What Took You So Long? A Public Health Approach to Mitigate the Delayed Childbearing

Background: The delayed childbearing has doubled in prevalence during the last decade. It affects reproductive health, population distribution and economy. We use the public health approach to survey among women aged at least 35 years seeking fertility treatment. Methods: A self-administered questionnaire-based survey was conducted in women aged at least 35 years attending an infertility clinic in a university hospital. The questionnaire consisted of background information and three domains: (1) reasons for delayed childbearing, (2) required social policy incentives, and (3) acceptability toward infertility treatment. Each domain was scored from ‘5 — most important’ to ‘1 — least important’. Results: A total of 590 women (median age 38.0 years) were recruited; 86.4% of them held at least a bachelor degree and 93.2% had higher income than Thailand’s GDP per capita. They thought that the most appropriate age to have the first child was 28.7 years. The top three reasons for delayed childbearing were “I need more financial security”, “no spouse”, and “I need progress on my career”. The participants thought that “paid paternity leave”, “increase paid maternity leave”, and “good quality childcare” were essential for them to make an earlier fertility decision. The most acceptable infertility treatments were IUI, IVF/ICSI, and social oocyte banking. Conclusions: Women who delayed childbearing focus on financial and career security or finding the proper partner before fertility decision making. However, they have greater concerns over family welfare than money when it comes to domestic issues. The social policy and the related fertility treatment should adapt to serve the needs of the people and promote national fertility rate.