Publications from Institute of Health and Society

• Nordenfelt, Lennart & Hofmann, Bjørn Morten (2027). Dignity. In Nesi, Hilary & Milin, Petar (Ed.), Reference Module in Social Sciences. Elsevier. ISSN 9780443157851. p. 1–7. doi: 10.1016/b978-0-443-15715-8.00018-2. Full text in Research Archive
• Fossmo, Hanne Ludt; Robinson, Hilde Stendal; Bjåstad, Karianne Grûner; Varhaug, Kristin Nielsen; Frich, Jan C & Ørstavik, Kristin (2026). Muscle Strength and Outcome Measures for Upper Limb Function in Adults With Myotonic Dystrophy Type 1: A Cross-Sectional Study. European Journal of Neurology. ISSN 1351-5101. 33(11). doi: 10.1111/ene.70799. Full text in Research Archive Show summary

  Background: Myotonic dystrophy Type 1 (DM1) is a multisystem neuromuscular disorder with progressive distal and proximal weakness, including in the upper limbs. Limited research has been conducted on hand function and outcome measures. Methods: Eighty nine adult DM1 participants were included in this cross-sectional study. The study describes upper limb strength and function and examines associations between motor impairments and clinical outcome measures, including comparing strength measurement methods. Disease severity was classified with the muscular impairment rating scale (MIRS) and the Brooke upper extremity scale was used as a classification scale of upper limb function. Muscle strength was measured using handheld dynamometers, and fine motor function with the Nine-Hole Peg Test and Nut and Bolt task. Upper limb function was rated with the Revised Upper Limb Module and global motor function with the Motor Function Measure 32. Patient-reported outcome measures included ABILHAND-NMD, ACTIVLIM, and the Myotonia behavior scale. Results: Participants showed a wide spectrum of motor impairment from minimal distal to severe proximal weakness. Strength measures correlated significantly with functional tests, while PROMs reflected perceived limitations but showed ceiling effects. Disease duration correlated with muscle strength and upper limb function, while age and subtype were less important. Myotonia severity showed only weak correlation with functional outcomes. Conclusion: No single measure fully captures upper limb function in DM1. A combination of strength testing, dexterity tasks, and PROMs provides a multidimensional assessment framework. Muscle strength assessment remains essential, and these findings support integrating multiple standardized measures for clinical trial endpoints and therapeutic evaluation in DM1.

• Moger, Tron Anders; Tjerbo, Trond; Vøllestad, Nina Køpke; Hellesø, Ragnhild; Holte, Jon Helgheim & Amundsen, Olav [Show all 18 contributors for this article] (2026). From data collection to action: Health registry data in chronic care management and policy. Journal of Public Health Research. ISSN 2279-9028. 15(4). doi: 10.1177/22799036261495552. Full text in Research Archive
• Ochili, CR; Whistance, M; Okolie, OJ; Hermet, L; Coraci, P & Touboul-Lundgren, PA [Show all 10 contributors for this article] (2026). Educational Needs for Vector Borne Disease Preparedness: A Multi Country Teacher Study. European Journal of Public Health. ISSN 1101-1262. 36(Supplement_5). doi: 10.1093/eurpub/ckag169.186. Full text in Research Archive Show summary

  Background The geographic expansion of vectors has heightened the global risk of transmission of vector‑borne diseases (VBDs). Within Europe, VBDs are increasingly recognised as an emerging public health concern, underscoring the importance of public education to support prevention and preparedness. This study explored the need for educational materials on VBDs for children and young people by examining teachers’ knowledge, current teaching practices, and resource requirements. Methods A qualitative study was conducted with teachers from England, France, Norway, and New Caledonia (a French territory outside Europe) who teach science, geography, and health education to 5–18‑year‑olds. Data were analysed using thematic analysis. Results 46 teachers took part in the focus groups. Most had a basic awareness of VBDs and its link with climate change, and the majority had never taught the topic. The teachers strongly emphasised the importance of VBD education and expressed a clear need for comprehensive, evidence‑based teaching resources. Reported barriers included limited curriculum time and the absence of VBD‑related content in existing programmes of study. Participants highlighted that clear terminology, structured content, and opportunities for students to engage with real‑world examples from other countries would enhance motivation and learning. Conclusions This study engaged teachers across diverse European VBD contexts to identify gaps in classroom preparedness and define requirements for effective teaching resources. It resulted in evidence-based materials designed to address these gaps, supporting improved teacher confidence, stronger curriculum integration, and behaviour-changing learning amongst students. As one of the first European studies to assess VBD education needs across countries facing emerging, locally transmitted, and established vector-borne threats, it introduces an innovative, cross-regional approach to strengthening public health preparedness. Key messages • Teachers from non-endemic European settings recognise the growing risks posed by VBDs, acknowledge the need to educate students, and express strong interest in accessible resources to support this. • Co‑developing clear, tailored teaching resources strengthens public health preparedness by improving teacher confidence, embedding VBD content in lessons, and promoting behaviour‑changing learning.

• Dahl, Cecilie; Madsen, Christian; Omsland, Tone Kristin; Frohn, Lise Marie; Geels, Camilla & Holvik, Kristin [Show all 7 contributors for this article] (2026). Air pollution and bone fractures in a high-risk population: differences by age and sex. Environment International. ISSN 0160-4120. 217, p. 110570–110570. doi: 10.1016/j.envint.2026.110570. Full text in Research Archive Show summary

  Purpose: Fracture incidence is high in Norway compared to other European countries. We examined whether ambient air pollution levels are associated with forearm and hip fracture incidence, and whether these associations differed by sex and age. Methods: Register data on 127,799 forearm fractures (age ≥40 years) and 103,754 hip fractures (age ≥50 years) were linked to population data from Statistics Norway (2008–2018). Annual levels of particulate matter <2.5 µm (PM2.5) and nitrogen dioxide (NO2) were modelled in the NordicWelfAir project using the Urban Background Model and combined via ArcGIS. Fracture Incidence Rate Ratios (IRRs) with 95% Confidence Intervals (CIs) by pollutant levels were estimated using Poisson regression, adjusting for education level, marital status, and immigrant background, urban/rural and inland location, health region, and climate, and examining interactions by sex and age (multiplicative and additive). Results: PM2.5 ranged from 0.90–66.1 µg/m3 (mean: 5.5) and NO2 from 0.20–72.2 µg/m3 (mean: 8.1). In the highest PM2.5 tertile compared to the lowest, age- and year-adjusted forearm fracture risk was IRR = 1.22 (95% CI: 1.18, 1.25) in men and IRR = 1.24 (95% CI: 1.22, 1.26) in women. They were partly attenuated after adjusting for annual temperature and geographic variables. Associations with NO2 and with hip fractures were similar, though weaker. Interactions by sex and age were present for both fracture types, most notably a stronger NO2– hip fracture association in individuals aged ≥80 years. Conclusion: Ambient air pollution is associated with fracture risk, even at low exposure levels. The most consistent finding was a stronger association among individuals aged 80 years and above.

• Silvestre, Jacopo Di; Salgado, M. Victoria; Jeon, Jihyoun; Mok, Yoonseo; Holford, Theodore R. & Vedøy, Tord Finne [Show all 9 contributors for this article] (2026). Age- and sex-specific smoking trends by birth cohort in Norway, 1978–2024: an analysis of cross-sectional survey data. The Lancet Regional Health - Europe. 71. doi: 10.1016/j.lanepe.2026.101886. Full text in Research Archive
• Mougin, Vincent; Gray, Authia; Naghavi, Mohsen; Allebeck, Peter; Kinge, Jonas Minet & Wool, Eve E. [Show all 9 contributors for this article] (2026). Income-related differences in survival across disease categories in Sweden: a retrospective population-based register study. The Lancet Regional Health - Europe. 71. doi: 10.1016/j.lanepe.2026.101896. Full text in Research Archive
• Allen-Unhammer, Anna Jane; Vøllestad, Nina Køpke & Mengshoel, Anne Marit (2026). Between a rock and a hard place: balancing roles of clinician and co-researcher in a primary health care setting - A qualitative study. Chiropractic & Manual Therapies. 34. doi: 10.1186/s12998-026-00681-9. Full text in Research Archive Show summary

  Background The participation of clinicians in clinical research is necessary, but balancing research and clinical duties can be challenging. We explored chiropractors’ experiences of participating in a clinical trial on spinal manipulation of the neck in primary health care (PHC). Methods A qualitative design was adopted, underpinned by social interactionism. Five virtual focus group interviews were performed between August-November 2023, including 15 chiropractors, who were involved in a clinical trial in PHC. Thematic analysis was applied. Results The interviewees were motivated to participate in the clinical trial to contribute to professional development through investigating the use of spinal manipulation. However, patient recruitment and adherence to the treatment protocol were more difficult than anticipated, especially when patients realised that the treatment would be determined by randomisation and because the chiropractors had to deliver the sham/placebo interventions. The interviewed chiropractors continually negotiated conflicting obligations of clinicians, co-researchers, and breadwinners, shifting loyalties between these roles in response to situational demands. Conclusions The clinicians’ motivations to take part in the trial varied but were in general rooted in a wish to contribute to strengthening the chiropractic profession. The negotiation of multiple roles and shifting loyalties rendered them moral agents. Our findings illustrate the social and relational nature of participating as a co-researcher in a trial conducted in a chiropractic PHC context. Our study also highlights a need for better support systems for research in PHC. This calls for political and organisational will to establish systems that provide necessary support to researchers and clinical co-researchers.

• Veshovda, Solveig; Richardsen, Kåre Rønn; Andersen, Marit Helen; Øiestad, Britt Elin; Eik, Hedda & Riiser, Kirsti (2026). Health literacy among adolescents: a cluster analysis. Frontiers in Public Health. 14, p. 1–11. doi: 10.3389/fpubh.2026.1853107. Full text in Research Archive Show summary

  Background: Adolescents represent a critical target group for health literacy (HL) research, as this stage of life involves increasing independence and responsibility for personal health behaviors. The growing burden of health challenges among adolescents highlights the importance of HL, as it equips individuals to navigate such challenges and actively engage with their health. Despite growing recognition of HL as a critical determinant of health, research on adolescent HL remains limited. This study aimed to describe HL among adolescents aged 14–16 years and to identify and characterize HL cluster affiliations. Materials and methods: This cross-sectional study included adolescents aged 14–16 years across six schools in Southern Norway. Data were collected between March and September 2023 using a web-based questionnaire. The study employed the Health Literacy for School-Aged Children (HLSAC) instrument (range 10–40). HL clusters were identified based on the instrument’s five core HL components (theoretical knowledge, practical knowledge, individual critical thinking, self-awareness, and citizenship) using Ward’s method. We employed multiple multinomial regression analyses to examine factors associated with different cluster affiliations. Results: The total sample’s ( n  = 440) mean score for HL was 31.6. The analysis indicated four HL clusters, reflecting ordered levels of HL, from low (Cluster A) to high (Cluster D). Adolescents with higher academic ambitions and fathers with a higher educational level had a lower relative risk (RRR) of being affiliated with the lowest HL cluster. Males had a lower RRR than females of being affiliated with the second-lowest HL cluster compared to the highest HL cluster. Conclusion: This study used cluster analysis to examine HL among adolescents, identifying four HL clusters ranging from low to high. The findings reveal social influences on HL, such as academic ambition and parental education, and how health determinants might shape its distribution at the population level. These data-driven insights underscore the need for further research into health outcomes.

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• Lie, Anne Kveim (2026). Mandag - Studio 2 - NRK Radio. [Radio]. NRK P2. Full text in Research Archive Show summary

  Helsereform er på vei, men hva forventer vi av helsevesenet?

• Nordhaug, Marita & Nortvedt, Per (2026). Høringsinnspill til Dokument 8:264 S (2025–2026) Høring: Representantforslag om utredning av selvbestemt livsavslutning. Stortingets og regjeringens publikasjoner. doi: https:/www.stortinget.no/no/Hva-skjer-pa-Stortinget/Horing/visning-av-skriftlig-innspill/?dnid=91927&h=10005906. Full text in Research Archive Show summary

  Hovedsynspunkt: Vi tilrår at representantforslaget ikke vedtas slik det foreligger. Forslaget omtaler selvbestemt livsavslutning som en rettighet uten å begrunne nærmere hvorfor en slik rett bør etableres. Vår viktigste innvending gjelder imidlertid rettighetens underliggende adgangsvilkår. Dersom livsavslutningen skal være selvbestemt, må personen selv kunne uttrykke en frivillig, informert og konsistent anmodning. Evnen til å be om hjelpen gjøres dermed til et avgjørende vilkår for tilgang. Dette utfordrer et normativt grunnprinsipp i norsk helse- og omsorgstjeneste: Likeverdig tilgang til hjelp skal bygge på medisinske behov og faglige vurderinger, ikke på evnen til selv å be om hjelpen.

• Nyen, J; Kristensen, A M D; Fagerland, Morten; Dammen, Toril; Zwisler, A D & Olsen, M H [Show all 13 contributors for this article] (2026). Beta-blocker therapy and sexual dysfunction after myocardial infarction: a sub-study of the BETAMI-DANBLOCK trial. European Heart Journal. ISSN 0195-668X. 47(Supplement_1). doi: 10.1093/eurheartj/ehag785.4110. Full text in Research Archive Show summary

  Abstract Background Sexual dysfunction is common after myocardial infarction (MI), but the role of beta-blockers on these disturbances remains unclear. Purpose To evaluate the presence of beta-blocker induced sexual dysfunction in post-MI patients without a reduced left ventricular ejection fraction (LVEF ≥40%) enrolled in the BETAMI-DANBLOCK trial. Methods A prespecified analysis of data from BETAMI-DANBLOCK which randomly assigned patients with a recent MI and an LVEF ≥40% to open-label beta-blocker therapy (median treatment dose metoprolol 50mg/day) or no beta-blocker therapy. For patients reporting sexual activity within the past 12 months, sexual function during the past 4 weeks was assessed at baseline and follow-up (3, 12, and 21 months) with the 5-item International Index of Erectile Function (IIEF, men) and the 6-item Female Sexual Function Index (FSFI, women). Sum scores for IIEF (range 5–25) and FSFI (6–30) provides measures of sexual function increasing with higher sexual function; thresholds for dysfunction were IIEF ≤21 and FSFI ≤19. Beta-blocker effects on IIEF and FSFI scores were analysed as between-group differences in change using linear mixed models (negative estimates indicating worse sexual function with beta-blockers). Odds ratios (ORs) for sexual dysfunction were estimated with multivariable logistic regression adjusting for randomisation stratification variables LVEF and study site. Results Among 5574 patients in BETAMI-DANBLOCK, 2850 stated sexual activity within past year at baseline. Of these, 2332/2850 (82%) responded to IIEF or FSFI at least once during the trial period. Among men, baseline median IIEF score was 23 (IQR: 19-24) in the beta-blocker group and 23 (IQR: 19-25) in the no beta-blocker group, with 39% reporting scores indicating erectile dysfunction and 12% in DANBLOCK dispensing sildenafil. We found no statistically significant effect of beta-blockers on the total IIEF score during follow-up (Table). However, the odds of erectile dysfunction was slightly higher in the beta-blocker group at the first follow-up (3 months OR: 1.58, 95% CI: 1.02, 2.42), but not on the subsequent timepoints. The proportion of filled sildenafil prescriptions was similar in the beta-blocker and no beta-blocker group (18% vs 17%) during follow-up in DANBLOCK. Among women, median FSFI score at baseline was 24 (IQR: 20-27) and 24 (IQR: 18-27), with 24% and 31% of patients having a score indicating sexual dysfunction for the beta-blocker group and the no beta-blocker group, respectively. We found no effect of beta-blocker therapy on FSFI scores during follow-up, but effect estimates were uncertain. Conclusions In the BETAMI-DANBLOCK trial, beta-blocker therapy after MI was associated with a small transient increase in erectile dysfunction among men, but no long-term effects were observed.

• Johannessen, Tonje Rambøll; Atar, Dan; Halvorsen, Sigrid Groven; Munkhaugen, John; Vallersnes, Odd Martin & Bakken, Arnhild [Show all 7 contributors for this article] (2026). Point-of-care high-sensitivity troponin testing for rapid chest pain triage in emergency primary care: preliminary efficacy findings from the OUT-POC Study. European Heart Journal. ISSN 0195-668X. 47(Supplement_1). doi: 10.1093/eurheartj/ehag785.1892. Full text in Research Archive Show summary

  Abstract Background High-sensitivity troponin testing at the point-of-care (POC) level may enable faster and more accurate assessment of chest pain in low-resource, out-of-hospital settings. The ongoing prospective OUT-POC study (One-hoUr Troponin using a high-sensitivity Point-Of-Care assay in emergency primary care), initiated in June 2025, aims to enrol 2,500 patients across six emergency primary care clinics in Norway. Purpose This interim analysis evaluates the triage efficacy of the study`s POC assay (TRIAGETRUE High Sensitivity Troponin I (hs-cTnI) Test) using the ESC 0/1-hour algorithm, comparing it to the standard-of-care central laboratory assay (Elecsys 5th-generation hs-cTnT) to identify discrepancies and assess potential safety concerns for patients classified as rule-out by the POC assay. Methods A prespecified interim analysis was performed on the first 300 participants enrolled at the largest study site. EDTA whole blood was collected for the POC assay, and lithium heparin samples were sent to the central laboratory via pneumatic tube for hs-cTnT analysis. The hs-cTnT results were blinded to the treating physicians. Major discrepancies were defined as cases in which the POC assay triaged a patient for direct rule-out, while the central laboratory assay classified the same patient as rule-in. Results During the first three months of inclusion, data were analysed from 308 patients with a median age of 55 years (IQR 42–69) and 47.4% (N=146) female. The POC assay triaged 65.6% (n=202) to 0-hour rule-out (&lt;4 ng/L and ≥3 hours since symptom onset), compared with 45.5% (n=140) triaged by the hs-cTnT assay (&lt;5 ng/L and ≥3 hours since symptom onset). The 0-hour rule-in rates were 4.2% for the POC assay (≥60 ng/L) and 2.6% for the hs-cTnT assay (≥52 ng/L). The POC assay also triaged 90 patients (29.2%) to the indeterminate observation group, requiring a repeat 1-hour sample. In comparison, the hs-cTnT assay would have required repeat sampling in 160 patients (51.9%), though 70 of these were not obtained due to blinded results. After the repeat sample, the POC 0/1-hour algorithm triaged 74.0% of the patients as rule-out, suggesting potential eligibility for discharge. No major discrepancies between the two assays were identified after a single sample. Technical error codes occurred in 3 of 308 patients (1.0%) during POC testing. Conclusions Compared with the standard-of-care central laboratory hs-cTnT assay, the TRIAGETRUE hs-cTnI POC assay provides a higher single-sample rule-out rate and a shorter turnaround time. Together, these features enable faster identification of rule-out patients and may improve patient flow and chest pain management in busy clinics. No safety concerns have been identified for the point-of-care assay, supporting continuation of the larger implementation study.Triage Efficacy after a single blood sample

• Bratland-Sanda, Solfrid; Nordbø, Ingeborg; Hagen, Reidar Strand; Heggestad, Anne Kari Tolo; Madsen, Linda & Lia, Hedda Øyeflaten [Show all 7 contributors for this article] (2026). Parents’ and guardians’ experiences of follow-up of maladaptive movement during pediatric treatment of eating disorders: a cross-sectional survey from Norway. Full text in Research Archive
• Eick, Frode & Jahnsen, Synnøve Økland (2026). Homelessness as Structural Vulnerability: Precarious Citizenship and Migrant Health. European Journal of Public Health. ISSN 1101-1262. 36(Supplement_5). doi: 10.1093/eurpub/ckag169.1739. Full text in Research Archive Show summary

  Abstract Background Housing is a key social determinant of health, yet little is known about how homelessness shapes migrants’ health in Nordic welfare states where legal status, labour market attachment and welfare entitlements are unevenly distributed. This article examines how homelessness directly and indirectly affects the physical and mental health of migrants, and how structural barriers limit their capacity to navigate access to health care. Methods Mixed-methods study combining registry data on shelter use in Oslo (2019–2023) and interviews with ten frontline health and social care staff at a long-term, NGO-run shelter. Analyses were informed by precarious citizenship and structural vulnerability. Results Homeless migrants represented a heterogeneous group in terms of citizenship status and health problems. Migrants’ region of origin influenced their resident status, the uncertainty of their situation, and the duration of their stay. Homelessness interacted with migrants’ pre-existing vulnerabilities, such as precarious legal status, limited finances, language barriers, lack of digital access to social services, and untreated chronic disease, to accelerate health decline. Precarious citizenship can be enacted through gendered arenas of exploitation, with consequences for safety, access to care and possibilities for recovery. Conclusions Homelessness among migrants reflects structural vulnerability and produces cumulative disadvantage. Homelessness is not simply a backdrop to migrant ill-health; it is an active health risk that exacerbates disease, disrupts treatment, and limits recovery. Shelters and low-threshold services play a crucial bridging role by enabling access to treatment and rehabilitation. Addressing migrant health inequities requires rights-based approaches and integrated policies linking housing stability and health care access. Key messages • Homelessness is not simply a backdrop to migrant ill-health; it is an active health risk that exacerbates disease, disrupts treatment, and limits recovery. • Addressing migrant health inequities requires rights-based approaches and integrated policies linking housing stability and health care access.

• Khalid, Saliha; Stub, Trine; Alpers, Lise-Merete; Borge, Christine Råheim; Qureshi, Samera Azeem & Kristoffersen, Agnete Egilsdatter (2026). Traditionell medisin brukt blant pakistanske innvandrere i Norge. Full text in Research Archive
• Ugelvik, Thomas; Nyvoll, Pernille; Lunde, Rose Elisabeth; Olsen, Hilgunn & Jølstad, Odd Borgar (2026). Helsefremmende fengsler? Full text in Research Archive
• Morken, Tone; Vallersnes, Odd Martin & Lindberg, Bent Håkan (2026). Legevaktpodden #55: Usikkerhet på vakt - kunsten å stå i det grå. Full text in Research Archive Show summary

  Usikkerhet på legevakt er ikke et tegn på utilstrekkelighet, men en iboende del av legejobben. Odd Martin Vallersnes og Bent Håkan Lindberg diskuterer hvordan vi kan flytte fokuset fra medisin som «svart-hvitt» naturvitenskap til en forståelse av det kliniske «gråfeltet».   Podkastvert: Tone Morken. Produsent: Nathalie Sandal.  

• Lindberg, Bent Håkan (2026). En ASP-forskers historie. Full text in Research Archive
• Andersen, Maria Lyster; Torvik, Fartein Ask & Hart, Rannveig Kaldager (2026). Family Transitions, Mental Health, and Work: Evidence from Parenthood, Grandparenthood, and Assisted Reproduction in Norway. Universitetet i Oslo. Full text in Research Archive Show summary

  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: not published) 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.

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