Delayed childbearing by education level in the United States, 1969-1994.

OBJECTIVES: Advanced maternal age at first birth, but not at subsequent births, may have detrimental health implications for both mother and child, such as a poor birth outcome and an increased risk of maternal breast cancer. However, positive outcomes may also result such as an improvement in economic measures and offspring's performance on cognitive tests. Research has indicated that women increasingly are delaying their first births beyond the early twenties, but the recent trends in socioeconomic disparity in age at first birth, and the implications for public health, have not been well described. METHOD: This study used national birth certificate data for 1969-1994 to examine age at first birth by maternal education level. Current Population Survey data were also used to examine changes over time in age and educational distribution among women of childbearing age. RESULTS: Age at first birth increased during the time period. Median age at first birth increased from 21.3 to 24.4 between 1969 and 1994, and the proportion of first-time mothers who were age 30 or older increased from 4.1% to 21.2%. Age at first birth increased rapidly among women with 12 or more years of education; nearly half (45.5%) of college graduate women who had their first birth in 1994 were age 30 or older, compared with 10.2% in 1969. However, little change was observed among women with fewer than 12 years of education; among those with 9-11 years of education, only 2.5% of first births in 1994 occurred at age 30 or older. CONCLUSIONS: The trend toward postponed childbearing has occurred primarily among women with at least a high school education. Health services use, such as infertility treatment and cesarean section, may increase as a result of delayed childbearing among higher educated women. Future examinations of the association between maternal age at first birth and health outcomes may need to take greater account of socioeconomic differentials.