure that any woman—regardless of her age, marital status, income or health insurance status—has access to the contraceptive services she wants and needs.
The second highlights the Hyde Amendment, in which the government has abdicated its responsibility to poor women faced with an unintended pregnancy. And the third focuses on a Medicaid eligibility expansion for pregnant women that revolutionized how pregnancy-related care is paid for in this country. Each of these case studies presents a starkly different portrait of government policies and the lessons that can be learned about addressing inequalities in the United States. Family Planning Program The s was a period of rapid social change, marked by the civil rights and women's rights movements, which in themselves were focused on reducing disparities and expanding human freedoms and opportunities.
Many in the civil rights and women's rights communities recognized family planning as fundamental to the drive for equality and social justice. Martin Luther King Jr. The oral contraceptive burst onto the U. Moreover, over the course of the s, there was increasing recognition among researchers, advocates and policymakers that enabling women and couples to better control the number and timing of their children would play a role in closing disparities in three key areas: First, numerous studies at the time documented the substantial and far-reaching economic consequences that unintended pregnancy could have—particularly for teenagers—by increasing a woman's risk of living in poverty and reducing her ability to participate in the workforce or complete an education.
Notably, the first federal family planning grants were made by the Office of Equal Opportunity, as part of the Johnson administration's signature War on Poverty.
Second, researchers provided evidence that closely spaced births and childbearing very early or late in the reproductive years could lead to adverse health outcomes for both mothers and their children. And, third, groundbreaking research showed that, although women at all income levels wanted about the same number of children, lower-income women continued to have more children than they desired because they lacked access to affordable and effective contraceptives see chart.
These concerns over disparities and social justice fed into the establishment in of Title X of the Public Health Service Act, the only program devoted solely to the provision of family planning services on a nationwide basis. Introduced with bipartisan support and signed into law by President Nixon, Title X was designed to make contraceptives available to all who want them and requires that services be provided to poor clients at no cost and to other clients at a fee based on their ability to pay.
The new program sought to fulfill Nixon's historic promise that "no American woman should be denied access to family planning assistance because of her economic condition.
Guidelines on Reproductive Health
The ability to decide if and when to have a child can be a central source of empowerment for individual women and couples. Recognizing that there needed to be a standard of care for the ethical delivery of services, the Title X statute from the beginning included key patient protections to ensure that participation was truly voluntary.
Notably, it provides a requirement that clients must be offered a broad range of contraceptive methods from which they can make a choice; a guarantee that they would not be coerced into accepting a particular method; and an express prohibition on conditioning the receipt of government assistance on the acceptance of any contraceptive method.
Title X spurred the development of a nationwide network of clinics that has come to serve as a primary source of high-quality, affordable contraceptive services for low-income women.
Title X, according to the most recent program data, supports roughly 4, of these clinics, which together serve nearly five million women.
They are predominately white, yet because poverty status is closely linked with race and ethnicity in this country, women seeking subsidized family planning services are disproportionately women of color. Publicly subsidized family planning services have helped millions of women avoid unintended pregnancies and the births, abortions or miscarriages that inevitably would follow. According to a Guttmacher study published in the Journal of Health Care for the Poor and Underserved, in alone, women attending publicly funded clinics avoided an estimated 1.
The program also played a key role in nearly equalizing contraceptive use between the early s and the mids. Among all women at risk for unintended pregnancy those who are sexually active, fertile and not seeking to become pregnant.
The newest data, however, show that these gains are in jeopardy, and, in fact, some key groups now appear to be losing ground. And nonuse has risen more sharply among poor women and women of color—those most likely to have an unintended pregnancy—than among more affluent and white women see chart. Moreover, unintended pregnancy is becoming increasingly concentrated among poor women.
The disparities by race did not change over this same period. Nonetheless, black and Hispanic women continue to have higher rates of unintended pregnancy than white women, and as a result, higher rates of unintended birth and abortion related article, page 2.
In short, the individual, societal or structural influences that had been working to close disparities between the early s and mids are no longer having that effect. Public Funding of Abortion The effort to make abortion legal in the United States was driven in large part by a concern with disparities, because poor women and women of color were always disproportionately affected by the criminalization of abortion.
Even in states where abortion was illegal, women with financial means often had access to a safe, although clandestine, procedure, whereas less affluent women—who disproportionately are minorities—had few options aside from a dangerous, back-alley abortion. According to a series of studies on abortion in New York City in the s and s, the incidence of abortion was much higher among patients with private physicians than among women without their own doctor, and low-income women were more likely than more affluent women to be admitted to hospitals for postabortion care following an illegal abortion.
Furthermore, one of every two childbirth-related deaths among women of color in New York City in the s was due to abortion, compared with one in four among white women.
It is ironic, then, that soon after the nationwide legalization of abortion in the year the Supreme Court handed down its decisions in Roe v.
Wade and Doe v. Boltonpoor women became pawns in the congressional debate over the procedure. After failing to overturn Roe by persuading Congress to pass a "human life amendment" to the U.
Constitution, abortion opponents focused on restricting poor women's access to the procedure, by withdrawing public funding for abortion under Medicaid.
Henry Hyde R-IL during a congressional debate over public funding in The current version of the amendment, established inallows federal funding for abortion only in cases of rape, incest or life endangerment. In addition, over the past two decades, Congress has enacted bans similar to the Hyde Amendment that affect the health care of other disadvantaged women, including low-income residents of the District of Columbia, federal prison inmates and Native Americans.
Reproductive Health and Contraception| Insight Medical Publishing
Importantly, 17 states currently have a policy to use their own funds to pay for all or most medically necessary abortions sought by Medicaid recipients, ameliorating the problem for poor women living in those states, but not for those living in the rest of the country. The Hyde Amendment has had a real-life impact on poor women and their families. Various studies have shown that most poor women in need of an abortion manage to obtain one; however, many have to postpone their abortion.
This delay can be substantial: Studies conducted over the last three decades show that poor women take up to three weeks longer than other women to obtain an abortion. When asked why they were delayed after deciding to have an abortion, poor women are about twice as likely as more affluent women to report having difficulties in arranging an abortion, usually because of the time needed to come up with the money.
According to Guttmacher research, poor women are often forced to divert money that would otherwise be spent on rent, utility bills, food or clothing for themselves and their children. Exacerbating her difficulties, the cost of an abortion increases the longer a woman waits to have the procedure.
Such delays also can have health implications, because the risk of complications increases exponentially at higher gestations. Perhaps the most significant result of the funding restrictions, however, is that a substantial proportion of Medicaid-eligible women are forced to forgo their right to abortion and bear children they did not intend.
Perhaps the best such study, published in the Journal of Health Economics inexamined abortion and birthrates in North Carolina, where the legislature created a special fund to pay for abortions for poor women. In five instances between andthe fund was depleted before the end of the fiscal year, leaving women whose pregnancies occurred after that point to fend for themselves.
Reproductive morbidity and mortality may also be more common for women who become pregnant at the very beginning and at the end of their reproductive years. Pregnancy may be more stressful physiologically to very young women, because their reproductive systems are not yet fully mature and they may not yet have completed their growth. Young girls may also be less likely to detect a pregnancy early on or, for a variety of reasons, they may deny the pregnancy.
In both cases they may seek prenatal care later in pregnancy than desirable or delay having an abortion in situations where either is available.
Older women may encounter problems more frequently during pregnancy and birth because the ability of their reproductive systems to cope with the burden of pregnancy has declined with age. Evidence of decline in the function of the reproductive system with maternal age includes an increased incidence of fetal chromosomal abnormalities and spontaneous abortion. Pregnancies that begin shortly after a previous birth may also pose higher risks for women.
Short interbirth intervals, especially if accompanied by intensive breastfeeding, may prevent a woman from rebuilding depleted nutritional stores before the next pregnancy begins. This problem is likely to be more serious among women who are malnourished to begin with and may be exacerbated by a sequence of closely spaced pregnancies.
A pregnancy that occurs when a woman's health is already jeopardized is likely to pose a greater risk than a pregnancy for a healthy woman. Women who are malnourished, who are seriously ill, or who have chronic health conditions are clearly at higher risk than healthier women. By avoiding pregnancy, women with health problems may substantially improve their own chances for survival and good health.
Third, in addition to reducing the total number of pregnancies and avoiding potentially higher-risk pregnancies, women in many developing countries can also substantially reduce their risk of reproductive morbidity and mortality by using contraception to avoid unwanted pregnancies rather than resort to unsafe abortion to terminate such pregnancies. In many developing countries, abortion is illegal and is often performed by untrained personnel in unhygienic conditions.
Abortions attempted by women themselves or performed by abortionists under septic conditions substantially increase a woman's risk of infection, injury or hemorrhage, and death. The three hypothesized mechanisms just described suggest that changes in reproductive patterns may improve health by decreasing exposure to infection, injury, and other reproductive complications. A fourth possible mechanism is the use of contraception itself, which may affect women's health.
There may also be a fifth and more general effect of changes in reproductive patterns on women's health. Most families in developing countries have limited resources that must be allocated to a variety of family needs. Families with fewer young children to care for are likely to have more resources including time, food, and money to devote to the health of each family member. For example, women in smaller families may have more time to go to a clinic for treatment of an illness or for a prenatal visit.
Reproductive Patterns and Children's Health A woman's reproductive pattern may also have important effects on the health and survival chances of her children.
Children's well-being, especially in the first year of life, is highly dependent on their mothers' health during and after pregnancy. For this reason, some of the hypothesized effects of reproductive patterns on children's health are closely related to the effects of reproductive patterns on women's health.
Specifically, children who are firstborn or are of high birth order, children born into larger families, children born to very young or older mothers, children born after short previous interbirth intervals or before a short subsequent interbirth interval, and children who were unwanted at the time they were conceived may be at higher risk of poor health and mortality than other children.
It is also possible that a mother's use of contraception may affect her child's health directly, for example through effects on lactation. These hypotheses are summarized in Table 2. Birth Order Since nulliparous women experience more problems during pregnancy, firstborn children may be less healthy at birth, may weigh less at birth because of poorer intrauterine growth or shorter gestationand may experience more trauma during birth.
The parents of firstborn children may also be less experienced in child care, although this explanation for poorer health among firstborns seems less plausible in societies in which new parents frequently live with older, more experienced relatives.
Reducing the number of first births that women have is obviously not a sensible policy objective, since families choosing to have children must have a first birth, but delaying first births could be an important policy objective, particularly for very young women.
Children born of higher-order pregnancies may experience higher risks of morbidity and mortality for at least two reasons. First, as discussed above, because of the cumulative toll of numerous previous pregnancies and associated breastfeeding on maternal nutritional stores described as the ''maternal depletion syndrome''mothers of higher-order children may be in poorer health prior to and during pregnancy, as well as after birth.
Women who have reached high parity fifth and higher parity are also more likely to have experienced injuries during childbirth, which may complicate a higher-order pregnancy and birth. Thus, higher-order children may be at greater risk of poor intrauterine growth, greater trauma during birth, and, more generally, poorer health than children born at orders 2, 3, and 4.
Second, children born at higher orders may be in poorer health because their families have fixed resources such as tune, money, food, and shelter and more children to care for with these resources. On one hand, the sixth or seventh child in a poor family may receive less time and attention from parents than the first or second child did at a comparable age because there are now many children who need attention.
On the other hand, older children may help to care for younger children in large families and may contribute to the economic well-being of the family, thus increasing both total family income and possibly per capita income.
Another hypothesis is that children who have a large number of siblings, regardless of their own birth order, are more likely to be in poor health. When there are a large number of children in a household with limited resources, there is increasing competition among children, so each child—not just children of higher birth order—may receive less time, attention, and care.
Moreover, a child who has a larger number of siblings, especially if they live and sleep in crowded quarters, will be at increased risk of contracting infectious diseases. Maternal Age Children born to very young mothers and to older mothers may also be at higher risk of poor health and mortality.
In the case of the children of very young mothers, as argued above, the reason may be that pregnancy is more stressful physiologically for adolescents because their reproductive systems are not yet fully mature, and they may not yet have completed their growth.
As a consequence, adolescent girls may be less able to produce healthy babies and may experience more trauma during childbirth. A second possible reason that the children of very young mothers may be in poorer health is that these mothers may be less likely to seek and receive adequate prenatal care and may be less ready psychologically and materially to care for their children. Children born to older mothers may also experience greater risks of mortality and morbidity.
As argued above, women at the older end of the reproductive span may encounter more frequent problems during pregnancy and birth because the capability of their reproductive systems to cope with the burden of pregnancy has declined.
Children born to older women may have poorer health at the time of birth because of the greater likelihood of birth trauma or genetic abnormalities. Birth Spacing Children born either after or before short interbirth intervals may also be at higher risk of morbidity and mortality, for several reasons. The first is related directly to the hypothesized effect of close pregnancy spacing on maternal health. For women living in poverty who are predisposed to malnutrition or poor health, a very short interval between one pregnancy and the next may not provide adequate time for rebuilding nutritional stores and for physiological recuperation.
The consequences for children born after short interbirth intervals may be poorer intrauterine growth as well as a higher risk of preterm birth. We noted above that competition among siblings in large families for scarce resources may mean that higher-order children, or possibly all children, may be at greater risk of poor health.
Competition among children for family resources may be even more of a problem among children of similar ages, especially when they are young, because they have similar needs. When two births are spaced very closely, each child may not receive as much care and attention as he would if he did not have a sibling of roughly the same age. Close birth spacing can also create even more direct competition among siblings in the case of breastfeeding. A mother who becomes pregnant soon after a child is born is likely to wean that child sooner than she would had she not become pregnant again.
Since breastfeeding is an important determinant of child health in many societies, premature termination of breastfeeding often substantially increases a child's exposure to infection and increases the risk of malnutrition.
Close birth spacing may also increase children's exposure to infectious diseases by fostering transmission of infections among household members who are of similar ages. Many infectious childhood diseases affect a relatively narrow age range. If there is more than one child in the household in that age range, the chances of introducing the disease to the household and-transmission of higher or repeated doses of the infectious organism may be dramatically increased, thus increasing the likelihood of multiple or more severe illnesses.
This is especially a problem with diarrheal diseases, for which repeated incidence may result in malnutrition, and with measles, for which transmission in the household may be associated with more severe and fatal infection.
Unwanted Births Finally, children who were unwanted at the time they were conceived may be at greater risk of poor health and mortality than other children. In households with limited resources, parents may, consciously or unconsciously, discriminate against unwanted children in the allocation of food, parental time and attention, or preventive and therapeutic health care.
An alternative hypothesis is that children who are unwanted often are conceived when the family or the mother is under economic, social, or psychological stress, and the child is at greater risk simply by being born into a stressful situation.
Women's sexual and reproductive health
Maternal Illness and Death and Effects on Child Health Reproductive patterns may have another type of effect on the well-being of families and especially children, through their association with maternal morbidity and mortality. The death of a mother, whether due to reproductive or other causes, is likely to cause major disruption in the lives of her children, as well as a breakup of the household in which she and her children lived. In addition to the serious emotional consequences for children, the disruption following their mother's death may be extremely detrimental to their physical health, particularly if they are very young and breastfeeding has ended.
Serious illness or reproductive injury may also prevent a woman from caring adequately for her children, with consequent negative effects on their health and survival chances. Maternal incapacity and death may be a growing burden on societies in which AIDS affects substantial numbers of women of reproductive age. Furthermore, it is possible that certain infectious diseases can be passed from mother to child.
Indirect Effects of Reproductive Patterns on Health Changes in reproductive patterns through control of fertility are also hypothesized to have important indirect effects on the health of women and children.
Although some means of controlling fertility including withdrawal and abstinence are theoretically always available to couples, the availability of modern methods of contraception brings the process of fertility regulation more firmly into the control of couples and of women themselves.
Successful intervention in what was formerly seen as a natural process may change couples' or families' attitudes about their ability to make changes in other traditional practices. These practices may include those related to child care, prenatal diet and care for women, and the use of modern health services.
The ability to regulate fertility may also increase women's autonomy and give them greater authority to make decisions concerning their own health and the health of their children. In some settings, increased control over fertility and the increased predictability of pregnancy timing that comes from contraceptive use may also make it easier for women to finish their education, to participate in the labor force, or to hold better-paying jobs.
Higher educational attainment, work outside the home, or a better job are all likely to increase family income, which can then be spent on a more nutritious diet, better clothing and shelter, improvements in sanitation and water supply, and health services for all family members. In some societies, the fact that women make financial contributions to the household budget may also give them additional decision-making power in allocating household resources to themselves and their children, thus potentially improving their health.
Women who have fewer children or fewer young children to care for may be under substantially less physical and psychological stress than women with very large families, especially women in poor families, in which the resources to care for children are often scarce or inadequate. Furthermore, the ability to control fertility may also change a woman's outlook on life and may contribute to her psychological well-being Dixon-Mueller, In other settings, the ability to control fertility may create new tensions in the family, at least in the short run.
The process of making explicit decisions about reproductive matters may lead to disagreement between spouses, conflicts between parents and their adult children about family size, and anxiety about violating traditional, often religious ideals surrounding sexual practices and child-bearing.
Another hypothesized indirect effect of family planning on health relates to the use of health services. In countries where the program is strong and well-organized, family planning services may serve as an introduction for women to maternal and child health care services. Contact with family planning clinics may provide these women with information about how the health care system worked, referrals to other types of care, and often the confidence to deal with other types of health care workers.
In other areas the opposite case may occur, with women being introduced to family planning through contact with the health care services. Other Possible Explanations Reproductive patterns and women's and children's health may be associated with one another, without the former causing the latter, either directly or indirectly. A third factor may cause both.Biology Reproductive Health part 12 (Infertility: Artificial Insemination) class 12 XII
For example, a baby born after a pregnancy of short gestation is more likely to be in poor health and to be born within a short interval after the preceding birth.
Although the short interval is not the cause of the child's poor health, both the short interval and the child's poorer health are due to the short gestation of the pregnancy. Or it is possible that the direction of causation rims from health to the reproductive pattern. For example, if a child dies shortly after birth, breastfeeding will be shorter than it otherwise would have been. As a consequence, postpartum amenorrhea the infertile period following a birth, which is related to the duration and intensity of breastfeeding will be shorter.