Could Obamacare have lead to lower fertility?

[just a thought]

US total fertility rates were bobbing along very placidly around 2.05 live births per woman from 1990 to 2010, when suddenly there was a clear drop to 1.8 in 2010-2017. That drop has even continued to 1.76 births per woman in 2017. When I asked myself what could possibly explain this, the only real candidate I come up with is Obamacare, which became active in 2010 and was successful at insuring more than 20 million people. Fertility rates peaked in 2010 at 2.1 and then steadily came down in 2011 (1.9) to 1.76 now.

Its an uncomfortable hypothesis, but it has to be the front runner because there is no other obvious culprit. The 2008-2010 recession had no effect on fertility, and the subsequent recovery after 2010 didn’t push employment levels above those of the early 00s. So its unlikely to be the economy. Its also unlikely related to the huge incarceration levels in the US (around 2.1 million in prison and jail in 2017), simply because those levels peaked just before 2010 and have actually gone down since then, without leading to a glut in new babies.

There is also a possible mechanism, which is that ‘the package known as Obamacare’ included increased availability of contraception and a lower barrier to entering the health system, both of which should be expected to increase use of contraceptives and more knowledge of reproductive health. This would have particularly mattered for those amongst whom pregnancy is a bit of an unwanted accident, ie teenagers. Interestingly, recorded abortions actually dropped 25% since 2008, so its not more abortions but simply less pregnancies that are causing the drop in fertility.

Surely not, I hear you scream! How could you think such a thing!

Well, there are actually papers which say pretty much the same thing. One is a 2016 paper looking at the effect of school-based health centers, finding a big drop in teenage fertility amongst the poor. There is also evidence that the cost of contraceptives reduced a lot. And you indeed see record lows in teenage pregnancies in the US.

It is difficult to convincingly show this train of thought though, because these effects are not likely to materialise immediately but will slowly emerge, which makes them impossible to detect with the methodology social scientists now prefer to identify these things: we like to see immediate jumps to a new equilibrium if a large change has occurred.

Still, the deep tradeoffs involved between average happiness and population numbers if this hypothesis were true are painful. Let us not forget that France lost its pre-eminence in Europe in the 19th century because it was out-bred by Germany! If a welfare system indeed prevents many teenage girls from becoming professional mothers, and instead leads them to more productive lives with less children, then that would mean there is a long-run effect of Obamacare on the level of the US population, which in turn will affect its clout in this world.

No more than a thought though. Happy to be proven wrong!


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8 Responses to Could Obamacare have lead to lower fertility?

  1. I am and will always be Not Trampis says:

    so the hypothesis of having less teenage births is a bad one?

  2. Paul
    What are the figures for other comparable developed countries?

  3. Moz of Yarramulla says:

    That seems plausible, but I’m not convinced that a larger underclass actually helps the US. Right now, let alone in the future. The US seems to be working very hard to decouple their economy from consumption by the lower classes which is their main remaining function that I can see.

    Sure, they have more desperate-to-work and petty criminal types available, but equally they also have more marginally employed and marginally employable type, and they also have more armed petty criminals – and it doesn’t matter how gated your community is and how segregated your life, without stripping the guns from your staff and any proles you come in contact with you’re directly vulnerable. (not sure what the actual death rate is, mind you).

    Longer term the pool of excess labour seems likely to grow as automation bites, so fewer proles seems like a win for the US. Especially once they automate enforcement and stop needing bodies to throw into the gap between rich and poor. Viz, a lot of the US “professional military” is desperate proles (any race) whose only way out is with a gun. I suspect likewise the attraction of the various internal forces (mostly white) to poor people.

  4. Ken Oliver says:

    Paul, some people think that a lower TFR, especially one lower due to fewer UNWANTED births, is an unequivocal blessing rather than a problem. If only on environmental grounds.

    It is a long while since there was a “deep tradeoff …between average happiness and population numbers” – these days it is quite the reverse. Rich countries don’t do cannon fodder anymore, so the travails of France in WW1 because of a low past birthrate are pretty irrelevant.

  5. conrad says:

    You could test that if you can get the Birth by SES by time figures (which I assume shouldn’t be too hard) — your prediction is that the drop should have occurred in low SES groups.

  6. conrad says:

    Here is some data. As a guess, more likely reasons are economic ones given the peak in 2007. Apart from this, given African-American births stay flat, I’m willing to bet Obamacare isn’t a big factor.

  7. I am and will always be Not Trampis says:

    Fertility has been on a downslide since at least 1970. If you observe the long term trend then it appears Obamacare has not done much at all.

    • conrad says:

      If you look at the data (you need to fiddle the options), there is in fact a slight uptick or levelling from about 2000-2007. However, there is no interaction between groups that would have got more benefit from Obamacare compared to groups that didn’t. So it’s thus hard to see how you could attribute much to Obamacare.

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