Does Getting Health Insurance Affect Women’s Fertility? Evidence from the United Mine Workers’ Health Insurance

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Does health insurance affect fertility decisions? Fertility may increase if insurance lowers the costs of having a child. Fertility may decrease if children are more likely to survive into adulthood (quality-quantity tradeoff). We study a largely permanent United Mine Workers of America (UMWA) insurance program. A large group of women of childbearing age gained pregnancy coverage for the first time. The insurance also covered children. We use a trend break specification with county-level variation in insurance. We find new evidence of the quality-quantity tradeoff. Fertility rates declined by about one percent per year in counties with average levels of insurance.