Utilization of Infertility Treatments: The Effects of Insurance Mandates

Over the last several decades, both delay of childbearing and fertility problems have become increasingly common among women in developed countries. At the same time, technological changes have made many more options available to individuals experiencing fertility problems. However, these technologies are expensive, and only 25% of health insurance plans in the United States cover infertility treatment. As a result of these high costs, legislation has been passed in 15 states that mandates insurance coverage of infertility treatment in private insurance plans. In this article, we examine whether mandated insurance coverage for infertility treatment affects utilization. We allow utilization effects to differ by age and education, since previous research suggests that older, more-educated women should be more likely to be directly affected by the mandates than younger women and less-educated women, both because they are at higher risk of fertility problems and because they are more likely to have private health insurance, which is subject to the mandate. We find robust evidence that the mandates do have a significant effect on utilization for older, more-educated women that is larger than the effects found for other groups. These effects are largest for the use of ovulation-inducing drugs and artificial insemination.     

“Dynamic Infertility”

Critical content analysis of eight years' of newspaper coverage of advanced reproductive technologies in Israel demonstrates that the public debate over assisted reproduction is largely characterized by personal narratives that accentuate, on the surface, a discourse of individualism. However, this study claims that beneath the surface, these women's “personal dreams,” are in fact realization of the “national dream” that promotes particular social values and demographic goals. The news coverage was found to promote a process we name “dynamic infertility,” in which women are encouraged not to accept physiological infertility but rather undergo as many fertility treatments as necessary, for as long as it takes, ultimately to bring their genetically related children into the world.     

What predicts breast cancer rates? Testing hypotheses of the demographic and nutrition transitions

Modern demographic and nutritional transitions have been implicated in global epidemiological transitions intensifying over the last 60 years. These transitions include steadily declining fertility rates, improving nutritional indicators, and increasing incidence rates of chronic diseases such as breast cancer. This research draws on the well established pathways linking individual reproductive and nutritional profiles to breast cancer risk, in order to test the links among demographic, nutritional, and epidemiological transitions on a global scale. We propose two hypotheses that test the reproductive and nutritional pathways that are suggested to increase breast cancer risk at the population level. We use total fertility rate (TFR) to test the reproductive behaviour hypothesis, and we use average height and the percentage of the population that is overweight for the nutritional hypothesis; these indicators are compared to breast cancer incidence rates for 2008. Accounting for national wealth and expenditures on healthcare, we found that both hypotheses were significantly associated with breast cancer incidence, although TFR appears to have a more consistent association with incidence. Drawing on our regression model, we explain trends in breast cancer incidence in selected countries, as well as making predictions about shifting breast cancer incidence rates over the next several decades. These data suggest that greater attention should be paid to the unintended health consequences of transitions that are largely considered to bring improvements in quality of life. Our findings suggest that greater investments in screening and treatment are particularly needed in regions undergoing transitions in fertility rates, particularly those areas experiencing super-low fertility.     

Fertility beyond the frontier: indigenous women,fertility, and reproductive practices in the Ecuadorian Amazon

Recent research suggests that after decades of population decline, indigenous populations of the lowland tropics of Latin America are now experiencing rapid growth. At the same time, conservationists have pronounced indigenous lands as a key to the future of Amazon forests. As such, conservationists should have a good understanding of indigenous demography and impacts on conservation and development. Yet, there is little depth to understanding of these demographic changes and a dearth of quantitative research on the reproductive practices of indigenous populations. This study addresses these gaps through analyses of a household survey of 648 women of reproductive age from five distinct ethnic populations in the Ecuadorian Amazon. We estimate fertility, analyze reproductive intentions and contraceptive use, and determine the unmet need for reproductive health services. The analyses confirm high fertility rates and high levels of unmet need for contraception. With regard to program and policy implications, we conclude by arguing that isolation and cultural barriers present unique challenges to meet the reproductive health needs of these populations. Innovative approaches, such as those merging population–health–environment topics, may be most relevant for meeting these challenges.

The Effect of Couple Disagreement about Child‐Timing Intentions: A Parity‐Specific Approach

Using couple data from a longitudinal study conducted in Italy, a country with persistently low fertility levels, we examined the effect of partners' discrepant child‐timing intentions on reproductive behavior. We found that the effect of couple disagreement on subsequent fertility is parity‐specific and does not depend on whether only the male or the female partner intends to have a(nother) child. The disagreement tends to produce an intermediate childbearing outcome at parities zero and one, while the outcome is shifted more toward agreement on not having a(nother) child at parity two. The empirical evidence suggests that gender equality in reproductive decisionmaking is not driven by partners' equal bargaining power or partners' equal access to economic resources. The findings indicate that the predictive power of child‐timing intentions strongly improves if both partners' views are considered in fertility models, and thus support the adoption of couple analysis in fertility research.     

The effects of infant mortality on fertility revisited: new evidence from latin america

In this paper, we examine empirical evidence for a relation between infant and child mortality and fertility in Latin American countries from 1920 to 1990. We investigate the relation at several levels of aggregation and evaluate the extent to which evidence at one level is consistent with evidence at other levels. We first examine aggregate cross-country information over several decades, a type of data typically used in past research on the topic. We also examine yearly series of births, deaths, infant deaths, and socioeconomic indicators for selected countries to track the association between short-term fluctuations in fertility and infant mortality. Finally, we use micro-level data from the Demographic and Health Surveys (DHS) to assess the relation between fertility and child mortality from individual reproductive histories. The evidence we assemble from these different data sets is remarkably consistent and suggests small positive effects of infant mortality on fertility. These effects, however, may be too small to support the hypothesis that changes in child mortality are of more than modest importance in the process of fertility decline in Latin America in the late twentieth century.     

Race,Remarital Status,and Infertility in 1910: More Evidence of Multiple Causes

The dominant approach to studying historical race-related fertility differences has been to limit samples to first-married and younger women. We argue that studying historical race-related fertility differences in the context of remarriage is also important: remarriage and fertility patterns are both rooted in the biosocial conditions that produce racial disparities in health. We employ a multiple causes framework that attributes variation in fertility patterns to voluntary limitation and involuntary factors (infecundity/subfecundity). We use data from the 1910 Integrated Public Use Microdata Series and estimate zero-inflated negative binomial models that simultaneously distinguish those who are infecund (vs. fecund) and estimate the number of remarital births among the fecund. Our approach allows us to evaluate historical remarital (in)fertility differences, accounting for marital, socioeconomic, and geographic influences on fecundity and fertility, while empirically accounting for the influence of children “missing” from the household due to mortality and fostering/aging out. Consistent with past studies that emphasized poorer African American health as a major influence on involuntary infertility, we find that African American women were more likely than white women to be in the always-zero (infecund) group and to have fewer remarital births. Supplemental analyses nuance these findings but indicate that these results are robust. Overall, we find support for a multiple-causes perspective: while the findings are consistent with the adoption of deliberate fertility control among urban and higher-status women at higher parities, remarital fertility differences in 1910 also reflected greater infecundity/subfecundity among subgroups of women, especially African American women.     

Sexual and Reproductive Strategies Among Serbian Gypsies

This paper deals with a full range of sexual and reproductive behaviors among different tribes of Gypsies in Serbia. The examined traits include rates of fertility, mortality, age distribution, education, crime rates, and parental care. In addition, Gypsy traditions of culturally prescribed sexual behavior are also studied. It is found that Gypsy tribes employ different reproductive strategies, ranging from an extreme, for humans, r (reproductive) strategy to a more typical K (parental) strategy. The reasons bringing about these differences come from the Gypsies' readiness to adjust their behavior and reproduction in order to create the most favorable strategy in a given environment. This paper elucidates and contrasts the more typical r-selected Gypsies with a group of K-selected Gypsies living in a Serbian village.     

Men's influence on the onset and progress of fertility decline in Ghana, 1988–98

While lower fertility is commonly associated with women's reproductive autonomy, we demonstrate that the influence of men's education on reproductive decision-making increased during the first decade of rapid fertility decline in Ghana. Husband's education exerts a stronger influence on wife's fertility intentions than does her own education, and the magnitude of the effect of his education increased significantly from 1988 to 1998. Lower fertility in Ghana seems to be associated more with men's declining fertility desires than with women's increasing reproductive autonomy. Nevertheless, there is some indication that women's education may play a relatively greater role in reproductive decision-making as fertility decline progresses still further.     

Credit programs for the poor and reproductive behavior in low-income countries: Are the reported causal relationships the result of heterogeneity bias?

Group-based lending programs for the poor have drawn much attention recently. As many of these programs target women, an important research question is whether program participation significantly changes reproductive behavior and whether the gender of the participant matters. Using survey data from 87 Bangladeshi villages, we estimate the impact of female and male participation in group-based credit programs on reproductive behavior while attending to issues of self-selection and endogeneity. Wefind no evidence that women s participation in group-based credit programs increases contraceptive use or reduces fertility. Men So participation reduces fertility and may slightly increase contraceptive use.     

试论时期总和生育率、终身生育率与政策生育率的关系

通过对总和生育率(TFR)、终身生育率(CFR)与政策生育率(PFR)的概念及相关数据分析,论证总和生育率与政策生育率是完全不同的概念,不可直接比较。在特定条件下TFR、CFR和政策生育率会产生差异,在一个国家生育水平下降的历史时期,TFR必然小于当年49岁组女性的CFR;"超生率"、"未婚率"、"未育率"和"不孕率"的变化,决定了政策生育率与终身生育率的差异。借鉴日本经济与人口发展相关数据,可以相信由平均初婚年龄推迟、女性有偶率下降导致的生育水平下降很可能成为对我国人口均衡发展的最大潜在威胁。因此,当前以及今后相当的时期内,我国的政策生育率应高于1.8。     

Does female circumcision affect infertility and fertility? A study of the central African Republic, Côte d’Ivoire, and Tanzania

This study explores the association between female circumcision and infertility and fertility, using information from the Demographic and Health Surveys (DHS). In Côte d’Ivoire and Tanzania, circumcised women had lower childlessness, lower infertility by age, and higher total fertility rates than women who were not circumcised; the reverse pattern prevailed in the Central African Republic. In all three countries, however, circumcised women grouped by age at circumcision did not have significantly different odds of infertility nor of having a child than did uncircumcised women, when the effects of covariates were controlled. Thus we find evidence suggesting that the practice of female circumcision does not have a statistically discernible effect on women’s ability to reproduce.     

2000年以来人口学研究国际前沿解读——基于CiteSpace对Web of Science数据库的文献计量

为探究国际人口学学科的文献特征与趋势,本文运用科学计量学的前沿研究方法,基于Web of Science数据库(2000—2018年)收录的人口学研究领域的文献数据,应用CiteSpace软件,就被引文献和主题词进行实证分析。结果表明,人口转变、国际移民、低生育率与生育行为是21世纪以来国际人口学最核心的学术研究分支;受教育程度、已婚女性、人口特征、年轻女性、年轻人、生殖健康等主题词是该领域的研究热点,具体来看,“代际问题”、“缓慢衰老”、“结婚与同居”、“生育意图和生育行为”、“移民融合”以及“女性雇佣和生育”等主题是近年来国际人口学界研究的前沿方向。     

Fraught with Ambivalence: Reproductive Intentions and Contraceptive Choices in a Sub-Saharan Fertility Transition

Demographic studies that search for signs of fertility transition in sub-Saharan Africa rarely examine the complex gamut of individual aspirations and misgivings, hopes and frustrations, failures and triumphs that accompany the emerging declines of fertility rates in the subcontinent. This study draws upon qualitative data collected in peri-urban areas of Maputo, Mozambique’s capital and largest metropolis, to explore contradictory meanings and feelings surrounding changes in fertility intentions and contraceptive choices. It argues that although changes in these two aspects of reproductive life are interrelated, they are predicated on distinct types and configurations of external pressures and psychological apparatus, which is often manifested as a puzzling disjunction between fertility preferences and contraceptive use. This disjunction can be further reinforced by persistent gender divisions in reproductive views and strategies. Informal social interaction plays an important role in building societal consensus over fertility matters, but because such interaction deals with reproductive intentions and contraceptive use through largely different mechanisms, it may also help accentuate the intentions-contraception disjunction. This study’s findings therefore call upon both researchers and policymakers to attend more closely to the multidimensionality of fertility transitions in sub-Saharan societies and specifically to the complexities underlying such popular notions as “unmet need for family planning,” “spacing” versus “limiting” births, or “spousal communication” on reproductive matters.     

Sterility in a Population with Natural Fertility

In this paper we examine the age pattern of sterility in a natural fertility population of 16 English parishes. We examine estimators of sterility proposed by historical demographers. We demonstrate through Monte Carolo simulation of reproductive histories that the estimators proposed earlier work well only if the ages to which the estimates pertain are substantially modified from the original formulation. The new estimates show a much larger positive effect of childbearing on sterility than would the earlier ones. We also present estimates of the age pattern of sterility due solely to the process of ageing by eliminating secondary sterility induced by childbearing. This curve rises slowly until age 40, after which the proportion sterile increases rapidly with age. We find no evidence of a sharp rise in the risk of sterility in the 30s. We find strong evidence of a decline in fecundity by examining age-specific fertility rates only for those women who are known to be fecund because they later bear children. The evidence suggests only a moderate decline until ages 35–39 and a much steeper decline thereafter.Finally, we illustrate the danger of the use of a clinical test of infertility commonly employed. We show that if women are judged to be infertile because they have not become pregnant within one year of unprotected exposure, then a large fraction of those so judged will be falsely diagnosed. We conclude that the one-year period is too short.     

Absent and Problematic Men: Demographic Accounts of Male Reproductive Roles

Both men and women are important actors in bringing children into life, yet demographic studies on reproduction have tended to focus on women alone. The aims of this article are: 1) to describe why men have attracted limited interest as subjects of such research; 2) to evaluate existing research on men's roles in developing countries; and 3) to suggest directions for future research on male reproductive roles. Men, once neglected, are now included in research on fertility but from a narrow, overly problem‐oriented perspective. A review of the literature, however, raises questions about the adequacy of a problem oriented approach. The authors argue that demography should focus on men not only as women's partners, but also as individuals with distinct reproductive histories. In situations, now increasingly common, where the links between marriage and childbearing erode, the differences in men's and women's reproductive experiences and the costs and benefits of parenting will become more salient for future research.     

Support for new mothers and fertility in the United Kingdom: Not all support is equal in the decision to have a second child

Low fertility across Europe highlights the need to understand reproductive decisions in high-income countries better. Availability of support may be one factor influencing reproductive decisions, though within high-income countries availability varies between environments, including socio-economic environments. We test whether receiving higher levels of support, from different sources (informal and formal) and of different types (practical and emotional), is positively correlated with second births in the United Kingdom (UK) Millennium Cohort Study, and whether these relationships differ by socio-economic position (SEP). Our hypothesis is only partially supported: receiving emotional support correlates with higher likelihood of second birth, but the opposite is true for practical support. Availability of different types of support varies across SEP, but relationships between support and fertility are similar, with one exception: kin-provided childcare increases the likelihood of birth only among lower-SEP women. Our results highlight that not all support is equal in the decision to have a second child.     

A framework for modelling fertility motivation in couples

We present a theoretical framework that organizes individual-level fertility motivations into a couple-level model. One feature of this framework is the Traits-Desires-Intentions-Behaviour (TDIB) sequence through which the fertility motivations of individuals produce instrumental behaviours that are designed to promote or prevent childbearing. A second feature of this framework is the cognitive capacity of individuals to perceive a partner's motivational structure. We combine these two features into a dyad-level model that addresses interactions between partners at each step of the motivational sequence. We elaborate this model first with respect to the perception of partner's motivational structure and second with respect to the combination of partner's and own motivational structure. In the process we consider how couple-level processes of communication, influence, and disagreement can be measured and studied through these interactions. We conclude with a summary discussion of the framework and a consideration of the implications it has for a theory of reproductive psychology, population surveys, and family planning services.     

Racial opportunity structures and black fertility

This paper develops and tests hypotheses about the impact of opportunity structures on black fertility across local labor markets. US Vital Statistics and Census of Population data are combined and then examined with regression techniques to estimate the effect of both race-specific and relative measures of opportunity structure on black fertility in the United States. The results show that relative female opportunity structure has a negative relationship with black total fertility rates as well as with birth rates for specific points along the reproductive age structure. However, the hypothesized relationship between relative male opportunity structures and black fertility is not supported. We discuss these results as they relate to minority fertility theory and as they relate to public policy concerns.