title: Cohort study of early literacy and childbearing over the reproductive lifecourse.
abstract: Literacy is linked to a range of health outcomes, but its association with reproductive health in high-income countries is not well understood. We assessed the relationship between early-life literacy and childbearing across the reproductive lifecourse in the USA.
  
  
  
  A prospective cohort design was employed to assess early-life literacy and subsequent childbearing, using data from the National Longitudinal Survey of Youth 1979. The US youth aged 14-22 years in 1979, including 6283 women, were surveyed annually through 1994 and biannually thereafter. Literacy was assessed in 1980 using the Armed Services Vocational Aptitude Battery Reading Grade Level (RGL). Cumulative childbearing and grand multiparity (≥5 births) were assessed in 2010. Summary statistics, χ2, Kruskal-Wallis, test for trend and logistic regression, were used.
  
  
  
  Of 6283 women enrolled, 4025 (64%) had complete data and were included in the analyses. In 1980, these women were on average 18 years old and in 2010 they were 45. Median cumulative parity decreased for each RGL and ranged from 3.0 (<5th grade) to 2.0 (>12th grade) (p=0.001). Adjusting for race/ethnicity, poverty status, whether a woman had had a child in 1980, and age in 1980, odds of grand multiparity were 1.9 (95% CI 1.1 to 3.5) and 1.8 (95% CI 1.0 to 3.3), greater among women with <5th or 5-6th grade literacy compared with those ≥12th literacy.
  
  
  
  In the USA, early-life literacy is associated with total parity over a woman's lifecourse. Literacy is a powerful social determinant of reproductive health in this high-income nation just as it has been shown to be in low-income nations.
authors.affiliation: Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Seymour
authors.affiliation: Master of Public Health Program, Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Frasso
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.affiliation: Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington, USA.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Bennett
mesh_terms: D000293:Adolescent; D000328:Adult; D004651:Employment; D005006:Ethnicity / Q000193:education / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007182:Income; D000067010:Literacy / Q000208:ethnology / Q000266:history / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D060728:Reproductive Health / Q000639:trends; D064890:Social Determinants of Health / Q000266:history / Q000639:trends; D012931:Social Environment; D014481:United States / Q000453:epidemiology
keywords: Childbearing; Social determinants of health; grand multiparity; literacy; women's health