There are several striking results from our analysis. Unlike other studies, our findings do not show childlessness to be associated with any problems in the health indicators used in this chapter. There are no disadvantages for those without children and therefore, in the context of a familialistic country, without potential social support from children. Selection may have played a role here, if we hypothesised that only the fittest childless people survived to older age. However, given that for the cohorts born after the 30s the progression rate to parity one was quite high (Santini 1995), and that mortality levels in Italy for these generations were not higher compared to other Western countries (Human Mortality Database 2015), selection itself cannot entirely explain such findings.
As previous studies have shown, having four or more children has an important impact on poor self-rated health, presence of limiting illnesses, and IADL limitations among older women, and on ADL limitations among older men. These results do not shed a clear light on the pathways (physiological vs psychological) that may link fertility histories and health; however, they do suggest that high parity may have negative consequences on health, especially for women. As shown in other studies (Grundy and Tomassini 2005; Christensen et al. 1998), not only do women with high parity more frequently rate their health as poor or declared mild or severe limiting illnesses, but they also seem to suffer problems with IADL. Because IADLs, unlike ADLs, include the social dimensions of functional limitations (such as shopping for groceries, managing finances, or maintaining the home) rather than the mere functional ones, this female disadvantage suggests that high parity women may have spent their lives with fewer external activities in addition to their family responsibilities. This may be linked to the presence of many children itself as well as to a more traditional and deprived environment, and it is possible that this relative disadvantage continues in later life. It is also possible that the unbalanced gender division in traditional Italian families in performing family work may play a significant role in female disadvantage related to high parity (Anxo et al. 2011).
When parents are considered, early motherhood has the same significant negative effect on self-rated health and presence of functional limitations as shown in previous studies, while it is protective for men regarding depression. One possible explanation for the latter result may be because younger fathers become grandfathers earlier in life and this role has beneficial consequences on men’s mental health (Di Gessa et al. 2015). This result may suggest that the association of fertility behaviour and psychological health is not as strong for women compared to the other health indicators used in this chapter, as found in other previous studies (Hank and Wagner 2013).
In order to expand our results, we also tested whether marital histories may have affected the associations found with the fertility indicators. Introducing in the model variables such as the total number of marriages, binary indicators of previous widowhood and divorce, as well as the age at or the length of the latest marital disruption change the relationship nor the strength of the associations. All such variables were never significant, suggesting that, in this context, the actual marital status is more important than marital histories for health and health related indicators. Furthermore, only among SHARE respondents, we repeated the same analyses also controlling for health and socio-economic conditions at childhood in subsequent models. The results (reported in Tables 4 and 5) showed that only the indicator of early life poor health was significantly associated with current health for all the outcomes considered except IADL limitations; such associations were significant only among women and mothers. However, even accounting for early life conditions, the direction and strength of associations between participants’ fertility experiences throughout life and the outcomes of interest did not change.
Table 4 Men’s and Women’s health by baseline socioeconomic and demographic characteristics, early-life characteristics, and number of children
Table 5 Fathers’ and Mothers’ health by baseline socioeconomic and demographic characteristics, early-life characteristics, number of children, and fertility history
We also considered, as a fertility history indicator, the occurrence of close births, defined as giving birth to two children, including twins, in less than two consecutive calendar years, but the variable was never significant for the health dimensions we considered in both samples. Some previous studies have found a negative association between closely spaced birth (including twins) and health (Grundy and Tomassini 2005), suggesting potential physiological harm or an additional load of stress for parents, but this effect was not found for any of the health indicators used in this study, suggesting no parental strain due to rearing more than one young child at once.
Another effort to clarify the relations between fertility quantum and tempo and health was introducing the model interactions between age groups and geographic area and number of children. We hypothesised that, for example, the effect of early motherhood and high parity on health could be positive among older cohorts of women from the South, given that among such groups higher and earlier fertility were more accepted and common compared to the rest of the country. We found a significant positive effect of the interaction between early pregnancies and living in the South only among mothers, while the main effect of both variables remained significant. This result may suggest that the consequences of early pregnancy on later life health might be less strong in Southern Italy, confirming our hypothesis.
Another peculiar characteristic of Italy is the potential influence of the quantity and quality of family exchanges on different aspects of health. Our results (not shown) indicate that even controlling for the quantity of contacts between mothers and children, such close relations do not affect the association between high parity and health, suggesting that the potential physiological consequences of multiple pregnancies on women’s health may not be buffered by close relations with children.
Although our study provides additional light on the relationship between parenthood and health at later life, it also has limitations. First, our analysis is based on cross-sectional data, and it is therefore possible that health problems may have prevented men and women from having any or additional children. Interestingly, however, we have not found any negative effect of being childless or with parity 1 on any indicators of health as in previous studies, suggesting that if reverse pathways (i.e. poor health preventing having any or additional children) shaped such associations, these were not significant.
Second, selection may act differently for different socio-economic groups and for different cohorts. For the older cohort, high parity was associated with lower socio-economic status and with the South of Italy (Santini 1995), but we are not able to control for those variables at the time of birth of the child. Still these results hold when considering current socio-economic indicators. Furthermore, selection by death may bias our sample and could explain why in our study we did not find any disadvantage associated with childlessness among women; however, as mortality before age 50 is very low in Italy (Human Mortality Database 2015), this source of distortion should be minimal.
Third, this study used data from two different sources, IFS and SHARE. Even though the distributions of the variables of interest seem to be relatively comparable across both datasets, the demographic and socio-economic distributions of SHARE respondents differ considerably, with SHARE respondents being younger, more likely to be married, with low education, and from the Centre-South of Italy compared with IFS participants. This may be due to a combination of initial low response rate of the SHARE survey, longitudinal attrition, and the fact that no weights were available for the pooled sample used in this study (Di Gessa 2011). Our research is based on complete case analyses of SHARE, and does not consider how sample attrition might potentially bias associations (Fitzgerald et al. 1998).
This study has tried to provide additional insights in the relation between fertility histories indicators and health in the context of a familialistic country such as Italy. In addition to the physiological justification that may explain the differences found between men and women for the detrimental effect on ADL of high parities, a more complicated link may be hypothesised. The negative effect of high parity on IADL for women may indicate a socially deprived environment for women with more children which the variables included in the questionnaires are not able to capture. Furthermore, in a familialistic country women are exposed to a greater overload of unpaid work (house chores and care activities), both during adult and later life. Both factors may explain the female disadvantage in terms of high parity and early motherhood. Because these characteristics are becoming rarer among younger cohorts (in 2013 only 0.4% of the births occurred to teenagers mothers compared to 4.7% in England and Wales), we hypothesised that these factors will not play a major role in younger cohorts.