Fertility behaviors and mid-late-life health status in China: From a life-course perspective

Despite extensive research on the impact of fertility behaviors on mid-late-life health, conclusions remain inconsistent, and understanding is limited regarding the role of fertility-correlated life events in this causality. This study uses the 2018 wave and life-history information of the China Health and Retirement Longitudinal Study (CHARLS) dataset to explore how the number of children born (NCB) and age at first birth (AFB) influence later-life health. It also examines the effects of early-life educational attainment and mid-late-life caregiving on later-life health from a life-course perspective. Health measures include the Health Deficit Index (HDI), Activities of Daily Living (ADL), and Mini-Mental State Examination (MMSE). Results from the instrumental variables (IV) approach indicate that higher NCB predicts worse health, while later AFB predicts better later-life health. These findings remain robust with different measures of fertility behaviors, and in models that control for cohort and community fixed-effects. However, introducing education variables could disrupt the causality between fertility behaviors and later-life health, but not with caregiving variables. This suggests a potential “horse race” effect between education and fertility behaviors, both of which significantly influence later-life health. Therefore, understanding this causality and formulating policy for an aging society from a life-course perspective is essential. •More children and early first birth worsen later-life health.•This fertility-health relation persists after using IV and sensitivity approach.•Education, not caregiving, potentially ‘horse race’ the fertility-health causality.•Various health measures are necessary in the mid-older people's health research.•Fertility and aging policies need to adopt the life-course perspective.