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.

Grant Number: 5F31HD115374-02
NIH Institute/Center: NIH
Principal Investigator: Lindsay Cannon