Abstract
INTRODUCTION: Delayed motherhood, defined as childbirth at advanced maternal age (≥35 years), is a growing trend globally and increasingly observed in India, driven by shifts in socio-economic conditions, rising female education, and urbanization. While studies from high-income countries have linked advanced maternal age to adverse maternal outcomes, including nutritional risks and obstetric complications, evidence from nationally representative Indian data remains limited. Women aged 40-49 whose most recent birth likely represents their final reproductive event provide a unique opportunity to study delayed motherhood in the context of completed fertility. DATA AND METHODS: This study analyzed cross-sectional data from the National Family Health Survey-5 (NFHS-5, 2019-21). The analytical sample included 148,655 ever-married women aged 40-49 years. Delayed motherhood was defined as having the most recent childbirth at age ≥35, irrespective of parity. Maternal health outcomes included nutritional status (underweight, overweight), anemia prevalence, reproductive healthcare utilization (delivery care, sterilization), contraceptive use prior to first childbirth, unmet need for contraception, and pregnancy termination. Bivariate analyses were conducted initially, followed by generalized linear models (logistic regression) adjusting for demographic (age, residence, religion, caste) and socioeconomic (education, wealth index, employment) covariates. RESULTS: Women experiencing delayed motherhood had significantly higher adjusted odds of being underweight (AOR: 1.15; 95% CI: 1.09-1.22) and having unmet contraceptive needs (AOR: 1.98; 95% CI: 1.89-2.09). They also showed increased odds of pregnancy termination (AOR: 1.43; 95% CI: 1.36-1.50) and using contraception prior to first childbirth (AOR: 1.23; 95% CI: 1.15-1.32). Conversely, delayed mothers were less likely to be overweight (AOR: 0.90; 95% CI: 0.86-0.94) or to have undergone sterilization (AOR: 0.35; 95% CI: 0.34-0.37). No significant association was observed with anemia after adjustment. CONCLUSION: Delayed motherhood among women aged 40-49 in India is associated with maternal vulnerabilities, higher underweight prevalence, unmet contraceptive needs, and elevated pregnancy termination rates, alongside lower sterilization and overweight prevalence. These findings underscore the need for age-responsive and culturally sensitive maternal and reproductive health policies ensuring comprehensive prenatal, postnatal care and robust family planning services, empowering women to make informed reproductive choices in context of advanced maternal age.