Fertility Among Women with Chronic Health Conditions: A Mixed Methods Study - Project Summary/Abstract Chronic health conditions—diseases that require ongoing medical attention—affect 1 in 5 people of reproductive age in the United States.1 Although these conditions are common, little is known about the interplay of chronic disease and fertility, defined as childbearing goals, timing, and achievement. It is likely that chronic health conditions have implications for fertility,4–7 as chronic diseases may affect the ability to healthily carry a pregnancy to term, to survive childbirth, and to parent with health restrictions and lifespan limitations.8– 10 Prior research has found that women with poor self-reported health and disabilities have lower fertility goals; 4–7 however, it is unclear how chronic health conditions that have implications for gestational health and increase the risk of premature disability and mortality affect fertility goals, timing, and achievement. Due to the likelihood that different diseases affect fertility in distinct ways, the proposed research examines the fertility implications of three serious health conditions: unipolar depression, cardiovascular diseases, and diabetes. This project uses mixed methods data, including two nationally representative datasets, 1) the National Longitudinal Survey of Youth 1997 and 2) the National Longitudinal Study of Adolescent to Adult Health, as well as semi-structured interview data collected by the investigator. This project addresses three aims. In Aim 1, the impact of three chronic health conditions on women’s fertility will be estimated. Using longitudinal data, I will estimate the fertility goals, timing, and achievement of women with and without any of the three health conditions. Sequence analysis and ordinary-least squares regression will be used to estimate the impact of chronic health conditions on these fertility processes. As fertility patterns may differ across health conditions, I will also investigate women’s fertility patterns across the three different chronic diseases. Finally, I will test for differences by race. In Aim 2, qualitative data collected by the investigator will be used to describe how women with the three chronic health conditions make decisions about fertility. Interviews will explore the importance of timing of chronic disease diagnosis, how chronic disease affects decisions about when, whether, and how to get pregnant, and mechanisms through which chronic conditions impact fertility. Data from the quantitative and qualitative phases will be combined using an explanatory integrative approach. In Aim 3, the investigator proposes a tailored training plan to develop the necessary knowledge, methodological skills, and professional competencies to implement the proposed research. This includes training in longitudinal and hierarchical data analysis, as well as integrative mixed methods data analysis. A strong team of senior scientists, with expertise in social demography, fertility, longitudinal data analysis, mixed methods, obstetrics and gynecology, and clinical management of patients with complex pregnancies will mentor the applicant. This study will enable understanding of the impacts of simultaneously managing fertility and chronic health conditions, which has important implications for clinicians, demographers, reproductive justice advocates, and policy makers.
