A woman born in 1993 is half as likely to have had a child by age 30 as her grandmother born in 1945—and her poorer health in childhood and adolescence may be part of the reason why. This project asks whether early-life health—including obesity, diabetes, and mental health problems, which have become more common in younger generations—shapes who forms stable partnerships, who has children, and who remains childless. While delayed parenthood is well documented, researchers do not know how much of that shift is driven by declining health rather than by education, values, or economic uncertainty. If the research succeeds, it will give the Office for National Statistics and the Office for Health Improvement and Disparities a clearer picture of future family patterns and the support people will need. Understanding that poor health in childhood can alter partnership and fertility trajectories decades later could shift how policymakers think about investing in adolescent health—not just for immediate wellbeing, but for the long-term shape of families and society.
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Many high-income societies, including the UK, are experiencing trends of delayed parenthood and declining fertility. For instance, while 82% of women born in 1945 had given birth by age 30 and 10% remained childless, these figures were 52% and 18% respectively for women born in 1975. For those born in 1993, only 44% had children by 30, with childlessness expected to rise further.1 While these trends have been partly linked to educational expansion,2,3 shifting values toward greater personal freedom,4 and, more recently, economic uncertainty,5,6 these factors do not fully account for the significant changes in family behaviours across generations. One less widely explored determinant is early-life health, which may play a fundamental role. For example, poor health may be related to lower ability to conceive7 and lower fertility intentions,8 while also affecting partnership formation and stability.9 Investigating how early-life health is linked to relationships and fertility is timely, given the decline in population health over recent decades ('Generational Health Drift’)10 which is marked by a higher prevalence and earlier onset of health conditions such as obesity,11 diabetes,12 and poorer mental health13,14 in younger generations compared to their predecessors. There is also value for policymakers in understanding the drivers of future family outcomes and how the health of young people is related to their family formation attitudes, which may in turn affect future behaviours. Moreover, understanding more about the drivers of family outcomes is crucial given that such outcomes can have adverse consequences for individuals, society, and population health. To address these gaps in knowledge, I will examine whether and how early-life health is associated with later-life relationships and fertility, using longitudinal data from the four British Cohorts studies and UK Household Longitudinal Study. The project has three interrelated objectives, to: Explore how different aspects of early-life health are linked to whether and when people form relationships, have children, or remain childless as adults. This objective will focus on people born between the 1940s and 1970s, who have finished their childbearing years, providing a holistic life course perspective on partnership and fertility trajectories. Investigate the relationship between early-life health and first co-residential partnership formation and transition to parenthood and how this has changed across cohorts (between those born in 1940s and 1990s). Although an overall postponement of these behaviours is well-documented, it is unclear whether it is linked to early-life health and how it might have changed across generations, given parallel trends in changing family norms and population health decline in younger ages. Examine associations between early-life health and attitudes towards partnerships and fertility (i.e., expectations to get married and have children) among cohorts who are in their active childbearing years (born 1990s-2000s), which has important implications for future fertility, household and population projections. This project will significantly advance the understanding of the determinants of family transitions and provide new evidence about the multiple enduring consequences of early-life health. The findings will be timely and policy-relevant, contributing not only to the scientific literature but also to society. I will provide evidence for third-sector organisations such as International Longevity Centre and government departments (Office for Health Improvement and Disparities (OHID), Office for National Statistics (ONS)) interested in understanding current family transitions and predicting future family behaviours and needs, as well as the later-life implications of these behaviours.
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