Babies are us

Kevin Lewis

March 03, 2016

An Adaptive Significance of Morning Sickness? Trivers-Willard and Hyperemesis Gravidarum

Douglas Almond et al.

Economics & Human Biology, May 2016, Pages 167–171

Nausea during pregnancy, with or without vomiting, is a common early indication of pregnancy in humans. The severe form, hyperemesis gravidarum (HG), can be fatal. The etiology of HG is unknown. We propose that HG may be a proximate mechanism for the Trivers-Willard (T-W) evolutionary hypothesis that mothers in poor condition should favor daughters. Using Swedish linked registry data, 1987-2005, we analyze all pregnancies that resulted in an HG admission and/or a live birth, 1.65 million pregnancies in all. Consistent with the T-W hypothesis, we find that: (i) HG is associated with poor maternal condition as proxied by low education; (ii) HG in the first two months of pregnancy is associated with a 7 percentage point increase in live girl births; and (iii) HG affected pregnancies have a 34-percent average rate of inferred pregnancy loss, higher among less educated women.


The Effects of State-Mandated Abstinence-Based Sex Education on Teen Health Outcomes

Jillian Carr & Analisa Packham

Health Economics, forthcoming

In 2011, the USA had the second highest teen birth rate of any developed nation, according to the World Bank. In an effort to lower teen pregnancy rates, several states have enacted policies requiring abstinence-based sex education. In this study, we utilize a difference-in-differences research design to analyze the causal effects of state-level sex education policies from 2000–2011 on various teen sexual health outcomes. We find that state-level abstinence education mandates have no effect on teen birth rates or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease rates in some states.


How Does Access to Health Care Affect Teen Fertility and High School Dropout Rates? Evidence from School-based Health Centers

Michael Lovenheim, Randall Reback & Leigh Wedenoja

NBER Working Paper, February 2016

Children from low-income families face persistent barriers to accessing high-quality health care services. Previous research studies have examined the importance of expanding children's health insurance coverage, but there is little prior evidence concerning the impacts of directly expanding primary health care access to this population. We address this gap in the literature by exploring whether teenagers' access to primary health care influences their fertility and educational attainment. We study how the significant expansion of school-based health centers (SBHCs) in the United States since the early 1990's has affected teen fertility and high school dropout rates. Our results indicate that school-based health centers have a negative effect on teen birth rates: adding services equivalent to the average SBHC reduces the 15-18 year old birth rate by 5%. The effects are largest among younger teens and among African Americans and Hispanics. However, primary care health services do not reduce high school dropout rates by very much despite the sizable reductions in teen birth rates.


Effect of Removal of Planned Parenthood from the Texas Women’s Health Program

Amanda Stevenson et al.

New England Journal of Medicine, 3 March 2016, Pages 853-860

Background: Texas is one of several states that have barred Planned Parenthood affiliates from providing health care services with the use of public funds. After the federal government refused to allow (and courts blocked) the exclusion of Planned Parenthood affiliates from the Texas Medicaid fee-for-service family-planning program, Texas excluded them from a state-funded replacement program, effective January 1, 2013. We assessed rates of contraceptive-method provision, method continuation through the program, and childbirth covered by Medicaid before and after the Planned Parenthood exclusion.

Methods: We used all program claims from 2011 through 2014 to examine changes in the number of claims for contraceptives according to method for 2 years before and 2 years after the exclusion. Among women using injectable contraceptives at baseline, we observed rates of contraceptive continuation through the program and of childbirth covered by Medicaid. We used the difference-in-differences method to compare outcomes in counties with Planned Parenthood affiliates with outcomes in those without such affiliates.

Results: After the Planned Parenthood exclusion, there were estimated reductions in the number of claims from 1042 to 672 (relative reduction, 35.5%) for long-acting, reversible contraceptives and from 6832 to 4708 (relative reduction, 31.1%) for injectable contraceptives (P<0.001 for both comparisons). There was no significant change in the number of claims for short-acting hormonal contraceptive methods during this period. Among women using injectable contraceptives, the percentage of women who returned for a subsequent on-time contraceptive injection decreased from 56.9% among those whose subsequent injections were due before the exclusion to 37.7% among those whose subsequent injections were due after the exclusion in the counties with Planned Parenthood affiliates but increased from 54.9% to 58.5% in the counties without such affiliates (estimated difference in differences in counties with affiliates as compared with those without affiliates, −22.9 percentage points; P<0.001). During this period in counties with Planned Parenthood affiliates, the rate of childbirth covered by Medicaid increased by 1.9 percentage points (a relative increase of 27.1% from baseline) within 18 months after the claim (P=0.01).

Conclusions: The exclusion of Planned Parenthood affiliates from a state-funded replacement for a Medicaid fee-for-service program in Texas was associated with adverse changes in the provision of contraception. For women using injectable contraceptives, there was a reduction in the rate of contraceptive continuation and an increase in the rate of childbirth covered by Medicaid.


The Implications of Unintended Pregnancies for Mental Health in Later Life

Pamela Herd et al.

American Journal of Public Health, March 2016, Pages 421-429

Despite decades of research on unintended pregnancies, we know little about the health implications for the women who experience them. Moreover, no study has examined the implications for women whose pregnancies occurred before Roe v. Wade was decided — nor whether the mental health consequences of these unintended pregnancies continue into later life. Using the Wisconsin Longitudinal Study, a 60-year ongoing survey, we examined associations between unwanted and mistimed pregnancies and mental health in later life, controlling for factors such as early life socioeconomic conditions, adolescent IQ, and personality. We found that in this cohort of mostly married and White women, who completed their pregnancies before the legalization of abortion, unwanted pregnancies were strongly associated with poorer mental health outcomes in later life.


Booms, Busts, and Fertility: Testing the Becker Model Using Gender-Specific Labor Demand

Jessamyn Schaller

Journal of Human Resources, Winter 2016, Pages 1-29

In this paper, I present estimates of the effect of local labor demand shocks on birth rates. To identify exogenous variation in male and female labor demand, I create indices that exploit cross-sectional variation in industry composition, changes in gender-education composition within industries, and growth in national industry employment. Consistent with economic theory, I find that improvements in men’s labor market conditions are associated with increases in fertility while improvements in women’s labor market conditions have smaller negative effects. I separately find that increases in unemployment rates are associated with small decreases in birth rates at the state level.


Impact of Parental Notification on Illinois Minors Seeking Abortion

Shanthi Ramesh, Lindsay Zimmerman & Ashlesha Patel

Journal of Adolescent Health, March 2016, Pages 290–294

Purpose: To describe the impact of the Illinois Parental Notification of Abortion Act on minors presenting for first-trimester abortion at an urban clinic in Chicago, Illinois.

Methods: Descriptive, retrospective review looked at minors obtaining a first-trimester abortion at John H. Stroger Jr. Hospital Reproductive Health Services during the 12 months prior (August 15, 2012–August 14, 2013) and after (August 15, 2013–August 14, 2014) the Illinois Parental Notification Act was in effect. Young women, ages 18–21 years, unaffected by the law, served as the control group.

Results: Before the law, 320 minors of a total of 5,505 patients (5.8%) obtained a first-trimester abortion and after the law went into effect, 311 minors of a total of 6,311 patients (4.9%) obtained an abortion. This constituted a 2.8% decrease in procedures among minors before and after the law went into effect (p = .003). However, this decrease was not significant when compared to an 8.8% growth in procedures among the control group, ages 18–21 years (p = .079). Among minors, there was no difference in race/ethnicity, age, and mean gestational age at the time of abortion before and after the law (p = .189, p = .116, and p = .961). There was a trend toward a larger decline in the youngest minors, aged 12–15 years and in those with at least one prior abortion.

Conclusions: The impact of a parental notification law on minors at an urban, public clinic is unclear. The 3% decrease warrants further study of both teen pregnancy rates and legislative barriers to minors' abortion access.


Projecting the Unmet Need and Costs for Contraception Services After the Affordable Care Act

Euna August et al.

American Journal of Public Health, February 2016, Pages 334-341

Objectives: We estimated the number of women of reproductive age in need who would gain coverage for contraceptive services after implementation of the Affordable Care Act, the extent to which there would remain a need for publicly funded programs that provide contraceptive services, and how that need would vary on the basis of state Medicaid expansion decisions.

Methods: We used nationally representative American Community Survey data (2009), to estimate the insurance status for women in Massachusetts and derived the numbers of adult women at or below 250% of the federal poverty level and adolescents in need of confidential services. We extrapolated findings to simulate the impact of the Affordable Care Act nationally and by state, adjusting for current Medicaid expansion and state Medicaid Family Planning Expansion Programs.

Results: The number of low-income women at risk for unintended pregnancy is expected to decrease from 5.2 million in 2009 to 2.5 million in 2016, based on states’ current Medicaid expansion plans.

Conclusions: The Affordable Care Act increases women’s insurance coverage and improves access to contraceptive services. However, for women who remain uninsured, publicly funded family planning programs may still be needed.


Maternal stress before and during pregnancy and subsequent infertility in daughters: A nationwide population-based cohort study

O. Plana-Ripoll et al.

Human Reproduction, February 2016, Pages 454-462

Study question: Is maternal stress following the death of a close relative before or during pregnancy associated with the risk of infertility in daughters?

What is known already: Animal studies have shown that prenatal maternal stress results in reduced offspring fertility. In humans, there is evidence that girls who have been prenatally exposed to stress have a more masculine behaviour and a slight delay in having their first child.

Study design, size and duration: This population-based cohort study, included 660 099 females born in Denmark between 1 January 1973 and 31 December 1993 to mothers of Danish origin and with at least one living relative in the exposure window, and followed the women through 31 December 2011.

Participants/materials, setting, methods: Overall, 13 334 women (2.0%) were considered prenatally exposed to stress because their mother had lost a spouse/partner, a child, a parent, or a sibling during pregnancy or in the year before conception. Infertility was defined as any record of infertility treatment or diagnosis of female infertility. We considered the date of onset as the date of the first appearance of any such record. The association between exposure and outcome was examined using hazard ratios (HR) with 95% confidence intervals (CI).

Main results and the role of chance: Based on our definition, 40 052 (6.5%) women were infertile in the follow-up period (median age at the end of follow-up: 26.7 years, maximum age: 39 years). Overall, prenatal exposure to maternal stress was not associated with risk of infertility (adjusted HR = 1.04 [CI: 0.95–1.14]). However, women prenatally exposed during the first trimester had a higher estimated risk (adjusted HR = 1.40 [CI: 1.05–1.86]). These findings were consistent in subgroups defined by the relationship of the mother to the deceased and in several sensitivity analyses, including a sibling-matched analysis, and in analyses restricted to women who were married or cohabitating with a man, or to women born at term.


Prevalence of High-Risk Sexual Behaviors Among Monoracial and Multiracial Groups from a National Sample: Are Multiracial Young Adults at Greater Risk?

Antoinette Landor & Carolyn Tucker Halpern

Archives of Sexual Behavior, February 2016, Pages 467-475

The present study compared the prevalence and variation in high-risk sexual behaviors among four monoracial (i.e., White, African American, Asian, Native American) and four multiracial (i.e., White/African American, White/Asian, White/Native American, African American/Native American) young adults using Wave IV data (2008–2009) from the National Longitudinal Study of Adolescent to Adult Health (N = 9724). Findings indicated differences in the sexual behavior of monoracial and multiracial young adults, but directions of differences varied depending on the monoracial group used as the referent and gender. Among males, White/African Americans had higher risk than Whites; White/Native Americans had higher risk than Native Americans. Otherwise, multiracial groups had lower risk or did not differ from the single-race groups. Among females, White/Native Americans had higher risk than Whites; White/African Americans had higher risk than African Americans. Other comparisons showed no differences or had lower risk among multiracial groups. Variations in high-risk sexual behaviors underscore the need for health research to disaggregate multiracial groups to better understand health behaviors and outcomes in the context of experiences associated with a multiracial background, and to improve prevention strategies.


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