Born Ultimatum
The Effect of Medicaid Eligibility Expansions on Fertility
Marianne Bitler & Madeline Zavodny
Social Science & Medicine, forthcoming
Abstract:
In the United States, pregnant women and children's eligibility for Medicaid was expanded dramatically during the 1980s and early 1990s. By lowering pregnancy and child health care costs, the Medicaid expansions may have increased the incentives for women to have children. To investigate this possibility, we examine whether state-level birth and abortion rates are related to the extent of states' Medicaid eligibility expansions and the fraction of women eligible for Medicaid, controlling for economic and demographic factors, during the period 1982 to 1996. We examine birth rates by race, marital status and education as well as overall abortion rates. We find little evidence that the Medicaid expansions led to changes in birth rates or abortion rates. However, some results do suggest that the Medicaid expansions boosted the birth rate among white women who have not completed high school. We find that restrictions on Medicaid funding of abortions decrease abortion rates and increase birth rates. The results thus do not provide definitive evidence that expansions in public health insurance eligibility have sizable effects on women's fertility.
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Zhou Yang & Laura Gaydos
Journal of Adolescent Health, June 2010, Pages 517-524
Purpose: After declining for over a decade, the birth rate in the United States for adolescents aged 15-19 years increased by 3% in 2006 and 1% again in 2007. We examined demographic and policy reasons for this trend at state level.
Methods: With data merged from multiple sources, descriptive analysis was used to detect state-level trends in birth rate and policy changes from 2000 to 2006, and variations in the distribution of teen birth rates, sex education, and family planning service policies, and demographic features across each state in 2006. Regression analysis was then conducted to estimate the effect of several reproductive health policies and demographic features on teen birth rates at the state level. Instrument variable was used to correct possible bias in the regression analysis.
Results: Medicaid family planning waivers were found to reduce teen birth rates across all ages and races. Abstinence-only education programs were found to cause an increase in teen birth rates among white and black teens. The increasing Hispanic population is another driving force for high teen birth rates.
Discussion: Both demographic factors and policy changes contributed to the increase in teen birth rates between 2000 and 2006. Future policy and behavioral interventions should focus on promoting and increasing access to contraceptive use. Family planning policies should be crafted to address the special needs of teens from different cultural backgrounds, especially Hispanics.
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Warren Miller, David Bard, David Pasta & Joseph Lee Rodgers
Demography, May 2010, Pages 393-414
Abstract:
In spite of long-held beliefs that traits related to reproductive success tend to become fixed by evolution with little or no genetic variation, there is now considerable evidence that the natural variation of fertility within populations is genetically influenced and that a portion of that influence is related to the motivational precursors to fertility. We conduct a two-stage analysis to examine these inferences in a time-ordered multivariate context. First, using data from the National Longitudinal Survey of Youth, 1979, and LISREL analysis, we develop a structural equation model in which five hypothesized motivational precursors to fertility, measured in 1979-1982, predict both a child-timing and a child-number outcome, measured in 2002. Second, having chosen two time-ordered sequences of six variables from the SEM to represent our phenotypic models, we use Mx to conduct both univariate and multivariate behavioral genetic analyses with the selected variables. Our results indicate that one or more genes acting within a gene network have additive effects that operate through child-number desires to affect both the timing of the next child born and the final number of children born, that one or more genes acting through a separate network may have additive effects operating through gender role attitudes to produce downstream effects on the two fertility outcomes, and that no genetic variance is associated with either child-timing intentions or educational intentions.
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A Belief-Behavior Gap? Exploring Religiosity and Sexual Activity Among High School Seniors
Kathleen Cobb Leonard & Diane Scott-Jones
Journal of Adolescent Research, July 2010, Pages 578-600
Abstract:
Religiosity, sexual activity, and contraception were examined via questionnaires and interviews in a diverse sample of 118 high school seniors. The majority reported religion to be important; importance and frequency ratings declined from private (e.g., prayer) to public (e.g., group activities) components of religion. Most were sexually active and used contraception. Nearly half acknowledged religious teachings on sexual activity, and one third believed premarital sex is proscribed. Religiosity items were negatively correlated with approval of sexual activity in hypothetical relationship scenarios, but religiosity was not related to self-reported sexual activity or contraceptive use. Participants emphasized relationships and physical health, not religious proscriptions, in their standards for sexual activity. Older adolescents may believe sexual activity is acceptable in committed romantic relationships.
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Deborah Kacanek, Amanda Dennis, Kate Miller & Kelly Blanchard
Perspectives on Sexual and Reproductive Health, June 2010, Pages 79-86
Context: The Hyde Amendment bans federal Medicaid funding for abortion in the United States except if a pregnancy resulted from rape or incest or endangers the life of the woman. Some evidence suggests that providers do not always receive Medicaid reimbursement for abortions that should qualify for funding.
Methods: From October 2007 to February 2008, semistructured in-depth interviews about experiences with Medicaid reimbursement for qualifying abortions were conducted with 25 respondents representing abortion providers in six states. A thematic analysis approach was used to explore respondents' knowledge of and experiences seeking Medicaid reimbursement for qualifying abortions, as well as individual, clinical and structural influences on reimbursement. The numbers of qualifying cases that were and were not reimbursed were assessed.
Results: More than half of Medicaid-eligible cases reported by respondents in the past year were not reimbursed. Respondents reported that filing for reimbursement takes excessive staff time and is hampered by bureaucratic claims procedures and ill-informed Medicaid staff, and that reimbursements are small. Many had stopped seeking Medicaid reimbursement and relied on nonprofit abortion funds to cover procedure costs. Respondents reporting receiving reimbursement said that streamlined forms, a statewide education intervention and a legal intervention to ensure that Medicaid reimbursed claims facilitated the process.
Conclusions: The policy governing federal funding of abortion is inconsistently implemented. Eliminating administrative burdens, educating providers about women's rights to obtain Medicaid reimbursement for abortion in certain circumstances and holding Medicaid accountable for reimbursing qualifying cases are among the steps that may facilitate Medicaid reimbursement for qualifying abortions.
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Sex Differences in Obesity Associated with Total Fertility Rate
Robert Brooks & Alexei Maklakov
PLoS ONE, May 2010, e10587
Abstract:
The identification of biological and ecological factors that contribute to obesity may help in combating the spreading obesity crisis. Sex differences in obesity rates are particularly poorly understood. Here we show that the strong female bias in obesity in many countries is associated with high total fertility rate, which is well known to be correlated with factors such as low average income, infant mortality and female education. We also document effects of reduced access to contraception and increased inequality of income among households on obesity rates. These results are consistent with studies that implicate reproduction as a risk factor for obesity in women and that suggest the effects of reproduction interact with socioeconomic and educational factors. We discuss our results in the light of recent research in dietary ecology and the suggestion that insulin resistance during pregnancy is due to historic adaptation to protect the developing foetus during famine. Increased access to contraception and education in countries with high total fertility rate might have the additional benefit of reducing the rates of obesity in women.
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Jay Belsky, Laurence Steinberg, Renate Houts & Bonnie Halpern-Felsher
Developmental Psychology, January 2010, Pages 120-128
Abstract:
To test a proposition central to J. Belsky, L. Steinberg, and P. Draper's (1991) evolutionary theory of socialization-that pubertal maturation plays a role in linking early rearing experience with adolescent sexual risk taking (i.e., frequency of sexual behavior) and, perhaps, other risk taking (e.g., alcohol, drugs, delinquency)-the authors subjected longitudinal data on 433 White, 62 Black, and 31 Hispanic females to path analysis. Results showed (a) that greater maternal harshness at 54 months predicted earlier age of menarche; (b) that earlier age of menarche predicted greater sexual (but not other) risk taking; and (c) that maternal harshness exerted a significant indirect effect, via earlier menarche, on sexual risk taking (i.e., greater harshness → earlier menarche → greater sexual risk taking) but only a direct effect on other risk taking. Results are discussed in terms of evolutionary perspectives on human development and reproductive strategy, and future directions for research are outlined.
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Contraception as Development? New Evidence from Family Planning in Colombia
Grant Miller
Economic Journal, June 2010, Pages 709-736
Abstract:
There has been considerable debate in the last decade about whether or not family planning programmes in developing countries reduce fertility or improve socio-economic outcomes. This article provides new evidence by studying the expansion of one of the world's oldest and largest family planning organisations - Profamilia of Colombia. It finds that family planning explains less than 10% of Colombia's fertility decline during its demographic transition. As in wealthy countries, however, lowering the costs of first birth postponement produced important socio-economic gains, enabling young women to obtain more education and to work more and live independently later in life.
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Religion and conscientious objection: A survey of pharmacists' willingness to dispense medications
Laura Davidson, Clare Pettis, Amber Joiner, Daniel Cook & Craig Klugman
Social Science & Medicine, July 2010, Pages 161-165
Abstract:
Some US states allow pharmacists to refuse to dispense medications to which they have moral objections, and federal rules for all health care providers are in development. This study examines whether demographics such as age, religion, gender influence 668 Nevada pharmacists' willingness to dispense or transfer five potentially controversial medications to patients 18 years and older: emergency contraception, medical abortifacients, erectile dysfunction medications, oral contraceptives, and infertility medications. Almost 6% of pharmacists indicated that they would refuse to dispense and refuse to transfer at least one of these medications. Religious affiliation significantly predicted pharmacists' willingness to dispense emergency contraception and medical abortifacients, while age significantly predicted pharmacists' willingness to distribute infertility medications. Evangelical Protestants, Catholics and other-religious pharmacists were significantly more likely to refuse to dispense at least one medication in comparison to non-religious pharmacists in multinomial logistic regression analyses. Awareness of the influence of religion in the provision of pharmacy services should inform health care policies that appropriately balance the rights of patients, physicians, and pharmacists alike. The results from Nevada pharmacists may suggest similar tendencies among other health care workers, who may be given latitude to consider morality and value systems when making clinical decisions about care.
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Michelle Broaddus, Heather Morris & Angela Bryan
Sex Roles, May 2010, Pages 603-614
Abstract:
We examined effects of proposer gender and condom negotiation strategy on perceptions of condom proposers in undergraduates in the southwestern regions of the US. Using a video manipulation (N = 150), a female proposer was evaluated no more harshly than a male proposer, and was evaluated more positively in some ways. In a vignette manipulation (N = 193) a female proposer using an Eroticization negotiation strategy (compared to Refusal of sex or Explanation of consequences) was seen as more exciting and likely to engage in sex. Surprisingly, women were harsher judges than men of a female condom proposer using an Eroticization strategy. Greater attention should be paid to the nature of condom negotiation within the framework of the sexual script.
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The State of the Union: Sexual Health Disparities in a National Sample of US College Students
Eric Buhi, Stephanie Marhefka & Mary Hoban
Journal of American College Health, January-February 2010, Pages 337-346
Objective: To examine sexual health disparities between blacks and whites in a national sample of US college students.
Participants and Method Summary: Analyses utilized secondary data from 44,165 nonmarried undergraduates (aged 18-24; M = 20.1) responding to the Spring 2007 American College Health Association-National College Health Assessment; 64% were female and 94.7% were white.
Results: Whites reported more experience in oral and anal sex, were less likely to use condoms for oral, anal, and vaginal sex, and less likely to have been tested for HIV (human immunodeficiency virus) compared with blacks. However, blacks reported more sex partners, lower use of hormonal contraceptives, and higher rates of adverse sexual health outcomes, such as sexually transmitted infections (STIs) and unintended pregnancy. Sexual behaviors and outcomes also varied across gender.
Conclusions: This study highlights a need to increase access to hormonal contraceptives and early STI screening/treatment among blacks, improve HIV testing among whites, and increase condom use promotion for all students.