The Fertility Behavior of Parents with Children with Autism

Background:

A child's developmental disorder may influence decisions about future childbearing. Some parents of children with disabilities report choosing not to have more children so that they may devote more resources to their affected child. Others report deciding to have additional children in order to benefit their affected child, both short and long term. Jones and Szatmari first linked autism in children to future fertility, concluding that parents of children with autism stop having further children. However, existing evidence that addresses this question related to autism is limited, relying on small and selective samples, and typically anecdotal. 

Objectives:  

Yet, until now, the topic has not been examined with a sociological eye. Thus, we are placing parents' decisions of children with autism in the broader context of family planning to elucidate the causal path that links autism to future childbearing. Our aim is to assess if there is "stoppage" at the population level.

Methods:

We use mixed methods: qualitative and quantitative. First, we deploy the voices of parents from the Autism Life Histories Survey to focus on theories of cause and effects of autism on the family ecology. Second, we link these theories to fertility behavior using matching and event history analysis on data from the California Birth Master Files from 1992-2007 and autism diagnoses from the Department of Developmental Services (DDS). We attempt to eliminate confounding effects of mothers' characteristics which could be related both to autism diagnosis in children and to family planning decisions. Moreover, we use three different strategies for inferring time of first suspicion, which is an important factor in the event history models.

Results:  

Based on the matching analysis, mothers of a first-born child diagnosed with autism are equally likely to proceed to a second birth as mothers of a first-born child without the condition. On the other hand, proceeding to a third birth is estimated to be 8% less likely. If the analysis is replicated among the most severely affected – based on the DDS' evaluative items that measure communication and social functioning – it appears that this dynamic is driven primarily by mothers of first children with autism who fall in the lowest quartile on communication functioning. The event history analysis gives similar results.

Conclusions:  

Based on our qualitative analysis, we conclude that parents' coping strategies are heterogeneous, which results in different fertility decisions across families. This, however, leads to no stoppage at the population level when proceeding to a second birth. On the other hand, severity seems to make a difference, especially if it manifests through communication skills, but its effects are only pronounced for third births.