Kevin Lewis

January 03, 2017

Assisted Reproductive Technology and Women's Timing of Marriage and Childbearing

Joelle Abramowitz

Journal of Family and Economic Issues, forthcoming

This paper exploited variation in mandated insurance coverage of assisted reproductive technology (ART) across US states and over time to examine the connection between the price of ART and women's timing of family including marriage and child bearing in and out of wedlock. Duration and competing risks analyses were estimated to investigate the effects of ART insurance mandates on women's timing of first marriage and first birth using the 1968-2009 Panel Study of Income Dynamics. The findings suggest that the mandates were associated with delayed marriage and childbearing at younger ages and an increased likelihood of marriage and motherhood at ages 30 and older, but only for college graduate women. For the full sample of women, the mandates were associated with an increased likelihood of marriage at ages 25 and older and motherhood within marriage after at ages 30 and older, but not with delay at younger ages. Results by race were similar to those for the full sample for Whites, but were generally less significant for Blacks. No significant effects of the mandates were found for out-of-wedlock childbearing.


Son-biased sex ratios in 2010 US census and 2011-2013 US natality data

Douglas Almond & Yixin Sun

Social Science & Medicine, forthcoming

If gender bias is receding, demographic manifestations of son preference should also tend to decrease. The sex composition of US children provides a key barometer of gender preference. In the 2010 US Population Census, Chinese and Asian-Indian families are more likely to have a son after a daughter, consistent with previous research. Korean-American families, by contrast, do not show this same pattern, paralleling recent declines in sex selection observed for South Korea. Non-Hispanic White families have sex ratios within the range of the biological norm regardless of the sex composition of previous children. We corroborate the 2010 Census data with 2011-2013 birth certificate microdata, which likewise show elevated sex ratios for Chinese and Asian Indians at higher birth orders.


Seeing is believing -- Can increasing the number of female leaders reduce sex selection in rural India?

Priti Kalsi

Journal of Development Economics, May 2017, Pages 1-18

Cultural values regarding gender roles encourage gender discrimination and the practice of sex selection. Increasing political and work force participation of women challenges such norms. Exploiting the implementation of an Indian law that required one-third of local political seats to be reserved for women, I investigate the impact of female leadership on sex selection in rural India. I find an increase in the survival of higher birth order girls if political seats at the local level have been reserved for women. I argue that the likely underlying mechanism is a change in beliefs due to exposure to female leaders.


The Roots of Modern Sex Ratios

Jesse Keith Anttila-Hughes, Patrick Krause & Yaniv Stopnitzky

University of San Francisco Working Paper, November 2016

While most measures of female empowerment have improved with development, sex ratios in many countries have become increasingly male. We exploit countries' prior history of plough-based agriculture to identify cultural variation in patriarchal norms following Boserup (1970) and Alesina, Giuliano, and Nunn (2013). Using detailed birth records from 76 countries between 1970 and 2010, we show that the cultural legacy of plough use explains a large portion of variation in modern sex ratios, and present evidence that plough countries' male-skewed sex ratios are achieved through a mix of in-utero sex-selection, son-based stopping rules, and increased mortality suggestive of neglect or infanticide. This cultural bias intensifies with lower fertility, even when controlling for a suite of economic and historical controls, a pattern that is not found in non-plough countries.


Women's Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study

Antonia Biggs et al.

JAMA Psychiatry, forthcoming

Design, Setting, and Participants: This study presents data from the Turnaway Study, a prospective longitudinal study with a quasi-experimental design. Women were recruited from January 1, 2008, to December 31, 2010, from 30 abortion facilities in 21 states throughout the United States, interviewed via telephone 1 week after seeking an abortion, and then interviewed semiannually for 5 years, totaling 11 interview waves. Interviews were completed January 31, 2016. We examined the psychological trajectories of women who received abortions just under the facility's gestational limit (near-limit group) and compared them with women who sought but were denied an abortion because they were just beyond the facility gestational limit (turnaway group, which includes the turnaway-birth and turnaway-no-birth groups). We used mixed effects linear and logistic regression analyses to assess whether psychological trajectories differed by study group.

Results: Of the 956 women (mean [SD] age, 24.9 [5.8] years) in the study, at 1 week after seeking an abortion, compared with the near-limit group, women denied an abortion reported more anxiety symptoms (turnaway-births, 0.57; 95% CI, 0.01 to 1.13; turnaway-no-births, 2.29; 95% CI, 1.39 to 3.18), lower self-esteem (turnaway-births, -0.33; 95% CI, -0.56 to -0.09; turnaway-no-births, -0.40; 95% CI, -0.78 to -0.02), lower life satisfaction (turnaway-births, -0.16; 95% CI, -0.38 to 0.06; turnaway-no-births, -0.41; 95% CI, -0.77 to -0.06), and similar levels of depression (turnaway-births, 0.13; 95% CI, -0.46 to 0.72; turnaway-no-births, 0.44; 95% CI, -0.50 to 1.39).

Conclusions and Relevance: In this study, compared with having an abortion, being denied an abortion may be associated with greater risk of initially experiencing adverse psychological outcomes. Psychological well-being improved over time so that both groups of women eventually converged. These findings do not support policies that restrict women's access to abortion on the basis that abortion harms women's mental health.


Estimating the Effect of Abortion Facility Closures on Fertility, Sexual Health and Human Capital

Scott Cunningham & Andrea Schlosser

Baylor University Working Paper, November 2016

Historically, abortion regulation has sought to reduce abortions by raising the costs pregnant women face when seeking an abortion. But a more recent wave of regulations has sought to reduce abortions by raising abortion facility costs. A contemporary example of these supply-side regulations is Texas House Bill 2 (HB2) which in 2013 banned abortions after 20 weeks, required physicians to have admitting privileges at a hospital within 30 miles of the facility, mandated medical abortions follow the labeling approved by the FDA, and imposed the requirement that all abortion facilities meet the standards of an ambulatory surgical center. These regulations significantly increased firm costs and caused more than half of all abortion facilities to close. We exploit the fact that the closures increased the driving distance to the nearest abortion facility to identify the causal effect of HB2 on abortions, births, low weight births, first trimester prenatal care, and gonorrhea incidence. We find robust evidence that HB2 increased the distance to the nearest facility by 61 miles. We also find that this increased distance reduced abortions by 9-12%. These effects were concentrated among 15-24 year olds. We also find that the increased driving distance caused county-level births to increase, suggesting that the two are substitutes. We estimate the abortion elasticity of births is between -0.1 and -0.4. Finally, we find increases in driving distance increased prenatal healthcare investments, low weight births and gonorrhea incidence. While we ultimately find restrictive abortion access led to large changes in reproductive health, we find no evidence that it interrupted the schooling of high school students.


Reducing Health Disparities by Removing Cost, Access, and Knowledge Barriers

Melody Goodman et al.

American Journal of Obstetrics and Gynecology, forthcoming

Importance: While the rate of unintended pregnancy has declined in the U.S. in recent years, unintended pregnancy among teens in the U.S. is the highest among industrialized nations, and disproportionately affects minority teens. Our objective of this secondary analysis was to estimate the risk of unintended pregnancy for both Black and White women age 15- 19 years when barriers to access, cost, and knowledge are removed. Our hypothesis was that the Black-White disparities would be reduced when access, education, and cost barriers are removed.

Design, Setting, and Participants: We performed an analysis of Contraceptive CHOICE Project (CHOICE) database. CHOICE is a longitudinal cohort study of 9,256 sexually active women ages 14-45 in the St. Louis region from 2007 to 2013. Two measures of disparities were used to analyze teenage pregnancy rates and pregnancy risk from 2008 to 2013 among teens ages 15-19. These rates were then compared to the rates of pregnancy among all sexually active teens in the US during the years 2008, 2009, 2010, and 2011. We estimated an absolute measure (rate difference (RD)) and a relative measure (rate ratio (RR)) to examine Black-White disparities in the rates of unintended pregnancy.

Results: While national rates of unintended pregnancy are decreasing, racial disparities in these rates persist. The Black-White rate difference dropped from 158.5 per 1,000 in 2008 to 120.1 per 1,000 in 2011; however, the relative ratio disparity decreased only from 2.6 to 2.5, suggesting that Black sexually active teens in the U.S. have 2.5 times the rate of unintended pregnancy as White teenagers. In the CHOICE Project, there was a decreasing trend in racial disparities in unintended pregnancy rates among sexually active teens (age 15-19); 2008-2009 (RD=18.2; RR=3.7), 2010-2011 (RD=4.3; RR=1.2) and 2013-2014 (RD=-1.5; RR=1.0).

Conclusions: When barriers to cost, access, and knowledge were removed, such as in the Contraceptive CHOICE Project, Black-White disparities in unintended pregnancy rates among sexually active teens are reduced on both absolute and relative scales. The rate of unintended pregnancy was almost equal between Black and White women compared to large Black-White disparities on the national level.


Teen Childbearing and Depression: Do Pregnancy Attitudes Matter?

Tanya Rouleau Whitworth

Journal of Marriage and Family, forthcoming

The relationship between teen childbearing and depression has been extensively studied; however, little is known about how young women's own attitudes toward becoming pregnant shape this association. This study used data from the National Longitudinal Study of Adolescent Health to investigate whether the relationship between teen childbearing and adult depression is moderated by adolescent attitudes toward becoming pregnant. The results showed that although, on average, women who had first births between ages 16 and 19 experienced no more depressive symptoms in adulthood than women who had first births at age 20 or older, the relationship between teen childbearing and adult depression varied significantly based on adolescent pregnancy attitudes. When they had negative adolescent attitudes toward getting pregnant, teen mothers had similar levels of depression as adult mothers, but when they had positive adolescent pregnancy attitudes, teen mothers actually had fewer depressive symptoms than women with adult first births.


Sperm Donor Anonymity and Compensation: An Experiment with American Sperm Donors

Glenn Cohen et al.

Journal of Law and the Biosciences, December 2016, Pages 468-488

Most sperm donation that occurs in the USA proceeds through anonymous donation. While some clinics make the identity of the sperm donor available to a donor-conceived child at age 18 as part of 'open identification' or 'identity release programs,' no US law requires clinics to do so, and the majority of individuals do not use these programs. By contrast, in many parts of the world, there have been significant legislative initiatives requiring that sperm donor identities be made available to children after a certain age (typically when the child turns 18). One major concern with prohibiting anonymous sperm donation has been that the number of willing sperm donors will decrease leading to shortages, as have been experienced in some of the countries that have prohibited sperm donor anonymity. One possible solution, suggested by prior work, would be to pay current anonymous sperm donors more per donation to continue to donate when their anonymity is removed. Using a unique sample of current anonymous and open identity sperm donors from a large sperm bank in the USA, we test that approach. As far as we know, this is the first attempt to examine what would happen if the USA adopted a prohibition on anonymous sperm donation that used the most ecologically valid population, current sperm donors. We find that 29% of current anonymous sperm donors in the sample would refuse to donate if the law changed such that they were required to put their names in a registry available to donor-conceived children at age 18. When we look at the remaining sperm donors who would be willing to participate, we find that they would demand an additional $60 per donation (using our preferred specification). We also discuss the ramifications for the industry.


The 9/11 Dust Cloud and Pregnancy Outcomes: A Reconsideration

Janet Currie & Hannes Schwandt

Journal of Human Resources, Fall 2016, Pages 805-831

The events of 9/11 released a million tons of toxic dust into lower Manhattan, an unparalleled environmental disaster. It is puzzling, then, that the literature has shown little effect of fetal exposure to the dust. However, inference is complicated by preexisting differences between the affected mothers and other NYC mothers as well as heterogeneity in effects on boys and girls. Using all births in-utero on 9/11 in NYC and comparing them to their siblings, we show that residence in the affected area increased prematurity and low birth weight, especially for boys.


Testosterone and immune-reproductive tradeoffs in healthy women

Tierney Lorenz, Julia Heiman & Gregory Demas

Hormones and Behavior, forthcoming

Although testosterone (T) has been characterized as universally immunosuppressive across species and sexes, recent ecoimmunology research suggests that T's immunomodulatory effects (enhancing/suppressing) depend on the organism's reproductive context. Very little is known about the immune effects of T in healthy females, and even less about how reproductive effort modulates the immune effects of T in humans. We investigated how the interaction between endogenous T and sexual activity predicted menstrual cycle-related changes in several measures of immunity: inflammation (indexed by interleukin-6, IL-6), adaptive immunity (indexed by immunoglobulin A, IgA), and functional immunity (indexed by bactericidal assay). Thirty-two healthy women (sexually abstinent, N = 17; sexually active with one male partner, N = 15) provided saliva samples at four points in the menstrual cycle: menses, follicular, ovulation, and luteal phases. Among sexually abstinent women, T was positively associated with IL-6 across the cycle; for sexually active women, however, T was positively associated with IL-6 in the luteal phase only, and negatively associated with IL-6 at ovulation. High T predicted higher IgA among women who reported infrequent intercourse, but lower IgA among women who reported very frequent intercourse. Finally, across groups, T was positively associated with greater bacterial killing at menses, but negatively associated in the luteal phase. Overall, rather than being universally immunosuppressive, T appeared to signal immunomodulation relevant to reproduction (e.g., lowering inflammation at ovulation, potentially preventing immune interference with conception). Our findings support the hypothesis that the immunomodulatory effects of endogenous T in healthy females depend on sexual and reproductive context.

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