Feature Article – Policy Implications of Delayed Reproduction and Low Fertility Rates

Mark Wheeler
Health Canada

Clarence Lochhead
Canadian Labour and Business Centre

Sari Tudiver
Health Canada

Mark Wheeler is Assistant Director of the Policy Division with the Health Policy Branch at Health Canada.

Clarence Lochhead is a senior researcher with the Canadian Labour and Business Centre and former consultant to Health Canada.

Sari Tudiver is a senior policy analyst with the Bureau of Women’s Health and Gender Analysis at Health Canada.1



Canadians are having fewer children and having them later in life than ever before. These fertility trends in Canada and in other industrialized countries reflect profound changes in society over the past 40 years. Issue 10 (May 2005) of Health Canada’s Health Policy Research Bulletin, “Changing Fertility Patterns: Trends and Implications” from which this article is adapted, examines the complex dynamics behind recent fertility trends, including transformations in family structure, gender roles, and life transitions.

Research on reproductive delay, commissioned by Health Canada, shows that the gap between the socio-economic status of older first-time parents and their younger counterparts has grown. While later childbearing presents certain health risks for mothers and infants, socio-economic status is a key determinant of health and must also be considered in the study of fertility trends.

There is a need for discussion and debate on the implications of these findings, as well as the need for further research on factors that influence the childbearing decisions of both women and men. From a policy perspective, efforts might well focus on modifying the factors that contribute to these trends, and mitigating or eliminating the disadvantages arising from them. In pursuing debate on the potential for a population policy in Canada, this article puts forward several options to be explored.

Major Trends

Declining Fertility Rates

Total fertility rates (TFRs) in Canada have been declining for over a century. Over the past four decades, Canada’s TFR declined from 3.94 in 1959 to 1.50 in 2002, below the population replacement rate of 2.1 (Statistics Canada, 2004).

Declining fertility rates are a global trend. Canada’s fertility rates fall between those of “low fertility” countries, such as Ireland, and “very low fertility” countries, such as Italy, Greece, and Japan.2

Why Canada and many highly industrialized countries are “below replacement” is widely debated and of interest to policy makers, in part because of the economic and social implications of an aging society.3 Low TFRs contrast with the expressed desires and expectations of many women and men in Canada to have two or more children (Dupuis, 1998; Beaujot, 2004; Beaujot and Muhammad, 2004).

Delayed First Birth for Women and Men

On average, women and men in Canada have children later in life. Between 1976 and 2002, the average age of first-time mothers increased from 23.4 years to 27.7 years (Beaujot, 2004), and the proportion of first-time mothers 30 years and older increased from 9 percent to 34 percent.4 The age-specific fertility rates of women aged 30 to 44 have increased since the late 1970s, while those for women under the age of 30, including teens, have declined.


Figure 1
Maternal and Fetal Risks Associated with Reproduction at Older Ages

Maternal and Fetal Risks Associated with Reproduction at Older Ages


Figure 2
Difference Between Average and Median Two-Parent Family Incomes, by Mother’s Age at First Birth, Canada, 1971 and 1996*

Difference Between Average and Median Two-Parent Family Incomes, by Mother’s Age at First Birth, Canada, 1971 and 1996*

*Data are based on two-parent families with the oldest being 0-5 years of age. Average and median two-family incomes are measured in constant 1998 dollars.

Source: Statistics Canada, Vital Statistics, Statistics Canada Census data.


The trend toward later parenting also applies to men, although to a lesser degree. For example, the median age of first-time fathers rose from 28.1 years for those born between 1922 and 1940, to 29.6 years for men born between 1941 and 1960, to 31.7 years for those born between 1961 and 1980 (Ravanera and Rajulton, 2004a). Since women have traditionally been the primary subjects of reproductive research, clinical interventions and policies, the health and social implications of later fatherhood have received only limited attention (Sipos et al., 2004).

Other Delayed Transitions

Delayed reproduction is associated with other late transitions for women and men, including late median age leaving the parental home, entering the work force, cohabiting or marrying for the first time. In addition, the “pathways to adulthood” vary with gender, socio-economic status, paid employment, and family circumstances (Ravanera and Rajulton, 2004a,b).

Growing Disparities Among First-Time Parents: Health and Socio-Economic Impacts

The trend toward delayed childbirth is associated with increased health risks for older mothers and their infants. Physical health risks for both are outlined in Figure 1 (Senzilet et al., 2005). In addition, some studies have found that older mothers may have unique stressors arising from their perception of age-related risks to themselves and their babies, as well as their expectations of motherhood, which may affect how easily they make the transition to parenthood (Windridge and Berryman, 1999). These studies suggest that this age group may experience the transition to parenthood differently than younger first-time mothers. Early detection of older first-time mothers with high expectations of themselves as mothers, lower satisfaction in parenting, and inadequate social support systems would allow for appropriate interventions (Reece, 1993).

While fewer in number, today’s younger parents have much lower levels of education, employment activity, and income than parents who have delayed childbirth. (See the accompanying text box.) The divergence in the incomes of younger and older parents over time is shown in Figure 2, which compares the average total family income (after transfers) of different parental age groups to the overall median income (Lochhead, 2005). (These data refer to two-parent families.)


First-Time Parents: A Comparison

Educational Attainment – In 1971, 61 percent of first-time mothers and fathers had less than a Grade 12 education. In 1996, only 21 percent of mothers and 23 percent of fathers had less than a Grade 12 education. Gains are also apparent at the post-secondary level. Between 1971 and 1996, the percentage of first-time mothers with a university degree increased from 4 percent to 18 percent, and rose from 11 percent to 20 percent among first-time fathers.

Employment Activity – As a result of increased employment rates among mothers, the majority of couples today having their first child are dual earners (72 percent in 1996, compared with 44 percent in 1971). Many are employed on a full-time, full-year basis.

Family Income – Measured in constant 1998 dollars, the average total family income (after transfers) of first-time parents increased by $14,400 between 1970 and 1995 (from $36,600 to $51,000).


In 1971, the median income of twoparent families whose oldest child was under 6 years of age was $35,905 (in constant 1998 dollars), and the average income of two-parent families in which the mother was under 25 was about $3,800 lower. On the other hand, the average income of families in which the mother was age 35 or older was $43,230, surpassing the overall median income level by just over $7,000. In short, compared to the median level, younger first-time parents in 1971 were not as well off financially as older first-time parents. Figure 2 also shows the extent to which the income gap has widened over time. By 1996, the median income of two-parent families whose oldest child was age 5 or under had increased to $50,976 (in constant 1998 dollars). In the same year, the average inflation-adjusted family income of young parents fell to slightly less than $30,000. Therefore, the average income of younger parents was $21,000 below the median, compared to the average income of older parents, which was $19,000 above the median. The question remains: Is this growing income disparity an important factor in determining health and social outcomes?

Findings on the growing socioeconomic disparity among first-time parents, however, must also be considered in the context of research about the links between socioeconomic factors and health. One of the best-known concepts in health analysis is the “gradient,” the widely known positive association between the socio-economic status (SES) and health status of a population. A substantial body of literature illustrates that health differences exist throughout society, with every level in the social hierarchy experiencing better health outcomes than the level preceding it.5 For this reason, the trend to reproduction at older ages – to the degree that it is accompanied by higher levels of income, education, and labour force participation – could be regarded as advantageous to both parents and children. Thus, a trend that can carry physical health disadvantages may also carry social and economic advantages that, in turn, translate into benefits for healthy child development.

Current research at the Manitoba Centre for Health Policy (MCHP) uses Manitoba longitudinal data to explore how children’s health outcomes and educational performance vary depending on the age of the mother when she had her first child and whether the family received income assistance that delaying childbearing until after the teenage years may not be enough to protect families from having low incomes.6 Please refer to the accompanying text box for more information on this important research.

It would be incorrect to assume a mechanistic relationship between the economic status of families and child research studies using the National Longitudinal Survey on Children and Youth (NLSCY) have demonstrated that income is only one of several factors affecting child development and health. Other factors, such as parenting skills, do not necessarily vary with age, education, or income (McCain and Mustard, 1999).


Related Research: The Health and Educational Outcomes of Children in Manitoba

Preliminary results from the Manitoba Centre for Health Policy Research show that the vast majority of infants in Winnipeg families whose mother was a teen when she had her first child had normal birth weights. However, during the first year after birth, the child had poorer health status (based on hospitalization rates) than a child whose mother was aged 20 to 24 when she had her first child. Similarly, children in the latter group had higher hospitalization rates than children whose mother was 25 or older. Looking at educational outcomes, children whose mothers were teens when they had their first child were also less likely to pass Grade 3 and Grade 12 standardized tests on schedule than other children, and more likely to drop out or be behind in school by at least one year.

Children in families receiving income assistance in 2001 typically had normal birth weights, and yet a lower health status emerged for these children during the first year after birth. The relationship between socio-economic status and educational performance was also strong, with children in families receiving income assistance performing worse than other children, and performance increasing with each increase in socio-economic status.

Families in which the mother was a teen when she had her first child were most likely to have received income assistance in 2001, even if that was up to 20 years after the birth of her first child. Furthermore, the research suggests that delaying childbearing until after the teenage years may not be enough to protect families from having low incomes. Women who had delayed childbearing until they were aged 20 to 24 were also more likely to receive income assistance in 2001 than women who delayed childbearing until 25 or older. It is not yet known whether young motherhood is a risk factor for, or a symptom of, low income and researchers at MCHP are continuing research in this area.


Results from the 1998 General Social Survey on Time Use indicate that nearly 50 percent of married mothers who are employed full time and have children under 5 years of age experience severe time stress. The extent of time stress and its impact on the health of parents and children is not well understood, and it may be that time stress disproportionately affects older or younger parents. Additional research is needed on this issue in relation to the timing of childbirth, its impact on the health of parents and children, and its possible role as a factor contributing to families and children at risk.

Why Should We Be Concerned?

Roderic Beaujot has described the link between an aging population, delayed reproduction, and low fertility (Beaujot, 2005). These phenomena could well cause Canada to face serious labour market challenges in about 10 years which, if not offset through increased labour productivity, could lead to a decline in the rate of growth of real gross domestic product (GDP) (Fougère, 2005), a lower standard of living, and an insufficient tax base needed to sustain social programs, such as universal health care (Hogan, 2001).

Also, as discussed earlier, a key population level impact of delayed reproduction is increasing disparities in the educational and economic circumstances of “younger” and “older” first-time parents. Such economic disparities may portend a more stratified Canadian society, which could impact the overall health status gradient.

What Underlies the Problem?

The First and Second Demographic Transitions

Economic change was at the heart of average fertility rate fell from 6.6 children per woman in 1851, when farm life was the norm in Canada, to 4.6 in 1901, after people began moving to cities in search of economic opportunity. In 1921, after school attendance until the age of 16 had been made mandatory and child labour laws had been enacted, the fertility rate fell to 3.5 children per woman (Milan, 2000). Clearly, children were losing their economic value to the family unit (Beaujot, 2004).

The second transition began as women claimed a greater role in society and became less inclined to raise large families. Two factors contributing to this trend were the increasing opportunities for women to obtain higher education and then pursue careers, and the ever-increasing cost of raising and educating children (Ravenera and Rajulton, 2004b).


Figure 3
Relationship Between Provincial Enployment Rates (ERs)*(2001)
and Provincial Total Fertility Rates (TFRs) (2002)

Relationship Between Provincial Enployment Rates (ERs)*(2001)  and Provincial Total Fertility Rates (TFRs) (2002)

* The ER is the number of persons employed expressed as a percentage of the population aged 15 and over.

Source: Statistics Canada, Labour Force Survey (ER), and Vital Statistics (TFR).


Many of our social institutions and social policies have yet to catch up with the demographic transitions, since we have not had the “institutional transition” that is analogous to the introduction of a public education system. Such a transition could ensure that the apportionment of the costs of human capital formation between families and society at large aligns with our societal needs and aspirations, and is commensurate with the costs, and opportunity costs, of having children.

Stalled Life-Course Transitions

Parental age at first childbirth is explained by the number and timing of a variety of life-course transitions. Between the two world wars, transitions to adulthood and parenthood – completing education, entering the work force, leaving home, establishing a union, and starting a family – were compressed into a relatively short period of time. Today, life-course transitions may be more numerous, and trajectories (i.e., the order in which the life-course transitions occur) may be more varied, given increased educational requirements and the trend toward entering and leaving multiple relationships before establishing longterm unions. Transitions may take longer, especially as regards the (normatively preferred) imperative to secure a good job prior to contemplating a union. For women, higher education, career aspirations, and the all too frequent inability to achieve worklife balance further inhibit family formation (Tudiver, 2005).

Women with a university degree have better labour market prospects and are not as likely as their less educated counterparts to have a child (Milligan, 2004). The opportunity cost of having children is higher among university-educated Canadian women in couples, in that they work longer hours, work more weeks of the year, and earn more than their less-educated counterparts. For Canadian men, higher education delays fatherhood; however, after controlling other factors, higher income enables fatherhood as union formation occurs sooner (Ravanera and Rajulton, 2004a).

Figure 3 demonstrates an association between employment and fertility: by and large, babies are born where the jobs are (Tudiver and Senzilet, 2005). It does not, however, explain why British Columbia’s fertility rate is almost as low as that of Newfoundland and Labrador, and it does not provide insight into which life-course transitions are delayed, and why. Considering, though, that student debt levels are highest in Newfoundland and Labrador, and that mortgage debt is highest in British Columbia (Statistics Canada, 1999), it could be that debt and the unavailability of good jobs delay home leaving in the former, while housing costs might help explain why fatherhood is delayed most in the latter. While more research is needed to understand stalled transitions, it seems clear that the story will differ between regions.


Case Study: Sweden

In recent decades, Swedish fertility rates have fluctuated so much that demographers have compared its fertility trends to a roller coaster. The total fertility rate (TFR) was at its lowest (1.6) in the late 1970s. By 1985, the country was experiencing a baby boom, and by 1990 the TFR had exceeded replacement level (2.14 children per woman). By 1999, however, the TFR had fallen to 1.52, but by 2002 it had risen again to 1.65.

Policies that embraced working mothers, secure incomes, and improved employment conditions (including universal publicly subsidized, highquality child care), in combination with favourable economic conditions and low unemployment, succeeded in raising Sweden’s TFR in the 1980s. The reduction of some of these policies in the 1990s contributed to a sharp decline in TFR, and their subsequent partial restoration contributed to an increase.

The key lesson from Sweden is that TFR is sensitive to the presence or absence of policies supportive of family formation, as well as to prevailing economic conditions.


Housing costs, the pursuit of higher education, the servicing of student debt, experimenting with relationships prior to forming a union, and the unavailability of good jobs all help explain, to varying degrees, the delay in home leaving, arguably one of the most important transitions to adulthood and independence. In 2001, 41.1 percent of Canadians aged 20 to 29 were still living with their parents, compared to 27.5 percent two decades earlier. In Europe, the average age at home leaving ranges from the mid-20s in Italy and Spain to 20 years in Sweden. It would appear that home leaving is facilitated in countries, such as Sweden, where there are greater social transfers to young people.

The Economy and Earnings

In 1971, only 44 percent of families had two incomes, but by 2000, 62 percent of families had two incomes (Vanier Institute, 2004). A study of Canadian couples between 1980 and 2000 (where the man was between age 25 and 54) found that the average annual earnings of the men rose by two percent in constant dollars, while median annual earnings dropped by six percent (Morissette and Johnson, 2004), suggesting that the majority of those men had declining annual earnings. Men aged 35 to 44 with a university degree who were married to women who also were university graduates benefited the most, while men in all age categories with no more than high school education lost significant financial ground.

Increased labour force participation by female lone parents led them to some of the largest percentage gains in family earnings between 1989 and 2001 (Sauvé, 2004) although some of these gains appear to have been lost in the following year (Sauvé, 2005).

What, if Anything, Can We Do?

What can be done about the higher dependency ratios that the baby boom, increased life expectancy, and sub-replacement TFRs have generated? The possibilities include accepting the very real possibility of a lower standard of living (if higher productivity per worker does not compensate for a proportionately smaller work force), increasing economic immigration levels to replace workers who will retire during the coming decade, defering the transition to retirement, and implementing policies that seek to reverse the decline in TFR (Bongaarts, 2004). Pursuit of any or all of these scenarios would require debate on the merits of a population policy for Canada, to arrive at some consensus on desired population size and strategies for achieving it.

Quebec’s Allowance for Newborn Children (1988 to 1997) appears to have had greater influence on the occurrence of third births than on first births (Duclos et al., 2001). It is not clear, however, how much of Canada’s fertility decline can be attributed to “missing” first births (i.e., women not having any children) versus “missing” third and higher order children. Sweden (see text box on the previous page) (Grant et al., 2004) and France also found that incentives contributed to higher fertility, and it appears that the impact on parity was the same as in Quebec.

In Canada overall, while the rates of second and third and higher births have remained largely unchanged over time, the rate of first births has been more volatile. By and large, the literature is silent on the characteristics of childless families. More research is needed to study the extent to which infertility, as well as the various socioeconomic characteristics of childless couples (including the extent to which people of reproductive age are either between relationships or in unstable ones), are factors that contribute to the “missing” first child.

How Can We Do It?

The evidence shows that no single measure can influence fertility, but that a suite of them used in combination can (Caldwell et al., 2002). Policies and political cultures that favour social capital also appear to be favourable to the development of human capital. In pursuing debate on the merits of a population policy, the following options could be explored.

Rethink targeting. It is perfectly reasonable to target income supports on the basis of economic need; however, not all needs are economic in nature. For example, early childhood development programs should be more widely available, because not all children who would stand to benefit from an enriched early childhood experience are found in low-income families (McCain and Mustard, 1999). Similarly, before Canada’s Baby Bonus Program evolved into the incomedependent Child Tax Benefit, it had a symbolic value, which likely transcended its economic value, in the sense that it acknowledged that Canadian society as a whole valued children and had a stake in them.

Consider intergenerational equity issues. Helping young people through their important early life transitions and enabling them to become parents, if that is their wish, will require Canadian society to work out better ways of transferring resources to them. This, in turn, will require a longer period of post-reproductive productivity, which means that we should be thinking of later, rather than earlier, retirement from the labour force. In the 1980s, Canada showed that it was possible to deal with the high prevalence of poverty among seniors through greater intergenerational transfers; it ought to be equally possible to address the needs of younger Canadians.

Promote work-life balance. The recent Canada-Quebec agreement to de-link parental leave benefits from Employment Insurance, in order for such leave to be accessible to those who are self-employed, is illustrative of the kind of program innovation that is needed. But change here is not entirely up to the public sector. As employers increasingly feel the labour market pressures brought on by the retirement of baby boomers, and as the recruitment and retention of younger workers becomes increasingly critical, there likely will be avid interest in the best practices of achieving work-life harmony. But, it will be important for the public and private sectors alike to be cognizant of Ranson’s “deeper dilemma that anything done, in a structural or policy sense, to ’help’ women combine paid work and family responsibilities only entrenches the belief that children are women’s work” (Ranson, 1998).

Enable life-course transitions. To the extent that home leaving in Newfoundland and Labrador is due at least in part to student debt, and that later fatherhood in British Columbia is due at least in part to housing costs, the goal of facilitating life-course transitions may require a different strategic mix in different regions. Income-contingent repayment of student loans may be more critical in some regions than in others, although economic development and the creation of real, sustainable employment opportunities may be the sine qua non for any increase in TFR in Canada’s less affluent regions. Affordable housing opportunities may be of greater importance in Vancouver or Toronto than elsewhere in Canada, although the means to achieve this will need careful consideration, so as not to inadvertently increase housing prices.


The growing disparities among first-time parents described above may lead to a more stratified Canadian society, but increased stratification need not necessarily imply a steeper health status gradient. Inclusion and a commitment to relative fairness are hallmarks of countries where life expectancy and quality of life are higher (Marmot, 2004).

The foregoing options are among those available, should Canadians favour having a population policy, that favours measures to increase our fertility rates. These options also ought to favour a more inclusive Canadian society, by investing in all children, by accommodating the needs of young families in the workplace and by valuing young people and helping them through life transitions. This means that Canada will have an opportunity to build human and social capital simultaneously; this is a good thing, given the feelings of aimlessness and alienation among many of Canada’s youth today. They are, after all, our next generation of parents.


  1. With contributions from Linda Senzilet and Joanna Theriault, Policy Division, Health Policy Branch, and Nancy Hamilton, Applied Research and Analysis Directorate, Health Policy Branch.
  2. For example, in 2003, the TFR in Canada was 1.61, Ireland 1.89, Japan 1.38, Greece 1.35, and Italy 1.26. CIA World Factbook. Total fertility rate (children born/woman), 2003.
  3. Caldwell (2004) provides an overview of various demographic theories and their implications. See also Bongaarts (2002).
  4. Lochhead (2000) noted that women aged 30 years or older accounted for nine percent of all first-order births in 1976; by 1996, the share of first-order births to women aged 30 years and older more than tripled, accounting for three out of every ten first births. This proportion has continued to rise. See also Payne (2004).
  5. For one example describing how the gradient functions, please refer to Wilkinson (1996).
  6. This information is based on an unpublished manuscript and discussions with Marni Brownell about unpublished MCHP research.


Netherlands: Individual Life-Course Savings Scheme

Beginning in early 2006, the Dutch government introduced a voluntary lifecourse savings plan (levensloopregeling). The main objective is to allow workers to strike a better balance between their time and income needs during the different phases of life. Although this plan can be covered in collective bargaining agreements, individual employees are not obliged to participate.

Under the plan, workers can save out of their gross wage, and taxation is deferred until the time when the saving is drawn down. The money in the savings account can be used for various forms of unpaid leave, such as caring for children or ill parents, schooling, a sabbatical or early retirement. The maximum amount that can be saved is 210 percent of the latest annual gross wage.

Source: OECD, 2005.



Adams, M. 2003. Fire and Ice: The United States, Canada and the Myth of Converging Values. Toronto, ON: Penguin Canada.

Beaujot, R. 2000. Earning and Caring in Canadian Families. Peterborough, ON: Broadview Press.

———. 2004. “Delayed Life Transitions: Trends and Implications.” Contemporary Family Trends. Ottawa, ON: The Vanier Institute of the Family. <www.vifamily.ca/library/cft/delayed_life.html>.

———. 2005. “The Net Effects of Delayed Reproduction.” Health Policy Research Bulletin 10: 21-23. <www.hc-sc.gc.ca/sr-sr/pubs/hpr-rps/bull/2005-10-chang-fer-tilit/index_e.html>.

Beaujot, R. and A. Muhammad. 2004. Transformed Families and the Basis for Childbearing. London, ON: Population Studies Centre, University of Western Ontario.

Bongaarts, J. 2002. “The End of the Fertility Transition in the Developed Worlds.” Population and Development Review 28, no. 3: 419-443.

———. 2004. Population Aging and the Rising Cost of Public Pensions. Working Paper No. 185, Policy Research Division, Population Council. <www.popcouncil.org/pdfs/wp/185.pdf>.

Brownell, Marni. 2005. Comments about unpublished MCHP research.

Caldwell, J.C. 2004. “Demographic Theory: A Long View?” Population and Development Review 30, no. 2: 297-316.

Caldwell, J., P. Caldwell, and P. McDonald. 2002. “Policy Responses to Low Fertility and Its Consequences: A Global Survey.” Journal of Population Research 19, no. 1: 1-24.

Canada, Health Canada. 2005. “Changing Fertility Patterns: Trends and Implications.” Health Policy Research Bulletin.

Canada, Statistics Canada. 1999. Assets and Debts Held by Family Units. From Survey on Financial Security.

———. “Births, 2002.” The Daily. Monday, April 19, 2004. <www.statcan.ca/Daily/English/040419/d040419b.htm>.

CIA World Factbook. 2003. Total fertility rate (children born/woman). <www.geographic.org>.

Council of Europe. 2003. Recent Demographic Developments in Europe, 2003. Supplement on Country Data: Sweden. Belgium: Council of Europe Publishing. <www.coe.int/T/E/Social_Cohesion/Population/Demographic_Year_Book/2003_Edition/ 04%20Country%20Data/Member%20States/Sweden/Sweden%20General %20Page.asp>.

Duclos, E., P. Lefebvre, and P. Merrigan. 2001. A “Natural Experimenton the Economics of Storks: Evidence on the Impact of Differential Family Policy on Fertility Rates in Canada. Working Paper No. 136. Montréal, QC: Centre for Research on Economic Fluctuations and Employment, Université du Québec à Montréal. <www.unites.uqam.ca/eco/CREFE/cahiers/cah136.pdf>.

Dupuis, D. 1998. “What Influences People’s Plans to Have Children?” Canadian Social Trends 48: 2-5.

Fougère, M. 2005. Personal communication. February 8.

Grant, J. et al. 2004. Low Fertility and Population Ageing: Causes, Consequences, and Policy Options. Report prepared for the European Commission. RAND Corporation. <www.rand.org/pubs/monographs/2004/RAND_MG206.pdf>.

Hogan, S. 2001. “Aging and Financial Pressures on the Health Care System.” Health Policy Research Bulletin 1, no. 1: 5-8. <www.hc-sc.gc.ca/iacb-dgiac/arad-draa/english/rmdd/bulletin/bulletin.pdf>.

Lochhead, C. 2000. “The Trend Toward Delayed First Childbirth: Health and Social Implications.” ISUMA: Canadian Journal of Policy Research 1, no. 2: 41-44.

———. 2005. “Growing Disparities among First-Time Parents: 1971-1996.” Health Policy Research Bulletin 10: 11-14. <www.hc-sc.gc.ca/sr-sr/pubs/hpr-rps/bull/2005-10-chang-fertilit/index_e.html>.

Marmot, M. 2004. The Status Syndrome: How Social Standing Affects Our Health and Longevity. New York: Times Books.

McCain, M.N., and J.F. Mustard. 1999. Reversing the Real Brain Drain: Early Years Study Final Report. Report of a study under-taken by the Canadian Institute for Advanced Research for the Premier of Ontario.

Milan, N. 2000. “One Hundred Years of Families.” Canadian Social Trends. Catalogue No. 11-008, 2-12. Ottawa, ON: Statistics Canada.

Milligan, K. 2004. “Subsidizing the Stork: New Evidence on Tax Incentives and Fertility.” Monograph. <www.econ.ubc.ca/kevinmil/research/babies2004.pdf>.

Morissette, R., and A. Johnson. 2004. Earnings of Couples with High and Low Levels of Education, 1980-2000. Analytical Studies Branch Research Paper Series, Statistics Canada.

Payne, J. 2004. “The Impact of a Reduced Fertility Rate on Women’s Health.” BMC Women’s Health. <www.biomedcentral.com/1472-6874/4/S1/S11>.

Ranson, G. 1998. “Education, Work and Family Decision Making: Finding the ‘Right Time’ to Have a Baby.” Canadian Review of Sociology and Anthropology 35, no. 4: 517-533.

Ravanera, Z.R., and F. Rajulton. 2004a. Bifurcation by Social Status in the Onset of Fatherhood. Discussion Paper No. 04-04. London, ON: Population Studies Centre, University of Western Ontario. <www.ssc.uwo.ca/sociology/popstudies/dp/dp04-04.pdf>.

———. 2004b. Social Status Polarization in the Timing and Trajectories to Motherhood. Discussion Paper No. 04-06. London, ON: Population Studies Centre, University of Western Ontario <www.ssc.uwo.ca/sociology/popstudies/dp/dp04-06.pdf>.

Reece, S.M. 1993. “Social Support and the Early Maternal Experience of Primiparas Over 35.” Maternal-Child Nursing Journal 21, no. 3: 91-98.

Sauvé, R. 2004. “The Current State of Canadian Family Finances — 2003 Report.” Contemporary Family Trends. Ottawa, ON: The Vanier Institute of the Family. <www.vifamily.ca/library/cft/state03.html>.

———. 2005. “The Current State of Canadian Family Finances — 2004 Report.” Contemporary Family Trends. Ottawa, ON: The Vanier Institute of the Family. <www.vifamily.ca/library/cft/state04.html>.

Senzilet, L., D. McCall, and J. Theriault. 2005. “Reproduction at Older Ages: The Health Implications.” Health Policy Research Bulletin 10: 15-20. <www.hc-sc.gc.ca/sr-sr/pubs/hpr-rps/bull/2005-10-chang-fertilit/ index_e.html>.

Sipos, A., et al. 2004. “Paternal Age and Schizophrenia: A Population Based Cohort Study.” British Medical Journal 329: 1070.

Tudiver, S. 2005. “Exploring Fertility Trends in Canada Through a Gender Lens.” Health Policy Research Bulletin 10: 7-10. <www.hc-sc.gc.ca/sr-sr/pubs/hpr-rps/bull/2005-10-chang-fertilit/index_e.html>.

Tudiver, S. and L. Senzilet. 2005. “Understanding Variation: Fertility Trends in Some Canadian Sub-Populations.” Health Policy Research Bulletin 10: 24-27. <www.hc-sc.gc.ca/sr-sr/pubs/hpr-rps/bull/2005-10-chang-fertilit/index_e.html>.

Vanier Institute of the Family. 2004. Profiling Canada’s Families III. Ottawa, ON.

Wilkinson, R.G. 1996. Unhealthy Societies: The Affliction of Inequality. London: Routledge.

Windridge, K.C., J. Berryman. 1999. “Women’s Experiences of Giving Birth after 35.” Birth 26, no. 1: 16-23.