Did the US Infertility Insurance Mandates Affect the Time of First Birth?

Abstract

Currently 2.1 million couples in the United States experience difficulties in conceiving a child even after a year of unprotected intercourse. Whilst various infertility treatment options are available to assist these couples, they are often extremely costly. From 1977-2001, several US states mandated health insurance providers to offer coverage for infertility treatment. Although the majority of past literature has studied impacts on older women who are likely to seek treatment, this paper proposes that the mandates may have had a wider impact on the US population. Specifically, it may have given an option for younger women to delay birth since these policies reduced the opportunity cost of having a child in the future. Results estimated by the discrete-time proportional hazard model with piece-wise constant baseline hazard and gamma heterogeneity suggest a significant delay in the time of first birth among highly educated white women. Moreover, the size of the delay depends on the age at which women became exposed to the mandates. Specifically, women who were affected by the policy at the age of 25 and 30 each exhibit a delay of 1.5 and 2 years respectively. This result, in turn suggests a potential increase in future health care costs resulting from the various negative consequences of childbearing by older mothers to both maternal and infant health.