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Could Obamacare have lead to lower fertility?

June 11, 2018 - 22:53 -- Admin

[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!