Original article| Volume 24, ISSUE 1, e21-e27, January 2014

A Generation of Childless Women: Lessons from the United States



      Childlessness is a major public health concern in the United States, particularly among educated adults. Among women who turned 45 in 2006, one fifth had no children. We examine the likelihood that a childless woman wants a baby sometime in the future and its determinants.


      From 2006 to 2010, 5,410 in-person interview surveys were conducted with childless women as part of the National Survey of Family Growth. Age-specific likelihoods of wanting a baby were compared with likelihoods of having a baby before age 45. Female respondents were 1) born after 1960, 2) age 15 to 44, 3) childless (never given birth to a live infant), and 4) not pregnant at time of interview.


      Most childless women at any age want a baby sometime in the future. By age 32, fewer than half the childless women who want a baby will have one. At age 39, the majority of childless women (73%) still want a baby someday, but only 7% will have one. By age 45, more than 1 in 10 women will be childless, but still want to have a baby.


      Although attitudes toward childlessness have become more positive over time, our findings suggest that the United States is experiencing a high prevalence of childless women who want a baby. Clinicians may consider counseling young women about age-related declines in fertility and the costs and success rates of assisted reproductive echnologies often required for women with advanced maternal age to better inform their career, family, and lifestyle decisions.
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        • Abma J.C.
        • Martinez G.M.
        Childlessness among older women in the United States: Trends and profiles.
        Journal of Marriage and Family. 2006; 68: 1045-1056
        • Bitler M.
        • Schmidt L.
        Health disparities and infertility: Impacts of state-level insurance mandates.
        Fertility and Sterility. 2006; 85: 858-865
        • Bouwmans C.A.M.
        • Lintsen B.M.E.
        • Eijkemans M.J.C.
        • Habbema J.D.F.
        • Braat D.D.M.
        • Hakkaart L.
        A detailed cost analysis of in vitro fertilization and intracytoplasmic sperm injection treatment.
        Fertility and Sterility. 2008; 89: 331-341
        • Carbone J.
        • Gottheim P.
        Markets, subsidies, regulation, and trust: Building ethical understandings into the market for fertility services.
        Journal of Gender, Race & Justice. 2006; 9: 509-547
      1. Doughty, S. (2011, December 17). A generation of childless women: How a fifth of 45 year olds have not started a family. London, EK: Mail Online: News. Available:

        • Dye J.
        Fertility of American women: 2008, current population reports.
        U.S. Census Bureau, Washington DC2010
        • Finer L.B.
        • Henshaw S.K.
        Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.
        Perspectives on Sexual and Reproductive Health. 2006; 38: 90-96
        • Fisher A.P.
        Still “not quite as good as having your own”? Toward a sociology of adoption.
        Annual Review of Sociology. 2003; 29: 335-361
        • Greenlee A.R.
        • Arbuckle T.E.
        • Chyou P.H.
        Risk factors for female infertility in an agricultural region.
        Epidemiology. 2003; 14: 429-436
        • Grossman M.
        On the concept of health capital and the demand for health.
        Journal of Political Economy. 1972; 80: 223-255
        • Groves R.M.
        • Mosher W.D.
        • Lepkowski J.
        • Kirgis N.G.
        Planning and development of the continuous National Survey of Family Growth.
        Vital Health Statistics. 2009; 48
        • Guzick D.S.
        • Overstreet J.W.
        • Factor-Litvak P.
        • Brazil C.K.
        • Nakajima S.T.
        • Coutifaris C.
        • et al.
        Sperm morphology, motility, and concentration in fertile and infertile men.
        New England Journal of Medicine. 2001; 345: 1388-1393
        • Hayford S.R.
        The evolution of fertility expectations over the life course.
        Demography. 2009; 46: 765-783
        • Hayford S.R.
        • Morgan S.P.
        Religiosity and fertility in the United States: The role of fertility intentions.
        Social Forces. 2008; 86: 1163-1188
        • Heaton T.B.
        • Jacobson C.K.
        • Holland K.
        Persistence and change in decisions to remain childless.
        Journal of Marriage and the Family. 1999; 61: 531-539
        • Kirmeyer S.E.
        • Hamilton B.E.
        Childbearing differences among three generations of U.S. women.
        NCHS Data Brief. 2011; 68: 1-8
        • Koropeckyj-Cox T.
        • Pendell G.
        The gender gap in attitudes about childlessness in the United States.
        Journal of Marriage and Family. 2007; 69: 899-915
        • Lampic C.
        • Svanberg A.S.
        • Karlstrom P.
        • Tyden T.
        Fertility awareness, intentions concerning childbearing, and attitudes towards parenthood among female and male academics.
        Human Reproduction. 2006; 21: 558-564
        • Langdridge D.
        • Connolly K.
        • Sheeran P.
        Reasons for wanting a child: A network analytic study.
        Journal of Reproductive and Infant Psychology. 2000; 18: 321-338
        • Laruelle C.
        • Place I.
        • Demeestere I.
        • Englert Y.
        • Delbaere A.
        Anonymity and secrecy options of recipient couples and donors, and ethnic origin influence in three types of oocyte donation.
        Human Reproduction. 2011; 26: 382-390
        • Layman L.C.
        Human gene mutations causing infertility.
        Journal of Medical Genetics. 2002; 39: 153-161
        • Leiblum S.R.
        • Palmer M.G.
        • Spector I.P.
        Non-traditional mothers: Single heterosexual/lesbian women and lesbian couples electing motherhood via donor insemination.
        Journal of Psychosomatic Obstetrics and Gynaecology. 1995; 16: 11-20
        • Lepkowski J.M.
        • Mosher W.D.
        • Davis K.E.
        • Groves R.M.
        • Van Hoewyk J.
        The 2006-2010 National Survey of Family Growth: Sample design and analysis of a continuous survey.
        Vital and Health Statistics. 2010, June; 150 (Series 2): 1-36
        • Livingston G.
        • Cohn D.
        Childlessness up among all women; Down among women with advanced degrees.
        Pew Research Center, Washington, DC2010 (Available:)
        • Martin J.A.
        • Hamilton B.E.
        • Ventura S.J.
        • Osterman M.
        • Kirmeyer S.E.
        • Mathews T.J.
        • et al.
        Births: Final data for 2009.
        National Vital Statistics Reports. 2011; 60: 3-71
        • Martin S.P.
        Diverging fertility among US women who delay childbearing past age 30.
        Demography. 2000; 37: 523-533
        • Matzuk M.M.
        • Lamb D.J.
        The biology of infertility: Research advances and clinical challenges.
        Nature Medicine. 2008; 14: 1197-1213
        • Miller W.B.
        Childbearing motivations, desires, and intentions: A theoretical framework.
        Genetic, Social & General Psychology Monographs. 1994; 120: 223
        • Miller W.B.
        • Jones J.
        The effects of preconception desires and intentions on pregnancy wantedness.
        Journal of Population Research. 2009; 26: 327-357
        • Miller W.B.
        • Pasta D.J.
        Behavioral intentions: Which ones predict fertility behavior in married couples?.
        Journal of Applied Social Psychology. 1995; 25: 530-555
        • Munne S.
        • Alikani M.
        • Tomkin G.
        • Grifo J.
        • Cohen J.
        Embryo morphology, developmental rates, and maternal age are correlated with chromosome abnormalities.
        Fertility and Sterility. 1995; 64: 382-391
        • Oliva A.
        • Spira A.
        • Multigner L.
        Contribution of environmental factors to the risk of male infertility.
        Human Reproduction. 2001; 16: 1768-1776
        • Pearce L.D.
        The influence of early life course religious exposure on young adults' dispositions toward childbearing.
        Journal for the Scientific Study of Religion. 2002; 41: 325-340
        • Pena M.
        • Frehill L.M.
        Latina religious practice: Analyzing cultural dimensions in measures of religiosity.
        Journal for the Scientific Study of Religion. 1998; 37: 620-635
        • Poongothai J.
        • Gopenath T.S.
        • Manonayaki S.
        Genetics of human male infertility.
        Singapore Medical Journal. 2009; 50: 336-347
        • Proudfoot S.
        • Wellings K.
        • Glasier A.
        Analysis why nulliparous women over age 33 wish to use contraception.
        Contraception. 2009; 79: 98-104
        • Quesnel-Vallée A.
        • Morgan S.P.
        Missing the target? Correspondence of fertility intentions and behavior in the U.S..
        Population Research and Policy Review. 2003; 22: 497-525
        • Reynolds M.A.
        • Schieve L.A.
        • Martin J.A.
        • Jeng G.
        • Macaluso M.
        Trends in multiple births conceived using assisted reproductive technology, United States, 1997-2000.
        Pediatrics. 2003; 111: 1159-1162
        • Sauer M.V.
        • Paulson R.J.
        • Lobo R.A.
        A preliminary report on oocyte donation extending reproductive potential to women over 40.
        New England Journal of Medicine. 1990; 323: 1157-1160
        • Schmidt L.
        • Sobotka T.
        • Bentzen J.G.
        • Andersen A.N.
        • Soc E.R.
        • Task F.
        Demographic and medical consequences of the postponement of parenthood.
        Human Reproduction Update. 2012; 18: 29-43
        • Schwartz D.
        • Mayaux M.J.
        Female fecundity as a function of age.
        New England Journal of Medicine. 1982; 306: 404-406
      2. Shang, Q., & Weinberg, B. (2009). Opting for families: Recent trends in the fertility of highly educated women. Cambridge, MA: National Bureau of Economic Research Working Paper Series, No.15074.

        • Shang Q.Y.
        • Weinberg B.A.
        Opting for families: Recent trends in the fertility of highly educated women.
        Journal of Population Economics. 2013; 26: 5-32
        • Siller A.
        • Tompkins L.
        The big four: Analyzing complex sample survey data using SAS, SPSS, STATA, and SUDAAN.
        U.S. Centers for Disease Control and Prevention, Atlanta2006: 172-231
        • Smith E.M.
        • HammondsEhlers M.
        • Clark M.K.
        • Kirchner H.L.
        • Fuortes L.
        Occupational exposures and risk of female infertility.
        Journal of Occupational and Environmental Medicine. 1997; 39: 138-147
        • StataCorp
        Stata statistical software: Release 12.
        Author, College Station, TX2011
        • Sutton P.D.
        • Hamilton B.E.
        • Mathews T.J.
        Recent decline in births in the United States, 2007-2009.
        NCHS Data Brief. 2011; 60: 1-8
        • Thewes B.
        • Meiser B.
        • Taylor A.
        • Phillips K.A.
        • Pendlebury S.
        • Capp A.
        • et al.
        Fertility- and menopause-related information needs of younger women with a diagnosis of early breast cancer.
        Journal of Clinical Oncology. 2005; 23: 5155-5165
        • Thomson E.
        Couple childbearing desires, intentions, and births.
        Demography. 1997; 34: 343-354
        • Tietze C.
        Reproductive span and rate of reproduction among Hutterite women.
        Fertility and Sterility. 1957; 8: 89-97
        • Unger J.B.
        • Molina G.B.
        Desired family size and son preference among Hispanic women of low socioeconomic status.
        Family Planning Perspectives. 1997; 29: 284-287
        • Unger J.B.
        • Molina G.B.
        Educational differences in desired family size and attitudes toward childbearing in Latina women.
        Population and Environment. 1999; 20: 343-351
      3. U.S. Centers for Disease Control and Prevention. (2006). NSFG 2006-08 questionnaire, year 1 CAPI-Lite version. Available:

      4. Centers for Disease Control and Prevention. (2013, September 13). National survey of family growth. Available:

        • van den Akker O.
        A review of family donor constructs: Current research and future directions.
        Human Reproduction Update. 2006; 12: 91-101
        • van Empel I.W.H.
        • Dancet E.A.F.
        • Koolman X.H.E.
        • Nelen W.L.D.M.
        • Stolk E.A.
        • Sermeus W.
        • et al.
        Physicians underestimate the importance of patient-centredness to patients: A discrete choice experiment in fertility care.
        Human Reproduction. 2011; 26: 584-593
        • van Loendersloot L.L.
        • Moolenaar L.M.
        • Mol B.W.J.
        • Repping S.
        • van der Veen F.
        • Goddijn M.
        Expanding reproductive lifespan: A cost-effectiveness study on oocyte freezing.
        Human Reproduction. 2011; 26: 3054-3060
        • vanBalen F.
        • Verdurmen J.E.E.
        • Ketting E.
        Age, the desire to have a child and cumulative pregnancy rate.
        Human Reproduction. 1997; 12: 623-627
        • Velez F.F.
        • Fincher C.
        • Slotnick A.L.
        • Kramer E.
        • Collura B.L.
        • Mahony M.C.
        High and low knowledge areas concerning the link between age and fertility among US women 25-35 currently using birth control or not trying to conceive: Key results from the Fertility IQ 2011 Survey.
        Fertility and Sterility. 2011; 96: S110
        • Vere J.P.
        “Having it all” no longer: Fertility, female labor supply, and the new life choices of generation X.
        Demography. 2007; 44: 821-828
        • Warburton D.
        Reproductive loss: How much is preventable?.
        New England Journal of Medicine. 1987; 316: 158-160
        • Wright V.C.
        • Chang J.
        • Jeng G.
        • Macaluso M.
        Assisted reproductive technology surveillance - United States, 2003.
        Morbidity and Mortality Weekly Report. 2006; 55: 1-22
        • Wu Z.
        • MacNeill L.
        Education, work, and childbearing after age 30.
        Journal of Comparative Family Studies. 2002; 33: 191-213


      Benjamin M. Craig, PhD, is an Associate Member at Moffitt Cancer Center and an Associate Professor at University of South Florida. He is an economist dedicated to improving the lives of cancer patients by informing medical decision making and health policy.


      Kristine A. Donovan, PhD, MBA, is an Assistant Member at Moffitt Cancer Center. Her research focuses on the etiology and management of side effects of cancer treatment and the identification of appropriate interventions to alleviate symptoms and improve quality of life in survivorship.


      Liana Fraenkel, MD, MPH, is an Associate Professor of Medicine (Rheumatology and Internal Medicine) at Yale School of Medicine. Her research interest is in developing robust and practical methods to elicit patient treatment preferences and to improve medical decision-making.


      Verity Watson, PhD, is a Senior Research Fellow at University of Aberdeen's Health Economics Research Unit. Her research interests include the valuation of non-market goods and experimental economics. In particular, how individuals complete hypothetical choice tasks.


      Sarah Hawley, PhD, MPH, is an Associate Professor at the University of Michigan and a Research Investigator at Ann Arbor VAMC Center for Practice Management and Outcomes Research. Her research focuses on understanding and improving decision-making related to cancer prevention and control services.


      Gwendolyn P. Quinn, PhD, is a Senior Member at Moffitt Cancer Center and a Biomedical Ethics Specialist at University of South Florida. Her research concentrates on assessing the behavioral determinants of consumer decisions and choices about health.