Timing of Motherhood: Women's Age-related Fertility Challenges and Considerations on the Timing of Motherhood

Over the past 50 years, the age at which Danish women have their first child has been steadily increasing, mirroring a global trend of delaying parenthood, particularly in European and Western countries. This delay in starting a family is accompanied by an increase in fertility treatments and a lack of fertility awareness among men and women of reproductive age. Thus, there is a growing need for initiatives raising awareness of the importance of age on fertility. The overall aim of this PhD thesis was to explore women’s reflections on the timing of motherhood and to develop and test a health initiative for Danish women of reproductive age to create awareness on the age-related fertility decline. Subsequently, the use of online focus groups on social media as a data collection method within the reproductive field was explored.

A Participatory Design inspired project with three phases constitutes the methodological framework: Phase 1 – Needs assessment: In Paper I reflections on timing of motherhood in women of reproductive age were investigated through a meta-synthesis, based on a systematic literature search. Using the meta-ethnographic method, we synthesized existing literature to aggregate new findings. An overall theme ‘Timing of motherhood’ and four overlapping subthemes were identified: 1) Making a life-changing decision; 2) The right time; 3) Fear of regret; and 4) Plan B. Women prioritize achieving personal goals, and finding the right partner, yet even in stable relationships, timing of motherhood can be challenging. Having children at ‘the right time’ is considered important. Despite awareness of the agerelated fertility decline, medical risks of advanced maternal age are often underemphasized. In Paper II and III three asynchronous online focus groups were conducted, lasting for three days on the social media platform Facebook with 26 women of reproductive age (18-45 years). In Paper II the challenges and opportunities of using online focus groups in the reproductive field was explored. Facebook was beneficial for recruitment of women of reproductive age nationwide, and the private groups were suitable for the research purpose. There was a noticeable difference in interactions among participants in each of the age groups, with younger women (18-24 years) engaging less than other age groups. Most participants found the online group experience positive and felt a sense of belonging to a community. In Paper III the reflections on the timing of motherhood among a group of Danish women of reproductive age were explored. Three themes were identified: 1) Life before parenthood, 2) Planning for a child and 3) Life without children. Common concerns related to the timing of motherhood include ambivalence towards motherhood, fear of infertility, loss of independence, comparison with female relatives, pressure from friends and family, and fear of regret. Phase 2 – Idea generation: Three online workshops with 26 women focusing on development of a health initiative generated a variety of ideas on how to raise fertility, including the idea of a Fertility Bus. The online workshops led to identification of three core principles for developing future health initiatives within the reproductive field, including Gender equality, Fertility education, and Innovative fertility dissemination. Phase 3 – Testing: The Fertility Bus was pilot tested among university college students at a Danish university college. 55 students (18 men and 37 women) aged 19-54 years participated in short interviews focusing on their thoughts on having children in the future and evaluating the Fertility Bus as a health initiative. Most students were optimistic about discussing fertility, though concerns about infertility were common, leading many students to wish for an individual fertility status. The Fertility bus initiative was well-received, sparking curiosity and making discussions on fertility more approachable.

In conclusion, this study is the first to explore women’s consideration on the timing of motherhood in an online setting, and to test a Fertility bus as a health initiative to raise fertility awareness among university college students. By engaging women of reproductive age through a Participatory Design approach in the development of a health initiative, valuable insights were obtained. The findings suggests that the decision to have children is influenced by a complex interplay of personal, relational, and societal factors. Online focus groups on Facebook proved to be an eligible method for accessing qualitative data from women of reproductive age. Online workshops indicated multiple ways to raise fertility awareness. We pilot tested the fertility bus as a contribution to raise awareness on fertility and the timing of parenthood with men and women of reproductive age. Future research exploring men's perspectives on planning fatherhood is needed to provide a more comprehensive understanding of the complexities in timing of parenthood.