The literature on the micro-level gendered associations between employment and fertility in couples has presented a mixed picture, contrasting a uniformly positive association of employment and first birth for men with negative, zero, or positive associations for women. Differences in period, country context, and women’s educational level have been proposed as explanations for the ambiguous findings. We attempted to resolve these differences and explanations by estimating the employment associations for co-residential different-sex couples’ first birth in 24 European countries using the 2004–2017 waves of the European Union Statistics on Income and Living Conditions (EU-SILC) panel survey. We paid particular attention to the stability of women’s pre-conception employment. We found that having both the woman and man full-time, full-year employed was associated with a higher first-birth risk relative to only the man full-time, full-year employed (“male-breadwinner”) and relative to neither the woman nor the man full-time, full-year employed. Women’s full-time, full-year employment across two pre-conception years was strongly positively associated with the risk of first birth for women’s low-, medium-, and high-educational-attainment groups. The association of women’s full-time, full-year employment with first birth was positive not only overall, but also separately for Western-, Eastern-, and Southern-European country groups. These findings suggest that women’s stable full-time employment may be a general precondition for initiating parenthood among European couples.

As is typical in low and middle-income countries (LMICs), India’s offspring frequently support their parents in old age through household co-residence. This may mitigate adverse health outcomes from natural disasters. We consider dynamic associations of increases in older adult disability and of stability of extended-family household structures. We compare these two outcomes between older persons experiencing the extreme flooding events that occurred in each of India’s four largest coastal cities over the years 2005 to 2007 and older persons living in other urban areas and in rural areas. Our analyses are of a population-representative sample of adults aged 50 and over in the 2004/05 first wave, and age 57 and over in the 2011/12 second wave, of the India Human Development Survey (IHDS) panel survey. We estimate multivariable regressions respectively for the between-wave outcomes of disability and impairment change and for the stability of older persons’ extended-family living arrangements. We find that increases in impairments, but not in restrictions to activities of daily living (ADLs), were associated with living in one of the large coastal cities. We find greater stability of extended-family household structures both for older persons living in one of the large coastal cities and for older persons who experienced increases in ADLs. We conclude favorably for the protective role of extended-family household structures of India’s older persons, and suggest that these will be protective also for those older persons exposed to unfavorable health impacts of disaster events in the coastal megacities of LMICs more broadly.

Racialized population displacement is one of the mechanisms through which a disaster may entrench existing social structures and processes. The present study uses Hurricane Katrina's residential mobility and outmigration impacts on Black and White adults as a case study to explore this question. Drawing on a population-representative survey of pre-Katrina Orleans Parish (City of New Orleans) residents four to five years after Katrina, and on 1985-1990 and 1995-2000 decennial Census microdata, we first compared observed 2005-2009/10 mobility to mobility patterns of all Black and White Orleans Parish adults estimated in the absence of Katrina. Second, we used the survey data to counterfactually apply working-age White mobility rates to working-age Black Orleans Parish residents with equivalent housing damage and socio-economic characteristics, and vice versa. We estimated that 53,000, or almost one in four, Black Orleans Parish adult residents were displaced long term from the New Orleans metropolitan area, whereas at the population level White Orleans Parish residents suffered no displacement. Racial disparities in residential moves from Orleans Parish to suburban New Orleans parishes were crucial in explaining racial disparities in displacement from the metropolitan area. Had White working-age Orleans Parish residents suffered the same housing damage as Black residents and had equivalent socio-economic characteristics, 29% would have moved to suburban New Orleans parishes, versus an observed 4% of Black Orleans Parish residents who made such moves, indicating strong entrenchment of pre-Katrina residential racial stratification and segregation processes.

Steep increases in the use of long-acting reversible contraceptives (LARCs) have occurred during the past two decades in the United States, driven in part by LARC-focused contraceptive access programs and policies designed to reduce early and unintended pregnancies and births. These outcomes have long been concentrated among women of lower socioeconomic status (SES). LARC use has been positively associated with subsequent intended fertility, but the frequency of this post-LARC outcome has not been compared among SES groups in national studies. Using health insurance type to proxy for SES, we combine data from two nationally representative surveys to compare Medicaid-insured and privately insured women's ages at LARC discontinuation, their risk of a post-LARC birth by age, and their reports of whether the post-LARC birth was at the "right time." We find that Medicaid-insured women discontinue LARC use at much younger ages than do privately insured women and have a much higher likelihood of giving birth soon after LARC discontinuation at these younger ages. Consequently, similar overall proportions of women in the two groups report post-LARC births occurring at the "right time." We conclude that the alignment of achieved and desired birth timing following LARC use is similar between these two SES groups.

Abortion has been found to be severely underreported overall, and underreported differentially across groups, when using a direct question. The list-experiment method attempts to overcome these reporting biases indirectly by asking how many items an individual has experienced, but not which, where abortion is one of the items asked to a randomly-assigned ‘treatment’ group but not to a control group. Abortion incidence is estimated as the difference in the mean number of items reported between the treatment and control groups. If list-experiment respondents are also asked a direct abortion question, a combined-data estimator can be constructed from respondents with and without affirmative responses to the direct question. We assess for four U.S. states how this combined estimator may improve estimation of cumulative lifetime abortion incidence relative to the direct question or the list experiment alone. Our combined-data estimate across the four states is 12.9% (95% CI: 10.5, 15.4), which is substantively and statistically higher than both the list-experiment estimate (11.0%, CI: 8.9, 13.2) and the direct-question estimate (9.6%, CI: 8.6, 10.5). Bias by state is much more variable for the direct question than for the list experiment. We conclude that the combined-data estimator improves estimation especially over the direct question.

Hypotheses explaining fertility levels in unions of women and men with different racial and ethnic origins (exogamous union fertility)—including stigma, in-between, pronatal, and assimilative fertility—apply equally when the minority group partner is the woman or the man. As an alternative, we propose a gendered theorizing of exogamous union fertility in which the fertility preferences of either the woman's or the man's racial and ethnic group might dominate. Our analyses reveal strong support for male-predominant patterns: the couple's fertility is nearer to that in an endogamous union of the man's racial and ethnic group than to that of an endogamous union of the woman's racial and ethnic group. We conjecture that women selecting into exogamous unions to realize their own individual fertility preferences might partially explain this finding. We find no cases of female predominance, in which the couple's fertility is nearer to that in an endogamous union of the woman's racial and ethnic group than that of an endogamous union of the man's racial and ethnic group. In addition, using a simple fertility model in which both the woman's and the man's racial and ethnic groups are included as predictors, we find that only the man's coefficients are statistically and substantively significant. A critical implication of our findings is that the standard demographic practice of using the woman's racial and ethnic group will increasingly downwardly bias estimates of fertility differences by race and ethnicity in the United States as exogamy becomes increasingly common.

Policy Points The 2015 to 2020 Delaware Contraceptive Access Now (DelCAN) initiative followed other long-acting reversible contraception-focused contraceptive initiatives in Colorado and in St. Louis, Missouri. and preceded statewide contraceptive-access initiatives in South Carolina, Massachusetts, and North Carolina with additional initiatives planned. Our principle conclusion is that the DelCAN did not achieve its goal of reducing the fraction of births from unintended pregnancies. However, we find evidence of a substantial magnitude of decrease in unplanned pregnancies that can be attributed to the initiative, and that this decrease occurred entirely among Medicaid-covered women.ContextThe 2015 to 2020 Delaware Contraceptive Access Now (DelCAN) initiative was motivated by Delaware's having among the highest rates of unintended pregnancies in the United States, of which were either wanted later or unwanted. The expectation of the DelCAN initiative was that by providing greater contraceptive access, especially to long-acting reversible contraception, Delaware's unintended-pregnancy rates could be substantially reduced. In this study, we assess the role of the DelCAN in explaining, for live births, changes in women's pregnancy intentions around the time of conception.MethodsWe examine not only pregnancy intentions, but also the planned status of the pregnancies, including whether the woman was trying to get pregnant and whether she or her partner was using contraception when an unplanned pregnancy occurred. We use the Pregnancy Risk Assessment Monitoring System data with difference-in-difference estimators to compare Delaware with six states in 2007 to 2020 with respect to the planned status of pregnancies ending in births and with 14 states in 2012 to 2020 with respect to the intended status of pregnancies ending in births. Because several components of the DelCAN were designed to facilitate contraceptive access for low-income women, we conduct both an overall analysis and separate analyses for Medicaid-covered and non-Medicaid-covered women.FindingsThe DelCAN was not associated with reductions in unintended pregnancies ending in births in Delaware relative to comparison states but was associated with an increase in pregnancies that were wanted sooner. DelCAN was also associated with an increase in planned pregnancies concentrated among Medicaid-insured women and produced through reductions in pregnancies occurring when not using contraception.ConclusionsPregnancy intentions and pregnancy planning should be treated as distinct concepts in contraceptive-access program design and evaluation. Programs should attend to both pregnancies wanted later and pregnancies wanted sooner to address public health goals in concert with enhancing women's reproductive autonomy.

OBJECTIVE:To investigate the pathways that may elevate risks of desire for sterilization reversal, specifically through nonuse of long-acting reversible contraception (LARC), viewing abortion as unacceptable for oneself, and being economically disadvantaged. METHODS:We used chi-squared tests and binary logistic models to analyze data on 3422 women, including 299 sterilized women, from a population-representative sample of Delaware women aged 18-44 in 2021. We estimated models for female sterilization use and for desire for sterilization reversal. RESULTS:Among sterilized Delaware women aged 18-44, 28% report desiring sterilization reversal. In multivariate models, those who had never used LARC were more likely to have been sterilized (OR = 1.62; 95% CI = 1.09-2.40), although not more likely to desire sterilization reversal if sterilized. Women who viewed abortion as unacceptable for themselves were not more likely to be sterilized, but they were more likely to desire sterilization reversal if sterilized (OR = 2.42; 95% CI = 1.09-5.36). Economically disadvantaged women were both more likely to be sterilized (OR = 7.56; 95% CI = 4.51-12.68) and more likely, if sterilized, to desire sterilization reversal (OR = 3.88; 95% CI = 1.18-12.74). CONCLUSION:We find varied pathways linking a woman's nonuse of LARC, her personal nonacceptability of abortion, and her economic disadvantage to increased risk of desiring sterilization reversal. Economic disadvantage is easily the greatest risk factor. We interpret these findings through a conceptual framework of constrained choice.

Objectives. To analyze births and birth intendedness after long-acting reversible contraception (LARC) removal among Medicaid-insured women. Methods. We linked all Delaware women with a Medicaid-covered LARC removal in 2012 to 2020 (n = 8047) to birth records and to Pregnancy Risk Assessment Monitoring System (PRAMS) pregnancy intendedness survey responses (n = 241). Results. Births within 3 years of a Medicaid-covered LARC removal were much more likely to be to women in their 20s compared with all Medicaid births (63.5% vs 53.4%; P < .001). The intended proportion for births within 3 years of Medicaid-covered LARC removal (65.2%) was higher than for all Medicaid-covered births (58.8%; P = .08) and was consistently above 60% across all age groups younger than 30 years. Conclusions. A state Medicaid-insured population's use of highly effective reversible contraception was associated with births being concentrated among women in their 20s and with consistently high fractions of intended births across younger ages at birth. Public Health Implications. Programs and policies may consider LARC access for its potential to increase low-income women's reproductive autonomy by enhancing their ability to achieve births at the age of their choosing. (Am J Public Health. 2025;115(1):95-102. https://doi.org/10.2105/AJPH.2024.307844).

Limited data are available on the characteristics and outcomes both of people who have and who have not had an abortion. Administrative data sources contain information on aggregate abortion counts and some demographic characteristics describing individuals who had an abortion but not on those who did not have an abortion. They are therefore of limited use for analyzing the characteristics, reproductive behaviors, and attitudes associated with abortion risk. Direct questions in population representative surveys yield downwardly biased estimates of abortion and likely differential underreporting of abortion by socio-demographic characteristics. In the present study, we evaluate the effectiveness of an indirect survey method, the list experiment, for improving estimates of abortion risk and differentials in population-representative surveys. We estimate cumulative-lifetime abortion incidence in 2017 and five-year incidence in 2021 using two cross-sectional surveys administered in Delaware and Maryland and evaluate the five-year estimates against external benchmarks from administrative data. We use multivariate regression with the list-experiment data to examine abortion incidence by socio-demographic predictors. We find that list-experiment estimates of five-year abortion incidence are similar to estimates calculated from external data: that cumulative lifetime abortion incidence increases monotonically with age, and that five-year incidence is inverse U-shaped. Black adults are found to be much more likely to have had an abortion both in the past five-years and over the reproductive lifetime, before and after controlling for age, parity, relationship status, education, and household income. We conclude positively about the validity and utility of the list experiment method.

Extreme climate events are infrequently considered for elder health and wellbeing in low and middle income countries. The world’s first and fourth largest urban populations exposed to extreme coastal flooding are in India (Mumbai and Kolkata). These and the next largest of India’s coastal cities, Chennai and Surat, each experienced an extreme flood event in the years 2005-2007 that was either unprecendented in recorded meteorological history (Mumbai and Chennai) or whose magnitude exceeded any in the last 30 and 40 years (Kolkata and Surat). We use panel data collected before these events (2004-2005), and collected again approximately seven years later (2011-2012), analyzing individuals aged 50 and over. We analyzed acquisition of any disability condition between 2004-2005 and 2011-2012, comparing these four large coastal cities to all India’s urban areas and to India’s five inland cities (Dehli, Bangalore, Hyderabad, Ahmadabad, and Pune) whose population sizes were between those of the four exposed coastal cities of our study. Residing in a coastal city that experienced an extreme flood event was associated with an 80% higher odds of acquiring disability (OR 1.80; 95% CI:1.468, 2.207), whereas residing in equivalent-sized inland city was not associated with a change in the odds of acquiring a disability, relative to all other urban areas. Being older, female, unmarried, in a single-generation household, and having a chronic morbidity condition had positive associations with disability acquisition, but only older age had a magnitude of association exceeding that for living in a coastal city that experienced an extreme flood event.

ObjectiveTo estimate the association of Medicaid coverage of abortion care with cumulative lifetime abortion incidence among women insured by Medicaid.Data Sources and Study SettingWe use 2016-2019 (Pre-Dobbs) data from the Survey of Women studies that represent women aged 18-44 living in six U.S. states. One state, Maryland, has a Medicaid program that has long covered the cost of abortion care. The other five states, Alabama, Delaware, Iowa, Ohio, and South Carolina, have Medicaid programs that do not cover the cost of abortion care. Our sample includes 8972 women residing in the study states.Study DesignOur outcome, cumulative lifetime abortion incidence, is identified using an indirect survey method, the double list experiment. We use a multivariate regression of cumulative lifetime abortion on variables including whether women were Medicaid-insured and whether they were residing in Maryland versus in one of the other five states.Data Collection/Extraction MethodsThis study used secondary survey data.Principal FindingsWe estimate that Medicaid coverage of abortion care in Maryland is associated with a 37.0 percentage-point (95% CI: 12.3-61.4) higher cumulative lifetime abortion incidence among Medicaid-insured women relative to women not insured by Medicaid compared with those differences by insurance status in states whose Medicaid programs do not cover the cost of abortion care.ConclusionsWe found that Medicaid coverage of abortion care is associated with a much higher lifetime incidence of abortion among individuals insured by Medicaid. We infer that Medicaid coverage of abortion care costs may have a very large impact on the accessibility of abortion care for low-income women.

Many demographic problems require models for partnership formation. We consider a model for matchings within a bipartite population where individuals have utility for people based on observed and unobserved characteristics. It represents both the availability of potential partners of different types and the preferences of individuals for such people. We develop an estimator for the preference parameters based on sample survey data on partnerships and population composition. We conduct simulation studies based on the Survey of Income and Program Participation showing that the estimator recovers preference parameters that are invariant under different population availabilities and has the correct confidence coverage.

Although multi-component policy interventions can be important tools to increase access to contraception, we know little about how they may change contraceptive use among postpartum women. We estimate the association of the Delaware Contraceptive Access Now (DelCAN) initiative with use of postpartum Long-Acting Reversible Contraception (LARC). DelCAN included Medicaid payment reform for immediate postpartum LARC use, provider training and technical assistance in LARC provision, and a public awareness campaign. We used a difference-in-differences design and data from the 2012 to 2017 pregnancy risk assessment monitoring system to compare changes in postpartum LARC use in Delaware versus 15 comparison states, and differences in such changes by women’s Medicaid enrollment. Relative to the comparison states, postpartum LARC use in Delaware increased by 5.26 percentage points (95% CI 2.90–7.61, P < 0.001) during the 2015–2017 DelCAN implementation period. This increase was the largest among Medicaid-covered women, and grew over the first three implementation years. By the third year of the DelCAN initiative (2017), the relative increase in postpartum LARC use for Medicaid women exceeded that for non-Medicaid women by 7.24 percentage points (95% CI 0.12–14.37, P = 0.046). The DelCAN initiative was associated with increased LARC use among postpartum women in Delaware. During the first 3 years of the initiative, LARC use increased progressively and to a greater extent among Medicaid-enrolled women. Comprehensive initiatives that combine Medicaid payment reforms, provider training, free contraceptive services, and public awareness efforts may reduce unmet demand for highly effective contraceptives in the postpartum months.

Objective To understand the importance of family and household structure, including cohabiting partners and nonkin adults, in explaining Black-White versus Hispanic-White newborn poverty disparities in the United States. Background The official poverty measure (OPM) has typically been used in scholarly studies of newborn and childhood poverty, but this measure excludes cohabitors' and nonkin household members' presence and income. Both are likely to have poverty-preventing roles when a birth is nonmarital. Method A household poverty measure inclusive of all household members is compared to the OPM, using data on households of White, Black, and Hispanic newborns from the 2005-2017 American Community Survey (N = 342,048). Regression decompositions are used to investigate the roles of mother's education and partner and other coresident adult presence and resources. Results Lower maternal educational attainment explains most of the Hispanic-White poverty disparity at birth. The prevalence and poverty-alleviating effectiveness of cohabitation and living with other adults, however, is greater for Hispanic than for Black unmarried mothers, and is greater for foreign-born than for US-born Hispanics. Conclusion Black mothers' lesser access to the resources of a partner or other adults in the year of the newborn's arrival is critical in producing a remarkably high Black-White newborn poverty disparity. Official poverty obscures the greater benefits of cohabitation and living with other adults for newborns of Hispanic mothers overall, and of foreign-born Hispanic mothers in particular.

We consider an empirical likelihood framework for inference for a statistical model based on an informative sampling design and population-level information. The population-level information is summarized in the form of estimating equations and incorporated into the inference through additional constraints. Covariate information is incorporated both through the weights and the estimating equations. The estimator is based on conditional weights. We show that under usual conditions, with population size increasing unbounded, the estimates are strongly consistent, asymptotically unbiased, and normally distributed. Moreover, they are more efficient than other probability-weighted analogs. Our framework provides additional justification for inverse probability weighted score estimators in terms of conditional empirical likelihood. We give an application to demographic hazard modeling by combining birth registration data with panel survey data to estimate annual first birth probabilities.

Objective: To evaluate the likelihood of a short interpregnancy interval (IPI) resulting in a birth among women covered by Medicaid, as a function of postpartum contraceptive method type. Study Design: We used Medicaid claims and eligibility data to identify women (aged 15-44) who had a Medicaid-financed birth in Delaware in the years 2012-2014 ( n = 10,328). Claims were analyzed to determine postpartum contraceptive type within 60 days of the index birth, and linked birth certificates were used to determine the incidence and timing of a subsequent birth through 2018 (regardless of payer). We used logistic regression to analyze the likelihood of having a short IPI following the index birth as a function of postpartum contraceptive type, controlling for preterm births, parity, having a postpartum checkup, and maternal characteristics including age, race, education, and marital status. Results: Compared to patients receiving postpartum long-acting reversible contraceptive methods (LARC), patients with no contraceptive claims had nearly 5 times higher odds (odds ratio [OR] = 4.98, confidence interval [CI] = 3.05-8.13) and those with claims for moderately effective methods (injectable, pill, patch, or ring) had 3.5 times higher odds (OR = 3.51, CI = 2.13-5.77) of a subsequent birth following a short IPI. Conclusions: In a state population of Medicaid-enrolled women, women with claims for postpartum LARC had substantially lower risk of a short IPI resulting in a birth. Implications: Women who received LARC within 60 days postpartum are less likely to experience a short interpregnancy interval resulting in a birth. The evidence suggests that recent state policy changes that make postpartum LARC more accessible to those that desire it will be an effective strategy in helping patients obtain desired birth intervals. (c) 2021 Elsevier Inc. All rights reserved.

Unplanned pregnancies in the U.S. disproportionately occur among poor, less educated, and minority women, but it is unclear whether poverty following a birth is itself an outcome of this pregnancy planning status. Using the National Longitudinal Survey of Youth 1997 (n = 2101) and National Survey of Family Growth (n = 778), we constructed 2-year sequences of contraceptive use before a birth that signal an unplanned versus a planned birth. We regressed poverty in the year of the birth both on this contraceptive-sequence variable and on sociodemographic indicators including previous employment and poverty status in the year before the birth, race/ethnicity, education, partnership status, birth order, and family background. Compared to sequences indicating a planned birth, sequences of inconsistent use and non-use of contraception were associated with a higher likelihood of poverty following a birth, both before and after controlling for sociodemographic variables, and before and after additionally controlling for poverty status before the birth. In pooled-survey estimates with all controls included, having not used contraception consistently is associated with a 42% higher odds of poverty after birth. The positive association of poverty after birth with contraceptive inconsistency or non-use, however, is limited to women with low to medium educational attainment. These findings encourage further exploration into relationships between contraceptive access and behavior and subsequent adverse outcomes for the mother and her children.

A major shift in the U.S. contraceptive method mix has been the recent growth in the use of long-acting reversible contraceptives (LARCs)—intrauterine devices and implants. Quantitative research into LARC’s impacts until now has focused on evaluating their efficacy in reducing unintended pregnancies. The next question, of whether births after discontinuing LARC use are then more likely to result from an intended pregnancy, has received almost no attention. We analyzed data from 2984 women who reported a live birth in the 3–4 years prior to survey interview for the 2006–2015 cycles of the National Survey of Family Growth. We compared the proportion of births intended by last contraceptive method used. To capture contraceptive failure versus stopping contraceptive use to become pregnant, we estimated logistic regressions alternately not controlling for, and controlling for, use of contraception in the month of conception. We found that four in five births following LARC use were reported to result from an intended pregnancy, compared to only three in five births following use of a moderately-effective or less-effective method. After controlling for use of contraception in the month of conception and for socio-demographic characteristics, women whose last-used method was a LARC had twice the odds of reporting that the pregnancy was intended relative to women whose last-used method was either a moderately-effective method or a less-effective method. We conclude that U.S. women’s LARC use has the potential to increase the fraction of subsequent births from intended pregnancies, and in doing so promote their reproductive autonomy.