Many countries have experienced substantial declines in fertility, later transitions to parenthood, and increased use of assisted reproductive technologies (ART). These changes can matter for demographic patterns, but also for health, wellbeing, and labour market trajectories across the life course. Family formation may affect health and employment in different, potentially opposing, ways. Parenthood and grandparenthood can provide meaning and social support, but they may also involve stress, care responsibilities, and economic costs. Similarly, difficulties conceiving and undergoing fertility treatment might affect mental health and working life well beyond the treatment period. Yet we do not fully understand how these different experiences of family formation are associated with health and labour-market outcomes over the life course.
Consequently, this thesis examines how different family formation processes relate to health, sick leave, and employment, with a particular focus on gender differences. The three papers of this thesis consider distinct but connected stages of the family life course: parenthood, grandparenthood, and infertility treatment.
Paper 1 studies differences in mental health between parents and childless individuals across the full adult life course. Parents have a consistently lower risk of mental disorders than the childless, even when adjusting for important confounders such as socioeconomic status and marital status. We find the lowest risk of mental disorders among individuals who have not yet become parents. This suggests that the observed parent–childless gap at least partly reflects selection into parenthood rather than a protective causal effect of having children on mental health. Importantly, we also find differences in the association depending on the specific mental health condition studied, with certain symptoms such as stress more likely among parents.
Paper 2 examines the causal effects of becoming a grandparent on health and labour market outcomes, again with particular attention to gender. The results show that grandparenthood affects both health and employment, although the magnitude and direction of effects vary across outcomes. Becoming a grandparent is associated with an increased risk of respiratory infections, a reduction in cardiovascular-related health care use, and a slightly lower risk of mental disorders. It also marks a clear transition in labour market attachment: both women and men become more likely to work part-time and experience reductions in income. The employment effects are substantially larger among grandmothers. These gender differences may reflect women’s greater involvement in informal childcare.
Paper 3 investigates the consequences of ART treatment for mental health, sick leave, and income. The findings show a marked change in outcome trajectories around treatment start, suggesting that ART comes with important social and health-related costs. Women whose treatment is unsuccessful become more likely to seek primary care for mental health concerns, have higher levels of sick leave for several years after treatment, and show flatter income trajectories relative to their pre-treatment trends. We also observe some changes among partners, in the form of weaker income growth following unsuccessful treatment.
Taken together, the three papers show that family formation is linked to health and working life in varying ways across the life course. The papers also illustrate how family formation reflects gendered processes. The thesis highlights the importance of selection into parenthood, identifies grandparenthood as a meaningful life-course transition with health and economic consequences, and shows that unsuccessful fertility treatment may have lasting effects on mental health and employment. By examining these processes together, the thesis shows that family formation is not only an isolated reproductive event, but also a potential source of gender differences and inequalities in health and economic wellbeing.