More women delay births — What are their options?
More women delay births — What are their options?
A healthy, nonsmoking woman, age 36, waits in your examination room. While she has been married for seven years, she and her husband are not yet ready to begin their family. What contraceptive choices are available to her?
Providers need to know these options, as more women are opting to delay their first birth, according to a new analysis by the National Center for Health Statistics (NCHS) in Hyattsville, MD.1 In 2006, about one out of 12 first births were to women 35 years of age and older; in 1970, the ratio was one out of 100, says T.J. Matthews, MS, an NCHS demographer and lead author of the analysis.
Although the trend toward older first-time mothers has been gradual over the time period reviewed, the changes were much more dramatic from 1970 to 1990, Matthews notes. While the analysis did not look at reasons behind the shift, the changing roles of women in society over the last 36 years have made their impact in delayed childbearing, he contends.
Which women are more likely to delay childbirth? While the analysis shows the average age at first birth increasing for all racial and ethnic groups between 1990 and 2006, Asian and Pacific Islander women now have the highest average age at 28.5 years, while American Indian/Alaska Native women have the youngest at 21.9 years. The average age at first birth for non-Hispanic white women (26.0 years) was older than the average for the U.S. population (25.0 years) while those for non-Hispanic black women (22.7 years) and Hispanic women (23.1 years) were younger, the analysis shows.1
Geography also is a factor. In 2006, Massachusetts' first-time mothers recorded the oldest average age (27.7), while Mississippi's first-time mothers were the youngest, recording an average of 22.6 years.1
In looking at similar population trends in other developed countries, analysts found that the United States has the youngest age of first-time mothers. This trend stayed consistent in 1970 and again in 2006, notes Matthews. The United States is making some progress in lowering the percentage of first-time births in younger women. In 2006, only 21% of first births were to mothers under age 20, down from 36% in 1970.1
For women who are choosing to delay childbirth, what methods of contraception are being selected? Philip Ivey, MD, a physician at Southwest Women's Health in Casa Grande, AZ, says most are using intrauterine devices (IUDs).
Women who are healthy, lean, and nonsmoking can choose combination hormonal methods, in pill, patch, and ring form until menopause, says Andrew Kaunitz, MD, professor and associate chair in the Obstetrics and Gynecology Department at the University of Florida College of Medicine — Jacksonville. Progestin-only and intrauterine methods are reasonable options for older women who are obese; smoke cigarettes; or have hypertension, diabetes, or migraine headaches.2
A recent clinical practice guidance notes that age, weight, and combination contraceptive use represent three independent risk factors for venous thromboembolism (VTE).2 The risk for VTE jumps in women older than age 39 who use combination birth control. There is an estimated incidence of more than 100 cases per 100,000 person-years among women who are older than age 39, compared with 25 cases per 100,000 person-years among adolescents.3 The risk almost doubles among obese women in comparison to nonobese women who receive oral contraceptives.4
"If all three risk factors — combined contraceptive use, age, weight — are present in the same woman, you're dealing with a substantially elevated thromboembolism risk, meaning that other nonestrogen methods are more appropriate," says Kaunitz.
References
- Matthews TJ, Hamilton BE. Delayed childbearing: More women are having their first child later in life. NCHS Data Brief 2009; 21:1-8.
- Kaunitz AM. Clinical practice. Hormonal contraception in women of older reproductive age. N Engl J Med 2008; 358:1,262-1,270.
- Nightingale AL, Lawrenson RA, Simpson EL, et al. The effects of age, body mass index, smoking and general health on the risk of venous thromboembolism in users of combined oral contraceptives. Eur J Contracept Reprod Health Care 2000; 5:265-274.
- Sidney S, Petitti DB, Soff GA, et al. Venous thromboembolic disease in users of low estrogen combined estrogen-progestin oral contraceptives. Contraception 2004; 70:3-10.
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