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This study aims to enhance the understanding of how the increasing use of assisted reproductive technologies (ART) has contributed to the increase in the total fertility rate (TFR) and to further delaying childbearing. Moreover, it addresses the gap in the methodology concerning the quantification of the effect of ART on fertility postponement. Czechia is one of few countries that are able to serve for the study of the demographic impacts of ART. ART and non-ART fertility rates were calculated using unique data on all children born in Czechia. Excluding mothers who received cross-border reproductive care, the proportion of ART live births in Czechia has not exceeded 4%. However, without ART the TFR would have stood at just 1.65 instead of 1.71 in 2020. ART significantly contributed to a reduction in childlessness and to the increase in fertility rates at ages over 35. Applying the decomposition method, the contribution of the use of ART to delaying childbearing between 2013 and 2020 was 4%. The findings have important policy implications. ART has the potential to support fertility recovery in the context of delayed childbearing. The findings served to alleviate concerns about the contribution of ART to the further undesired delay of childbearing.

Fertility postponement, which has comprised the most significant reproductive trend in developed countries over the last few decades, involves a number of social, personal and health consequences. The length of stay (LOS) in hospital following childbirth varies considerably between countries. Czechia, where the fertility postponement process has been particularly dynamic, has one of the longest mean LOS of the OECD member countries. We analyse the influence of the age of mothers on the LOS in hospital associated with childbirth. We employed anonymised individual data provided by the General Health Insurance Company of the Czech Republic on women who gave birth in 2014. Kaplan-Meier survival plots and binary logistic regression were employed to identify factors associated with long stays (> = 7 days for vaginal births, > = 9 days for CS births). The impact of the maternal age on the LOS is U-shaped. A higher risk of a longer hospitalisation period for young mothers was identified for both types of birth (OR = 1.58, 95% CI 1.33-1.87, p˂0.001 for age less than 20, OR = 1.31, 95% CI 1.20-1.44, p˂0.001 for age 20-24 compared to 30-34). The risk of a longer stay in hospital increases with the increasing age of the mother (OR = 1.23, 95% CI 1.13-1.35, p˂0.001 for age 35-39, OR = 2.05, 95% CI 1.73-2.44, p˂0.001 for age 40+ compared to 30-34), especially with concern to vaginal births. The probability of a long LOS increases significantly after the age of 35, especially in the case of vaginal births. Thus, the fertility postponement process with the significant change in the age structure of mothers contributes to the increase in health care costs associated with post-birth hospitalisation.

Cross-border reproductive care (CBRC) represents a growing component of assisted reproductive technologies (ART), particularly in Europe. This article presents a descriptive, register-based analysis of CBRC in Czechia, focusing on the volume of ART cycles, the countries of origin of patients, and treatment types in comparison with domestic patients. We analysed 176,588 ART cycles recorded in the Czech National Registry of Assisted Reproduction (NRAR) between 2016 and 2019. Patients were classified by country of residence, nationality, and insurance status. Descriptive statistics were used to identify patterns in terms of patient characteristics and treatment choices. The analysis was contextualised with reference to national ART legislation in selected source countries. The findings revealed that nearly 40 percent of ART cycles in Czechia are attributable to CBRC, making the country one of Europe’s leading destinations for cross-border fertility treatment. The largest groups of CBRC patients are from Germany, Italy, Slovakia, the UK, France, Serbia, Ireland, and Hungary. Women who seek CBRC in Czechia are significantly older than their Czech counterparts, with a modal age of 41 years compared to 38 years, respectively, for IVF/ICSI cycles and 43 years compared to 38 years, respectively, for cycles in which a woman receives donated eggs. Moreover, the treatment preferences of CBRC patients differ markedly: they are more likely to undergo frozen embryo transfer (FET) cycles (37 percent vs. 30 percent among Czech patients) and egg receipt (OoR) cycles (32 percent vs. 3 percent among Czech patients). The study provides a unique, data-driven perspective on the dynamics of cross-border reproductive care in Czechia, drawing on comprehensive national registry data. By identifying key source countries and differences in treatment preferences, it highlights Czechia’s growing role in the European reproductive care landscape and sheds light on how legal, demographic, and economic conditions shape cross-border patient mobility in Europe.

As with Northern European countries, Czechia experienced unexpected fertility developments during the Covid-19 pandemic. Fertility in Czechia increased between 2020 and 2021 from 1.76 children per woman to 1.83. However, between 2021 and 2022, fertility fell significantly to just 1.62 children per woman. The main change that occurred between 2020 and 2021, which is thought to have affected fertility one year later, comprised vaccination against Covid-19. This vaccination of the adult population was very specific in terms of both its scope and the timing of vaccination for each age group as organised by the state. The mass scale of the vaccination campaign and its implementation within a very short period of time were unprecedented. However, along with the significant degree of uncertainty concerning the appropriateness of vaccination for pregnant women, vaccination was seen as a factor that potentially acted to significantly change women’s reproductive plans in the short term and, as a consequence, potentially exerted a significant short-term impact on both birth rates and fertility indicators. This study models the maximum potential impact of vaccination on fertility levels under the assumption that all the vaccinated women chose to avoid conception in the month in which they were vaccinated. Applying the indirect standardisation principle, we calculated the expected monthly live births after excluding women who were vaccinated nine months earlier. The comparison of hypothetical and observed fertility revealed that the perceived potential impact of vaccination was largely consistent with the observed fertility decline in Czechia between 2021 and 2022.

Childbearing postponement is a key demographic change that has been experienced by most European countries. It leads to a late-fertility pattern, with women realizing their reproductive plans preferentially after the age of 30. This may result in a lower fertility level. Since the ideal family size has not changed in most European countries, it has been argued that the end of the postponement transition further depends on the extent to which the lower fertility of younger women is compensated for by an increase in that of older women. Thus, the completion of the transition depends not only on the formation of a late childbearing pattern, but also on the capability of women to realize their reproductive plans if they commence childbearing later in their lives. This study employed a new approach to assess postponement transition based on analysis of the realization of the fertility intentions of women at later childbearing ages using survey panel data. A method that enables the differentiation between transitional and post-transitional cohorts was applied. The investigation was based on a comparison of the postponement transition in Czechia and France, the former being a post-communist and the latter a Western European country. It was found that despite having a similar pattern of fertility timing, Czechia and France underwent differing phases of postponement transition. The Czech population was identified as being transitional since only the ‘transition’ cohorts had completed their fertility during the period under study. These cohorts did not show a significant increase in realization of fertility intentions in later age. In contrast, the post-transitional French population is characterized by higher completed cohort fertility rates amongst women who entered motherhood at the age of 30 and over and by the significantly higher realization of fertility intentions for women aged 30–34 years.

Objective: To investigate the association between a mother’s age and the risk of caesarean section (CS) when controlling for health factors and selected sociodemographic characteristics. Methods: Binary logistic regression models for all women who gave birth in Czechia in 2018 (N = 111,749 mothers who gave birth to 113,234 children). Results: An increase in the age of a mother significantly increases the odds of a CS birth according to all of the models; depending on the model, OR: 1.62 (95% CI 1.54–1.71) to 1.84 (95% CI 1.70–1.99) for age group 35–39 and OR: 2.83 (95% CI 2.60–3.08) to 3.71 (95% CI 3.23–4.27) for age group 40+ compared to age group 25–29. This strong association between the age of a mother and the risk of CS is further reinforced for primiparas (probability of a CS: 11% for age category ≤ 19, 23% for age category 35–39, and 38% for age category 40+). However, the increasing educational attainment of young women appears to have weakened the influence of increasing maternal age on the overall share of CS births; depending on the model, OR: 0.86 (95% CI 0.80–0.91) to 0.87 (95% CI 0.83–0.91) for tertiary-educated compared to secondary-educated women. Conclusions: The age of a mother comprises an independent risk factor for a CS birth when the influence of health, socioeconomic, and demographic characteristics is considered.

The paper investigates the transition to second births in Czechia and Slovakia in the context of the development of parental leave policies since the beginning of the 1990s. We focus on two countries that share many similarities in terms of their economic, cultural and institutional settings but differ in their parental leave policies. We analyse to what extent the significant changes introduced to the parental leave system, particularly in Czechia, have influenced second-birth timing in two low-fertility countries that are experiencing a shift to the late childbearing pattern. Using data from the Czech Statistical Office and the Statistical Office of the Slovak Republic, we employ the parity-cohort method and use duration-specific second-birth rates and the second-birth progression ratio to investigate changes in the spacing and quantum of second births for women who had their first child between 1992 and 2013. The results show that for an increasing proportion of mothers in Czechia, the option to claim higher parental benefits for shorter periods of leave contributed to the shortening of the birth interval between their first and second children. No such changes in birth intervals were detected in Slovakia, where no important changes regarding the flexibility or amount of the parental benefit were introduced. The difference in the development of second-birth rates between the two countries was also reflected in a growing difference in the share of mothers having two children within 10 years of the first birth.

The fertility gap, which indicates the difference between the planned and actual number of children born, can be explained by the shift in parenthood to older ages and is associated with the non-attainment of one’s intended reproductive plans. This paper focuses on the gap in the timing of entry into parenthood, i.e. between the planned and actual age at the birth of the first child. The study is based on data from the Women 2016 survey which re-interviewed women of fertile age from the second wave of the Czech Generations & Gender Survey conducted in 2008. At the population level, the fertility timing gap differs across generations. While for Czech women born between 1966 and 1971 the planned age exceeded the actual observed age by one year, the realisation of fertility occurred two years later than planned for the youngest generation (1983–1990) included in the study. At the individual level, the later-than-planned realisation of fertility was found to be related primarily to partner-related factors.

Background Although the percentage of cesarean sections (CS) in Czechia is below the average of that of other developed countries (23.6%), it still exceeds WHO recommendations (15%). The first aim of the study is to examine the association between a CS birth and the main health factors and sociodemographic characteristics involved, while the second aim is to examine recent trends in the CS rate in Czechia.  Methods Anonymized data on all mothers in Czechia for 2018 taken from the National Register of Expectant Mothers was employed. The risk of cesarean delivery for the observed factors was tested via the construction of a binary logistic regression model that allowed for adjustments for all the other covariates in the model. Results Despite all the covariates being found to be statistically significant, it was determined that health factors represented a higher risk of a CS than sociodemographic characteristics. A previous CS was found to increase the risk of its recurrence by 33 times (OR = 32.96, 95% CI 30.95–35.11, p <0.001). The breech position increased the risk of CS by 31 times (OR = 31.03, 95% CI 28.14–34.29, p <0.001). A multiple pregnancy increased the odds of CS six-fold and the use of ART 1.8-fold. Mothers who suffered from diabetes before pregnancy were found to be twice as likely to give birth via CS (OR = 2.14, 95% CI 1.76–2.60, p <0.001), while mothers with gestational diabetes had just 23% higher odds of a CS birth (OR = 1.23, 95% CI 1.16–1.31, p <0.001). Mothers who suffered from hypertension gave birth via CS twice as often as did mothers without such complications (OR = 2.01, 95% CI 1.86–2.21, p <0.001). Conclusions The increasing age of mothers, a significant risk factor for a CS, was found to be independent of other health factors. Accordingly, delayed childbearing is thought to be associated with the increase in the CS rate in Czechia. However, since other factors come into play, further research is needed to assess whether the recent slight decline in the CS rate is not merely a temporal trend.

This study examines how the role of abortion has evolved in the context of low fertility and delayed childbearing, with a focus on Czechia and Slovakia-two countries that experienced both high abortion rates and a demographic shift toward later motherhood since the 1990s. Using demographic data and survey analysis, it investigates the interplay between abortion, fertility, and contraceptive use under changing reproductive regimes. The analysis is structured around three objectives: (1) to assess long-term changes in the intensity and structure of induced and spontaneous abortions since 1993; (2) to evaluate the relationship between modern contraceptive use and abortion trends; and (3) to compare evolving public attitudes toward abortion in both countries. Data from national statistical offices were used for the demographic component, while binary logistic regression was applied to European Values Study data to explore the sociocultural dimension. The findings show that in low-fertility contexts with liberal abortion laws and widespread contraceptive access, abortion rates can remain low even as contraceptive prevalence declines, suggesting a weakening of the direct association between contraceptive use and abortion trends. This challenges the assumption that abortion levels directly reflect contraceptive failure. The study offers new theoretical insights into how reproductive behavior adapts to late fertility patterns and highlights the need for nuanced reproductive health policies that account for shifting social norms and individual agency.