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.     

Do Health Insurance and Residence Pattern the Likelihood of Tubal Sterilization among American Women?

American women have increasingly opted for tubal sterilization or tubal ligation surgery in recent decades. While research has begun to examine the unequal access to health care in the United States, little research has considered how this may impact whether women opt for a tubal ligation surgery. We first profile women with and without tubal ligations using bivariate analysis of the most recent data available, a nationally representative sample of 7,643 women from the National Survey of Family Growth, Cycle 6 (NSFG, Public use data file, 2002). We then use logistic regression models to examine the relationship between having tubal ligation and two focal variables: (1) type of health insurance (Medicaid compared with private, government or military, and no health insurance), and (2) rural or urban place of residence. We find that women on Medicaid are nearly twice as likely to have had a tubal sterilization compared with women who have private health insurance coverage. Also, women on Medicaid are substantially more likely to have a tubal sterilization than women with government or military insurance and women with no health insurance (26% and 36%, respectively). Further, we find that women living in rural areas are nearly twice as likely to have a tubal sterilization, compared with women in urban or suburban areas, all else being equal.     

Explaining the Gender Wealth Gap

To assess and explain the United States’ gender wealth gap, we use the Wisconsin Longitudinal Study to examine wealth accumulated by a single cohort over 50 years by gender, by marital status, and limited to the respondents who are their family’s best financial reporters. We find large gender wealth gaps between currently married men and women, and between never-married men and women. The never-married accumulate less wealth than the currently married, and there is a marital disruption cost to wealth accumulation. The status-attainment model shows the most power in explaining gender wealth gaps between these groups explaining about one-third to one-half of the gap, followed by the human-capital explanation. In other words, a lifetime of lower earnings for women translates into greatly reduced wealth accumulation. After controlling for the full model, we find that a gender wealth gap remains between married men and women that we speculate may be related to gender differences in investment strategies and selection effects.     

Social Integration and Health Insurance Status Among African American Men and Women

Using 2010 national data, we investigate the relationship between social integration and health insurance for African American adults. During the previous year 21.6% of men and 19.8% of women lacked continuous health insurance. The effect of marital status, income, and employment on insurance coverage differed by age and gender. Additionally, frequency of church attendance was positively associated with continuous health insurance for women aged 51–64. Spiritual/religious identity was marginally associated with insurance status for men aged 36–50. As provisions of the Affordable Care Act take effect, implementation programs should expand enrollment efforts to include the conjugal unit and the church.     

Family leave policies and women's retention after childbirth: Evidence from the United States, Britain, and Japan

This paper uses labour force survey data to examine the employment rates and employment decisions of women with young children in the United States, Britain and Japan. Our results confirm that young children have a very strong negative effect on women's employment; this effect is most pronounced in Britain. We then take advantage of panel data to investigate the effects of family leave coverage on women's job retention after childbirth. We find that family leave coverage increases the likelihood that a woman will return to her employer after childbirth in all three countries, with a particularly marked effect in Japan. This result suggests that the recent expansions in family leave coverage in the sample countries are likely to lead to increased employment of women after childbirth. Received: 10 July 1997/Accepted: 8 June 1998     

Individual Uncertainty About Longevity

This article presents an assessment of individual uncertainty about longevity. A survey performed on 3,331 French people enables us to record several survival probabilities per individual. On this basis, we compute subjective life expectancies (SLE) and subjective uncertainty regarding longevity (SUL), the standard deviation of each individual’s subjective distribution of her or his own longevity. It is large and equal to more than 10 years for men and women. Its magnitude is comparable to the variability of longevity observed in life tables for individuals under 60, but it is smaller for those older than 60, which suggests use of private information by older respondents. Our econometric analysis confirms that individuals use private information—mainly their parents’ survival and longevity—to adjust their level of uncertainty. Finally, we find that SUL has a sizable impact, in addition to SLE, on risky behaviors: more uncertainty on longevity significantly decreases the probability of unhealthy lifestyles. Given that individual uncertainty about longevity affects prevention behavior, retirement decisions, and demand for long-term care insurance, these results have important implications for public policy concerning health care and retirement.     

Opportunities to Meet: Occupational Education and Marriage Formation in Young Adulthood

Explanations for the positive association between education and marriage in the United States emphasize the economic and cultural attractiveness of having a college degree in the marriage market. However, educational attainment may also shape the opportunities that men and women have to meet other college-educated partners, particularly in contexts with significant educational stratification. We focus on work—and the social ties that it supports—and consider whether the educational composition of occupations is important for marriage formation during young adulthood. Employing discrete-time event-history methods using the NLSY-97, we find that occupational education is positively associated with transitioning to first marriage and with marrying a college-educated partner for women but not for men. Moreover, occupational education is positively associated with marriage over cohabitation as a first union for women. Our findings call attention to an unexplored, indirect link between education and marriage that, we argue, offers insight into why college-educated women in the United States enjoy better marriage prospects.     

Interrelationships between fertility and marital dissolution: Results of a simultaneous logit model

Previous studies have failed to examine (a) the simultaneity of decisions to bear children and to dissolve a marriage and (b) the effects of the childbearing in the period just before dissolution on the likelihood of disruption. We attempted to resolve both problems by developing a simultaneous logit model of the interrelationship between the probability of separation and of having a birth during this period (when dissolution presumably is being considered). The model was estimated at successive durations of first marriage, using data for white women in the 1970 National Fertility Survey. The results indicate that childbearing patterns— number of children and age of youngest child at the beginning of the marital interval being studied and fertility during the interval—did not influence the likelihood of separation in simple or consistent ways over the marital life course, nor did marital strife (as indicated by separation) seem to affect childbearing throughout marriage.     

A joint model of marital childbearing and marital disruption

Married couples with children appear to be less likely to end their marriages than childless couples, especially when the children are young. Although this suggests that children affect the chances that their parents will divorce, the process may not be so simple: the chances that the marriage will last also may affect couples’ willingness to make the commitment to the marriage implied by having children. This paper uses data from the Panel Study of Income Dynamics (PSID) to test the hypothesis that the risk of disruption faced by a married woman affects the chances that she will conceive and bear a child. The model used takes into account the simultaneous relationships between marital dissolution and marital fertility by including the hazard of disruption as a predictor of timing and likelihood of marital conception, and by including the results of previous fertility decisions as predictors of disruption of the marriage. We find that the hazard of disruption has strong negative effects on the hazard of marital childbearing, lengthening the intervals between births and decreasing the chances that a child will be born. This effect appears to be strongest for women who have had at least one child, either before or during the current marriage, although it is also large for childless women. Explicitly including the hazard of disruption in models of marital childbearing has sizable and important effects on many predictors of fertility.     

Unhealthy assimilation: Why do immigrants converge to American health status levels?

It is well documented that immigrants are in better health upon arrival in the United States than their American counterparts but that this health advantage erodes over time. We study the potential determinants of this "healthy immigrant effect, " with a particular focus on the tendency of immigrants to converge to unhealthy American BMI levels. Using data from the National Health Interview Survey, we find that average female and male immigrants enter the United States with BMIs that are approximately two and five percentage points lower than native-born women and men, respectively. Consistent with the declining health status of immigrants the longer they remain in the United States, we also find that female immigrants almost completely converge to American BMIs within 10 years of arrival, and men close a third of the gap within 15 years.     

生育保险立法问题研究

生育保险是国家通过社会保险立法的强制手段征集生育保险基金,在妇女劳动者因为妊娠、分娩而不能工作、工资收入暂时中断时,可以从国家和社会获得医疗保健服务和物质帮助,以保障参保母子的基本生活和身心健康,确保社会人口再生产和妇女、儿童权益的一项社会保障制度。生育保险促进了男女的实质平等,保障了劳动力的再生产,维护了社会的和谐和稳定。提高生育保险的立法层次,扩大生育保险的覆盖范围,建立合理的基金筹集机制,加强对生育保险基金的管理,规范生育保险待遇标准是完善生育保险立法的当务之急。     

The Retirement Life Course in America at the Dawn of the Twenty-First Century

As the baby boom cohorts expand the number of U.S. retirees, population estimates of the employment, withdrawal and reentry behaviors of older Americans’ remain scarce. How long do people work? How frequently is retirement reversed? How many years are people retired? What is the modal age of retirement? And, how do the patterns for women compare to those for men? Using the 1992–2004 Health and Retirement Study, we estimate multistate working life tables to update information on the age-graded regularities of the retirement life course of men and women in the United States. We find that at age 50 men can expect to spend half of their remaining lives working for pay, while women can expect to spend just one-third. Half of all men and women have left the labor force by ages 63 and 61, respectively. Although the majority of retirement exits are final, variation in the nature and duration of the retirement process is substantial, as about a third of men’s and women’s exits are reversed. By quantifying these patterns for men and women, we provide a sound empirical basis for evaluating policy designed to address the financial pressures population aging places on public and private pension systems.     

The economic costs of marital disruption for Young Women over the past two decades

This paper examines the economic costs of separation and divorce for young women in the United States from the late 1960s through the late 1980s. Broadened opportunities for women outside marriage may have alleviated some of the severe economic costs of marital disruption for women. This paper contrasts the experiences of two cohorts of young women: those who married and separated or divorced in the late 1960s through the mid-1970s and those who experienced these events in the 1980s. Based on panel data from the National Longitudinal Surveys of Youth 1979–1988, Young Women 1968–1978, and Young Men 1966–1978, the results show stability in the costs of disruption. A multivariate analysis shows that young women in the more recent cohort have more labor force experience before disruption than those in the earlier cohort, but prior work history does not protect women from the severe costs of marital disruption.     

International Migration, Sex Ratios, and the Socioeconomic Outcomes of Nonmigrant Mexican Women

This article assesses whether international migration from Mexico affects the marital, fertility, schooling, and employment outcomes of the Mexican women who remain behind by exploiting variation over time as well as across Mexican states in the demographic imbalance between men and women. I construct a gauge of the relative supply of men for women of different age groups based on state-level male and female population counts and the empirically observed propensity of men of specific ages to marry women of specific ages. Using Mexican census data from 1960 through 2000, I estimate a series of models in which the dependent variable is the intercensus change in an average outcome for Mexican women measured by state and for specific age groups, and the key explanatory variable is the change in the relative supply of men to women in that state/age group. I find that the declining relative supply of males positively and significantly affects the proportion of women who have never been married as well as the proportion of women who have never had a child. In addition, states experiencing the largest declines in the relative supply of men also experience relatively large increases in female educational attainment and female employment rates. However, I find little evidence that women who do marry match to men who are younger or less educated than themselves.     

Turning back the ticking clock: the effect of increased affordability of assisted reproductive technology on women’s marriage timing

This paper exploits variation in the mandated insurance coverage of assisted reproductive technology (ART) across US states and over time to examine the connection between increased access to ART and female marriage timing. Since ART increases the probability of pregnancy for older women of reproductive age, greater access to ART will make marriage delay less costly for younger single women of reproductive age. Linear probability models are estimated to investigate the effects of ART state insurance mandates on changes in marital status of women in different age groups using the 1977–2010 Current Population Survey. Results show that greater access to ART is associated with marital delay for white (but not for black) women: white women in states with an ART insurance mandate are significantly less likely to marry between the 20–24, 25–29, and 30–34 age ranges, but significantly more likely to marry between the 30–34 and 35–39 age ranges.     

Trends in Spouses’ Shared Time in the United States, 1965–2012

Despite major demographic changes over the past 50 years and strong evidence that time spent with a spouse is important for marriages, we know very little about how time with a spouse has changed—or not—in the United States. Using time diary data from 1965–2012, we examine trends in couples’ shared time in the United States during a period of major changes in American marriages and families. We find that couples without children spent more total time together and time alone together in 2012 than they did in 1965, with total time and time alone together both peaking in 1975. For parents, time spent together increased between 1965 and 2012, most dramatically for time spent with a spouse and children. Decomposition analyses show that changes in behavior rather than changing demographics explain these trends, and we find that the increases in couples’ shared time are primarily concentrated in leisure activities.     

Religion and fertility in the United States: The importance of marriage patterns and hispanic origin

The marital fertility of white Catholic wives in the United States was higher than that of non-Catholic wives in 1977–1981, but when Hispanics were excluded, the differential disappeared; therefore, the Catholic-non-Catholic differential in recent years was due entirely to the higher fertility of Hispanic Catholics. The Total Fertility Rates (TFR) of Catholics were slightly lower in 1977–1981 than those for white Protestants, primarily because Catholic women tend to marry later than Protestant women. This finding was confirmed by multivariate analysis of data on children ever born. We examine some additional data and various theories to speculate on whether these patterns will last.     

Social structure and U.S. inter-state fertility differentials in 1900

This paper investigates the importance of agricultural land shortages versus modernization of the society in influencing inter-state differentials in fertility in 1900, when the United States was in midtransition. Urbanization and manufacturing characteristics of states were the strongest correlates of variations in the index of total fertility because urban-industrialism depressed both the probability of marriage and marital fertility. Other modern characteristics of American states were also important in understanding variations in marital fertility. Low labor force employment of children and farm mechanization, integrally related characteristics, seemed to depress levels of marital fertility in many parts of the United States, independent of the urban-industrial system. Agricultural land opportunity had little overall effect on marital fertility; however, it was quite important in understanding variations in patterns of marriage.