Brought To Bear
E Pluribus, Pauciores (Out of Many, Fewer): Diversity and Birth Rates
Umit Gurun & David Solomon
Boston College Working Paper, July 2024
Abstract:
In the United States, local measures of racial and ethnic diversity are robustly associated with lower birth rates. A one standard deviation decrease in racial concentration (having people of many different races nearby) or increase in racial isolation (being from a numerically smaller race in that area) is associated with 0.064 and 0.044 fewer children, respectively, after controlling for many other drivers of birth rates. Racial isolation effects hold within an area and year, suggesting that they are not just proxies for omitted local characteristics. This pattern holds across racial groups, is present in different vintages of the US census data (including before the Civil War), and holds internationally. Diversity is associated with lower marriage rates and marrying later. These patterns are related to homophily (the tendency to marry people of the same race), as the effects are stronger in races that intermarry less and vary with sex differences in intermarriage. The rise in racial diversity in the US since 1970 explains 44% of the decline in birth rates during that period, and 89% of the drop since 2006.
Income and Sex Moderate the Association Between Population Density and Reproduction: A Multilevel Analysis of Life History Strategies Across 23 Nations
Jose Yong et al.
Archives of Sexual Behavior, forthcoming
Abstract:
While previous studies guided by evolutionary life history theory have revealed several important socioecological moderators of the influence of population density (PD) on reproduction, absent is an understanding of how individual-level factors such as personal resources and sex differences might interact and play a role. Using data from a large sample of clients (N = 4,432,440) of an online dating company spanning 317 states nested within 23 countries, we contributed a robust multilevel analysis of life history effects by assessing the interaction between state-level PD and individual-level income on offspring quantity, and we further qualified this analysis by sex. Consistent with previous research, PD was negatively correlated with having children. Consistent with our novel hypotheses, this negative relationship was moderated by income such that the link between PD and low fertility became weaker with increasing levels of income and these patterns were stronger for men than for women. These results held despite controlling for a variety of country-level, state-level, and individual-level confounds. Findings are discussed together with theoretical and practical implications for the management of fertility based on evolutionary life history perspectives.
The pandemic preterm paradox: A test of competing explanations
Ralph Catalano et al.
American Journal of Epidemiology, forthcoming
Abstract:
Epidemiologists have long argued that side effects of the stress response include preterm birth. Research reports that fear of lethal infection stressed pregnant persons at the outset of the COVID-19 pandemic and that “shutdowns” and “social distancing” impeded access to social support and prenatal care. The decline in preterm births in high-income countries, including the United States (US), during the early months of the pandemic therefore poses a paradox for science. Explanations of this “pandemic preterm paradox” remain untested. We apply time-series modeling to data describing 80 monthly conception cohorts begun in the US from July 2013 through February 2020 to determine which of 3 explanations most parsimoniously explains the paradox. We infer that “prior loss,” or the argument that an increase in spontaneous abortions and stillbirths depleted the population of fetuses at risk of preterm birth, best explains data currently available. We describe the implications of these results for public health practice.
Pricing of medication abortion in the United States, 2021–2023
Ushma Upadhyay et al.
Perspectives on Sexual and Reproductive Health, forthcoming
Methods: We used Advancing New Standards in Reproductive Health (ANSIRH)'s Abortion Facility Database, which includes data on all publicly advertising abortion facilities and is updated annually. We describe facility out-of-pocket prices for medication abortion in 2021, 2022, and 2023, comparing in-person and telehealth provided by brick-and-mortar and virtual clinics, and by whether states allowed Medicaid coverage for abortion.
Results: The national median price for medication abortion remained consistent at $568 in 2021 and $563 in 2023. However, medications provided by virtual clinics were notably lower in price than in-person care and this difference widened over time. The median cost of a medication abortion offered in-person increased from $580 in 2021 to $600 by 2023, while the median price of a medication abortion offered by virtual clinics decreased from $239 in 2021 to $150 in 2023. Among virtual clinics, few (7%) accepted Medicaid. Median prices in states that accept Medicaid were generally higher than in states that did not.
Lifetime abortion incidence when abortion care is covered by Medicaid: Maryland versus five comparison states
Heide Jackson & Michael Rendall
Health Services Research, forthcoming
Data Sources and Study Setting: We use 2016–2019 (Pre-Dobbs) data from the Survey of Women studies that represent women aged 18–44 living in six U.S. states. One state, Maryland, has a Medicaid program that has long covered the cost of abortion care. The other five states, Alabama, Delaware, Iowa, Ohio, and South Carolina, have Medicaid programs that do not cover the cost of abortion care. Our sample includes 8972 women residing in the study states.
Study Design: Our outcome, cumulative lifetime abortion incidence, is identified using an indirect survey method, the double list experiment. We use a multivariate regression of cumulative lifetime abortion on variables including whether women were Medicaid-insured and whether they were residing in Maryland versus in one of the other five states.
Principal Findings: We estimate that Medicaid coverage of abortion care in Maryland is associated with a 37.0 percentage-point (95% CI: 12.3–61.4) higher cumulative lifetime abortion incidence among Medicaid-insured women relative to women not insured by Medicaid compared with those differences by insurance status in states whose Medicaid programs do not cover the cost of abortion care.