Free Birth Control – IOM Report

Last week’s report from the Institute of Medicine on what Clinical Preventive Services for Women should be funded through the Patient Protection and Affordable Care Act (aka the new federal Health Care Program) generated headlines for its recommendation (among many others) that birth control be made available to all fertile females for free.

In the context of contemporary fertility battles, this is bound to lead to argument. Should a citizen who doesn’t approve of birth control be understood to be funding the birth control of those who choose to use it — and therefore have a basis for objecting? Or should we understand that the many tax payments from those who approve of birth control for those who want it are those that are funding it, while the taxes of those who don’t approve of birth control are funding the costs associated with birthing and raising unplanned kids?

The IOM, a nonpartisan medical review board, finds that birth control is one among several key preventive measures (along with screens for disease and domestic violence) that would markedly improve the health of women. A future in which women’s health matters? The fact that it’s proposed at all suggests that we’ve already made progress toward that future. Debate will follow. And women will doubtless have much to say, as well as increasingly powerful voices with which to say it.

Update: The Secretary of Health and Human Services Kathleen Sebelius has issued new guidelines adopting the IOM recommendations.

The guidelines call for no cost to patients for such services as:
Well-woman visits
Gestational diabetes screening
HPV DNA testing
STI counseling, and HIV screening and counseling
Contraception and contraceptive counseling (yes, that’s free birth control)
Breastfeeding support, supplies, and counseling
Domestic violence screening

“The Affordable Care Act – the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 – helps make prevention affordable and accessible for all Americans by requiring health plans to cover preventive services and by eliminating cost sharing. Preventive services that have strong scientific evidence of their health benefits must be covered and plans can no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider.”

Share

US Fertility Rate Continues Decline (Revised)

[An earlier version of this post called the 2010 fertility an all-time low, based on figures originally published in the annual CDC reports. Revised figures published in 2003 (NVSR 54, no.2, p. 29) suggest that there’s still a way to go before the fertility rate reaches the updated all-time low, which was 63.6 in 1997. This post has been altered to reflect the updated figures.]

This week the CDC issued a provisional overview of birth data for 2010 – providing a chart indicating the continuing decline, apparently linked to the continuing current recession, as well as the earlier rise linked to the false sense of economic well being that preceded that recession, since 2005:

CDC chart based on 2005-2009 birth data and 2010 provisional data

CDC chart based on 2005-2009 birth data and 2010 provisional data

The report was short, since it is provisional, including no details about the ages of the women involved in these births. The full preliminary report, with more details, will not be out for months. Final reports generally come out about a year after the preliminary data.

If the full reports confirm the provisional data, the 2010 US fertility rate (64.7 births per thousand women in the 15-44 age band) will have fallen below the recent low of 64.8 hit in 2002 – when we were also in recession. The years 1995-1999, characterized by economic boom, also had fertility rates under 64.7 (64.6, 64.1, 63.6, 64.3, 64.4, respectively).

You may recall that last year we had stories telling us that the BIRTH rate had fallen to an all time low – and I wrote a piece all about how the birth rate was not telling us that women were having kids at an all-time low level — it’s the fertility rate that tells us that. Instead the birth rate was going down in part because it tells you how many births there were per people in the whole population, and since people are living longer, and those old folks don’t have babies (or very few), there were fewer births per thousand.

The fertility rate was going down too in 2009 however – just not to record lows. And it’s still declining.

For a wider perspective, here’s a chart of the fertility rate from 1909-2009 – and you can add on the 2010 decline in your mind’s eye. (The Y [vertical] axis goes by 20s from 0 to 140.)

Births/thousand US women 15-44, 1909-2009

Births/thousand US women 15-44, 1909-2009

Share

Delayer Boom!

The June 2010 Census fertility survey is yielding data now, and today’s headline tells us there’s a “’Delayer Boom’ as More Educated Women Have Children Later.” Not a surprise here, or really not a surprise probably anywhere by now. But good to have the documentation.

Here are the charts.

Since women are increasingly having kids after 35 and 40, it’s not a complete portrait of what women will do to look at women 35-44 as a group and assume they’ve pretty much all had all their kids. Many of them will have more. So the chart is showing you there is a delay effect, but doesn’t quite tell you the full story, because they don’t have data on women at 45 and over, when they are pretty much finished bearing [though that’s going to be less and less true, as the egg-donation (way-delayer) boom is on the way].

The recessionary effect also plays in — birth rates have been down in the last few years in all age groups below 40, so the rate among women 35-39 is lower than it would otherwise have been, and not reflective of what will be the long run trend if the economy recovers.

All this affects the study’s conclusion that women with a college degree or more will end up with around 1.7 kids, as opposed to women with less than a high school degree with 2.5 kids. Increasing numbers of women, many of them with BAs and more, are having kids in the 40-44 range every year (see story on the 2009 data below). And of course none of this data includes adopted children. Stay tuned!

Share

A Dose of Pro-Natalism for Mother’s Day: What’s Up with That?

Lately birth rates have been down: 2009 and 2010 birth data indicate that the US birth rate is diving under recession pressure (except for moms 40+), and 2010 Census data indicates that while the population has grown in the past decade, “new” minority kids (Hispanics, Asians, etc) have been born at a rate much higher than white kids, predicting a much browner future for America. Births to blacks are also down (though not as much as to whites).

In the wake of this news, we have two new books out calling for MORE BABIES. Bryan Caplan’s Selfish Reasons to Have More Kids: Why Being a Great Parent Is Less Work and More Fun Than You Think makes the case that parents overdo it with the intensive parenting – since twin studies show that nurture (apart from good enough provision of the middle class basics) plays a small part in the success and happiness rates experienced by adults. So we could all do less high-stress intensive care giving, which would make parenting more fun.

Caplan then reasons that, if having kids becomes more relaxed and fun, we should have more kids (risking losing the benefit of the relaxed parenting, one might guess, since basics provision actually does involve some effort and expense, which does expand with the number of kids). Because?? Because, long-term, they will give us more grandchildren when we’re old, and contribute more to our care and support. And, by the way, staff the jobs of the future. And, by the way, staff those jobs with white people, given that his audience is people who are having fewer kids. Population/environmental problems? We can solve them easily with a global carbon tax, Caplan reassures readers. No discussion of how to go about getting that global agreement in place.

Like Caplan, Kasey Edwards, in a book out in the UK but not yet in the US, addresses the fact that many people are finding it too hard to have kids, given the tradeoffs in the work world it often involves, and choosing either to have fewer or none. Her story, Thirty Something and the Clock Is Ticking – is set in Australia, where the birth rate is lower than in the US (1.78 TFR, vs 2.06). At 32 Edwards was told by her doctor that her endometriosis was wreaking havoc on her lady parts, and that she’d better act fast if she wanted a family. So she and her beau did that, employing IVF along the way, although kids had not been in their plans at that point. She now has a baby girl. While in the process of conceiving she (already the author of Thirty Something and Over It, a consideration of the disappointments of modern work) spoke with a lot of her fellow travellers, and other people with opinions about parenting (that gives you a pool of just about everybody). Her takeaway: people should start families sooner and find ways to fit kids into their lives in spite of the difficulties.

Since this book is not out here yet, I’ve had to rely on British reviews and Edwards’ website. They suggest that Edwards is interested in the complexity of people’s experience (there’s evidently a lot of consideration of why people might find the job of mothering less than attractive). But the book seems also to skew data on fertility toward the frightening (most people do not have end-game endometriosis at 32). “It’s really hard to get pregnant in your thirties,” says Edwards on Irish TV. But in fact that’s not true for most. Saying that women at 30 have a 22% chance of getting pregnant per month, and that by 35 it’s down to 18% sounds a lot worse than the more big picture data like – 7% of women who try do not get pregnant within one year at 30, 11% at 35, 33% at 40, 50% at 41, and 87% at 45. There is an obvious decline over time, and people need the facts, but it’s not necessary to alarm young women – except that alarm always makes good media fodder.

And could lead to the birth of babies sooner than their mothers would otherwise have thought of doing. Fine enough if they’re happy with that outcome, but there’s no attention paid in these texts to the workplace problems that lead women to hold back on kids nowadays to begin with. Women who start sooner are stuck with lower wages, and a slow down in the trickle up of women into policy making roles in government and business – the lack of which, circularly, creates the problems that women face at work….. And some people seem to think they have an interest in preserving that status quo.

Pronatalism (basically, promoting more births) serves a variety of purposes, which you may variously like or not – but be on the look out in the coming months for texts that claim to be pushing babies on you for your benefit. There may be other logics at work and groups seeking to benefit as well.

On related work/family ground, but from a different direction, I’m looking forward to reading Bossypants, by new later mom Tina Fey, now pregnant at 40 with baby 2, as soon as the semester sunsets.

Happy Mother’s/ Mothers’ Day everybody — moms and non-moms, dads and non-dads, as you like it.
And feel free to circulate copies of Ready: Why Women Are Embracing the New Later Motherhood among your friends and relations if you’ve already got your copy, to balance out the ever-present birth timing conversation.

Share

Fertility Up, among women 40+

slide11
Data can always be variously interpreted.  This chart was published as part of a report called ” Recent Decline in Births in the United States, 2007-2009.”  And clearly the overall rate is down, as are the specific rates in most categories.  But not all.* Births to women 40-44 were up 6% overall in the past two years (3% per year).

The decline is generally tied to the recession — though this report does not discuss cause.

The suspenseful part for demographers: What will follow? When/if there’s an economic upswing, will births resurge, and will the effect ripple upward across age brackets (will women who would have liked a first, second or third child during the recession but refrained from childbearing in, say, the 35-39 age band go on to have that child in the 40-44 age band, or similarly will those who delayed at 30-34 pay it forward in the 35-39 band, and so on)?

Women who are currently in the 40-44 age band obviously are not delaying. In fact, they may be previewing the answer to the prior question –since the recession is already several years old, and a good proportion of those in the 40-44 band may well be women who were open to delaying in their 30s, but not in their 40s (a point when women often feel pressure to act fast). If the recession ends and a resurgence in births follows, it will combine the demand of people who didn’t want a child prior but now do and feel free to act on that wish, with the pent up demand of women who delayed.

Births to women 45-54, almost entirely due to donor eggs, were up 17% in the period. These are not on the chart, presumably because they were so few relatively speaking (7,934 in 2009, up from 3,722 in 1999). This is also an age band with potential for dramatic increase, though the actuality is entirely unpredictable.

Here’s the link to the full report

*The same trends are noted in 2010 birth data through June, but it is not broken down by age of mother.

Share