The effect of expansions in medicaid income eligibility on abortion

In this paper we examine the effect of expansions in Medicaid income eligibility on abortion, using individual-level data from South Carolina, Tennessee, and Virginia. The results suggest that for unmarried nonblack women with less than a high school degree, expansions of income eligibility lowered the probability of abortion by two to five percentage points. Most of the impact of the Medicaid expansions on abortion occurred in the first round of expansions from approximately 45% of the federal poverty level to 100%. For black unmarried women with less than a high school degree, we generally find no effect of expansions in Medicaid income eligibility on abortion.     

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.     

Business Cycles,Medicaid Generosity,and Birth Outcomes

Birth outcomes influence many aspects of later life health and wellbeing, making healthcare access during pregnancy a policy priority. Low-income mothers often depend on Medicaid, for which eligibility is determined by their income relative to state eligibility thresholds. The prevalence of adverse birth outcomes is known to exhibit cyclical variation, due in part to changes in the composition of women giving birth in response to changing economic conditions. However, cyclical variation in adverse birth outcomes also varies with respect to Medicaid eligibility thresholds. Our analysis uses birth-records data for 2000 through 2013, aggregated into 173,936 county-by-quarter observations and linked to county-level unemployment rates and state-level parental Medicaid thresholds. Using fixed-effects negative binomial models, we examine the role of Medicaid generosity in influencing birth outcomes across business cycles. We test for interactions between Medicaid and unemployment, hypothesizing that the negative effects of recessions are worse where Medicaid thresholds are more restrictive. We find that higher Medicaid generosity dampens the negative effects of recessions on birth outcomes. The extent to which Medicaid interacts with unemployment also varies according to the age and race composition of mothers; in particular, Black mothers are both most affected by unemployment and most responsive to Medicaid generosity. Given current concerns about racial gaps in both infant and maternal mortality, our findings suggest that Medicaid may be an important feature of a strategy to close gaps in the prevalence of adverse birth outcomes across racial groups, especially during bust years.     

The earned income tax credit and fertility

Government programs designed to provide income safety nets often restrict eligibility to families with children, creating an unintended fertility incentive. This paper considers whether dramatically changing incentives in the earned income tax credit affect fertility rates in the USA. We use birth certificate data spanning the period 1990 to 1999 to test whether expansions in the credit influenced birthrate among targeted families. While economic theory would predict a positive fertility effect of the program for many eligible women, our results indicate that expanding the credit produced only extremely small reductions in higher order fertility among white women.

Do children stabilize relationships in Denmark?

In this paper, we study the relationship between fertility behavior and the process of relationship duration. The potential endogeneity of fertility on dissolution risk is taken into account by modeling fertility and dissolution jointly. We apply the timing-of-event method (Abbring and van den Berg, Econometrica 71(5):1491–1517, 2003) to identify the causal effect of births on the dissolution hazard. We show that couples who are less prone to split up are more prone to invest in children, and therefore, one might (mistakenly) conclude that children stabilize relationships. However, when correcting for the selectivity bias arising from the fertility decision, we conclude that children themselves have a negative effect on relationship duration.      

Does family policy affect fertility?

From the mid-1960s to around 1980, Sweden extended its family policies that provide financial and in-kind support to families with children very quickly. The benefits were closely tied to previous work experience. Thus, women born in the 1950s faced markedly different incentives when making fertility choices compared to women born only 15–20 years earlier. This paper examines the evolution of completed fertility patterns for Swedish women born in 1925–1958 and makes comparisons to women in neighbouring countries where the policies were not extended as much as in Sweden. The results suggest that the extension of the policy raised the level of fertility, shortened the spacing of births, and induced fluctuations in the period fertility rates, but it did not change the negative relationship between women’s educational level and completed fertility.     

How powerful is demography? The Serendipity Theorem revisited

Introduced by Samuelson (Int Econ Rev 16(3):531–538, 1975), the Serendipity Theorem states that the competitive economy will converge towards the optimum steady-state provided the optimum fertility rate is imposed. This paper aims at exploring whether the Serendipity Theorem still holds in an economy with risky lifetime. We show that, under general conditions, including a perfect annuity market with actuarially fair return, imposing the optimum fertility rate and the optimum survival rate leads the competitive economy to the optimum steady state. That Extended Serendipity Theorem is also shown to hold in economies where old adults work some fraction of the old age, whatever the retirement age is fixed or chosen by the agents.     

Opting for families: recent trends in the fertility of highly educated women

After declining for many years, there are indications that fertility may be increasing among highly educated women. This paper provides a comprehensive study of recent trends in the fertility of college-graduate women. In contrast to most existing work, we find that college graduate women are indeed opting for families. Data from the Current Population Surveys and Vital Statistics Birth Data both show that fertility increases among college graduate women, especially at older ages since the mid- to late 1990s. There are also increases in fertility among less-educated women, but these are concentrated at younger ages.     

Fertility and women's employment reconsidered: A macro-level time-series analysis for developed countries, 1960–2000

This paper examines causality and parameter instability in the long-run relationship between fertility and women's employment. This is done by a cross-national comparison of macro-level time-series data from 1960 to 2000 for France, West Germany, Italy, Sweden, the UK, and the USA. By applying vector error correction models (a combination of Granger-causality tests with recent econometric time-series techniques) we find causality in both directions. This finding is consistent with simultaneous movements of both variables brought about by common exogenous factors such as social norms, social institutions, financial incentives, and the availability and acceptability of contraception. We find a negative and significant correlation until about the mid-1970s and an insignificant or weaker negative correlation afterwards. This result is consistent with a recent hypothesis in the demographic literature according to which changes in the institutional context, such as changes in childcare availability and attitudes towards working mothers, might have reduced the incompatibility between child-rearing and the employment of women.     

Aboriginal fertility: Trends and prospects

Estimates of Aboriginal fertility compiled from an analysis of 1981 and 1986 Census data on children ever borne by Aboriginal women reveal age-specific fertility rates slightly higher than those of other Australian women at ages above 25, but very much higher rates for younger women. The result is a total fertility ratio more than 50 per cent higher than in the total Australian population, with no more than slight variation between States and Territories. A differential analysis using standardized indices shows considerable differences in levels of fertility of categories of young Aboriginal women classified by education, labour force status and income, and also differences between urban and rural areas. Analysis of prospects for Aboriginal fertility levels confirms the likelihood of continuation in the downward drift in levels of fertility that has been established during the past decade. Comparison of the estimates with another recent set of estimates obtained using the own-children method shows broad conformity in levels of total fertility ratios over time, except in the most recent period, the mid-1980s. Nevertheless, the own-children estimates distort the recent trend and also the age distribution of Aboriginal fertility.     

Grandparental availability for child care and maternal labor force participation: pension reform evidence from Italy

In this paper, we exploit pension reform-induced changes in retirement eligibility requirements to assess the role of grandparental childcare availability in the labor force participation of women with children under 15. Our analysis shows that, among the women studied, those whose own mothers are retirement eligible have a 11% higher probability of being in the labor force than those whose mothers are ineligible. The pension eligibility of maternal grandfathers and paternal grandparents, however, has no significant effect on the women’s labor force participation. We also demonstrate that the eligibility of maternal grandmothers mainly captures the effect of their availability for childcare. Hence, pension reforms, by potentially robbing households of an important source of flexible, low-cost childcare, could have unintended negative consequences for the employment rates of women with young children.     

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.     

Migration, fertility, and state policy in Hubei Province, China

Despite China s one-child family planning policy, the nation experienced a slight rise in the birth rate in the mid-1980s. Many observers attributed this rise to the heightened fertility of those rural-to-urban migrants who moved without a change in registration (temporary migrants), presumably to avoid the surveillance of family planning programs at origin and destination. Using a sequential logit analysis with life-history data from a 1988 survey of Hubei Province, we test this possibility by comparing nonmigrants, permanent migrants, and temporary migrants. While changing family planning policies have a strong impact on timing of first birth and on the likelihood of higher-order births, migrants generally do not have more children than nonmigrants. In fact, migration tends to lower the propensity to have a child. More specifically, the fertility of temporary migrants does not differ significantly from that of other women.     

Fertility and women's employment reconsidered: a macro-level time-series analysis for developed countries, 1960-2000

This paper examines causality and parameter instability in the long-run relationship between fertility and women's employment. This is done by a cross-national comparison of macro-level time-series data from 1960 to 2000 for France, West Germany, Italy, Sweden, the UK, and the USA. By applying vector error correction models (a combination of Granger-causality tests with recent econometric time-series techniques) we find causality in both directions. This finding is consistent with simultaneous movements of both variables brought about by common exogenous factors such as social norms, social institutions, financial incentives, and the availability and acceptability of contraception. We find a negative and significant correlation until about the mid-1970s and an insignificant or weaker negative correlation afterwards. This result is consistent with a recent hypothesis in the demographic literature according to which changes in the institutional context, such as changes in childcare availability and attitudes towards working mothers, might have reduced the incompatibility between child-rearing and the employment of women.     

The links between women’s employment and children at home: Variations in low- and middle-income countries by world region

As fertility declines in low- and middle-income countries, the time women devote to childbearing and rearing may also be reduced. This shift has been described as one of the positive consequences of the demographic transition, as it opens opportunities for women to pursue educational and employment opportunities that were previously constrained by the demands of bearing and raising children. We estimate the numbers of children residing at home (with their mother) for women in 58 countries in Asia, Latin America, the Middle East and North Africa, and sub-Saharan Africa. We then examine the association between women’s employment and having children at home. Finally, we assess trends over recent decades in the relationship between employment and childbearing, and differences in this relationship by mother’s occupation. We find a negative association between women’s employment and having children at home; this association varies substantially by world region, age of child, and mother’s occupation.     

Fertility preferences and subsequent childbearing in Africa and Asia: A synthesis of evidence from longitudinal studies in 28 populations

Survey data on fertility preferences have played a central but controversial role in fertility research and advocacy for family planning. We summarize evidence from longitudinal studies in 28 Asian and African populations on the relationship between preferences and subsequent childbearing. While we found no consistent association between women's desire to delay childbearing and subsequent fertility, the baseline desire of women to stop childbearing was a powerful predictor of subsequent fertility in all populations and increased in strength as overall contraceptive use in the study populations rose. Partners’ desire also exercised some influence but was of modest importance in most populations. However, the correspondence between desire to stop and behaviour was found to be far from perfect. Weak implementation of preferences by contraception is likely to be the major cause of this preference–behaviour discrepancy. Uncertainty and instability in preferences may also contribute to the discrepancy, particularly in sub-Saharan Africa.     

The Long-Term Cognitive and Socioeconomic Consequences of Birth Intervals: A Within-Family Sibling Comparison Using Swedish Register Data

We examine the relationship between birth-to-birth intervals and a variety of mid- and long-term cognitive and socioeconomic outcomes, including high school GPA, cognitive ability, educational attainment, earnings, unemployment status, and receiving government welfare support. Using contemporary Swedish population register data and a within-family sibling comparison design, we find that neither the birth interval preceding the index person nor the birth interval following the index person are associated with any substantively meaningful changes in mid- or long-term outcomes. This is true even for individuals born before or after birth-to-birth intervals of less than 12 months. We conclude that in a contemporary high-income welfare state, there appears to be no relationship between unusually short or long birth intervals and adverse long-term outcomes.     

Contraception,attitude-practice,and fertility differentials among US Hispanic,African–American and white women

Hispanic fertility (primarily among nationals from Mexico, Central and South America in the US) is higher today than it is in Mexico and the other nations of origin (Frank and Heuveline 2005). It persists into the second and third generations, with only moderate signs of declining to replacement. Meanwhile, the fertility rates of African–Americans, American Indians Cubans, and Puerto Ricans have all declined to replacement, only slightly above the non-Hispanic white population. This study attempts to clarify the question why African–American fertility has declined to replacement, but Hispanic fertility has not. The data used are from Cycle 6 of the National Survey of Family Growth (NSFG) of 2002. Differences in physiological or marital-status factors are found not to explain these fertility differences; however, there are significant differences in the practice of contraception during early childbearing years. Slightly less effective methods if contraception is used, and less recourse to abortion if a pregnancy is undesired, all imply higher fertility for Hispanic women. Underlying contraceptive behaviour are sets of attitudes and motives that favour, permit, or seek childbearing. A much higher percentage of Hispanic than African–American women report that they wanted their last birth and intend to have another in the future. Hispanic women of all socio-economic statuses are considerably more pronatal in their attitudes, particularly with respect to the births of first and second children.     

SNAP Benefits and Pregnancy-Related Emergency Room Visits

Pregnant women are likely to be sensitive to daily fluctuations in nutritional intake. To see if income constraints at the end of the month limit food consumption and trigger health problems, we examine how the date that benefits are issued for the Supplemental Nutrition Assistance Program (SNAP) changes the probability that a woman will go to the Emergency Room (ER) for pregnancy-related conditions using administrative data from SNAP and Medicaid from Missouri for 2010–2013. SNAP benefits in Missouri are distributed from the 1st through the 22nd day of the month based on the birth month and the first letter of the last name of the head of the household, making timing of SNAP issuance exogenous. We estimate probit models of the calendar month and SNAP benefit month on the probability of a pregnancy-related ER visit for women age 17–45, or the sample at risk of being pregnant. We also examine the relationship between SNAP benefit levels and ER visits. We found that women who received SNAP benefits in the second or third week of the calendar month were less likely to receive pregnancy-related care through the ER in the week following benefit receipt. Results suggest that SNAP benefits might be related to patterns of pregnancy-related medical care accessed through the ER. Since SNAP issuance date is within state control in the United States, states may want to consider the health effects of their choice.