Can health care information technology save babies?

Electronic medical records (EMRs) facilitate fast and accurate access to patient records, which could improve diagnosis and patient monitoring. Using a 12-year county-level panel, we find that a 10 percent increase in births that occur in hospitals with EMRs reduces neonatal mortality by 16 deaths per 100,000 live births. This is driven by a reduction of deaths from conditions requiring careful monitoring. We also find a strong decrease in mortality when we instrument for EMR adoption using variation in state medical privacy laws. Rough cost-effectiveness calculations suggest that EMRs are associated with a cost of $531,000 per baby’s life saved.

Convict bastards, common-law unions, and shotgun weddings: premarital conceptions and ex-nuptial births in nineteenth-century Tasmania

This article uses reconstituted family data from birth, death, and marriage registers to measure ex-nuptial fertility and premarital pregnancies in nineteenth-century Tasmania. It also examines the extent to which convict origins of European society on the island caused a departure from English norms of family formation behavior, during a period when men greatly outnumbered women. Illegitimacy was high during the convict period. From the mid-1850s, after the convict system collapsed, levels of ex-nupital births were relatively constant until the end of the century, as indicated both by the illegitimacy rate and by the proportion of marriages associated with prenuptial births. By the end of the nineteenth-century, rates of illegitimacy and prenuptial conceptions in Tasmania were well within the range of those of contemporary English-speaking populations.

Maternalism, race, class and citizenship: aspects of illegitimate motherhood in Nazi Germany

This article juxtaposes three types of illegitimate motherhood that came in the wake of the Second World War in Nazi Germany. The first found institutional support in the Lebensborn project, an elite effort to raise the flagging birth-rates, which at the same time turned a new page in the history of sexuality. The second came before the lower courts in the form of paternity and guardianship suits that had a long precedent, and the third was a social practice that the regime considered a ‘mass crime' among its female citizenry: namely, forbidden unions between German women and prisoners of war. Through these cases the article addresses issues such as morality, sexuality, paternity, citizenship and welfarism. The flesh-and-blood stories have been culled from the Lebensborn Dossiers and Special Court files, as well as cases from the lower courts.

A global perspective on happiness and fertility

The literature on fertility and happiness has neglected comparative analysis. We investigate the fertility/happiness association using data from the world values surveys for 86 countries. We find that, globally, happiness decreases with the number of children. This association, however, is strongly modified by individual and contextual factors. Most importantly, we find that the association between happiness and fertility evolves from negative to neutral to positive above age 40, and is strongest among those who are likely to benefit most from upward intergenerational transfers. In addition, analyses by welfare regime show that the negative fertility/ happiness association for younger adults is weakest in countries with high public support for families, and the positive association above age 40 is strongest in countries where old-age support depends mostly on the family. Overall these results suggest that children are a long-term investment in well-being, and highlight the importance of the life-cycle stage and contextual factors in explaining the happiness/fertility association.

Socio-economic differentials in birth masculinity in China

This article examines the relationship between birth masculinity and socio-economic levels in China. Both 2000 and 2005 data suggest the presence of a non-linear relationship between the sex ratio at birth and socio-economic status, with a lower sex ratio at birth observed among both the poorest and the richest households. This inverted-U pattern is significantly different from what is observed in India and what has been assumed previously for China. Multivariate analyses indicate that this pattern persists after the introduction of several other covariates of birth masculinity such as ethnicity, fertility, migration status, age or parity. These results suggest that further economic advances and socio-economic mobility could contribute to the return to normalcy of the sex ratio at birth.

Tacit consent: the Church and birth control in northern Italy

This article employs novel documentation to examine ways in which the Church's moral rules on contraception were (or were not) communicated to parishioners in a predominantly Catholic context in a period of rapid fertility decline: the diocese of Padua, in the northeastern Italian region of Veneto, during the first half of the twentieth century. The account is based on documents that have until now been overlooked: the moral cases discussed during the periodic meetings among Padua priests in the years 1916–58, and the written answers provided by priests in response to a question asked of them concerning their efforts to combat the limiting of births. This documentation reveals the limited effect on the reproductive behavior of the position of the Catholic Church against birth control.

Effects of demographic and retirement-age policies on future pension deficits, with an application to China

A simple method is proposed for projecting future deficits in a defined benefit or defined contribution pension scheme. The annual pension deficit rate is expressed in terms of the elderly dependency ratio (determined by demographic factors), the average retirement age, and a few parameters describing the scheme. An illustrative application to China demonstrates that if the average age at retirement gradually increases from the current low level to age 65 for both men and women in 2050, the annual pension deficit rate would be greatly reduced or even eliminated under various plausible demographic regimes over this period. With all else equal, a transition to a two-child policy (assuming this would raise fertility) would also lower the deficit rate in comparison to keeping the current fertility policy unchanged, although the effect would be seen only after 2030. The effect of potentially faster mortality decline in raising future deficits is appreciable and starts earlier than the effects of fertility change. The proposed method may also be used to gauge the magnitudes and timing of impacts on future pension deficits of alternative assumptions regarding levels and age/sex composition of international migration.

"A matter of physical health and strength”: disciplining the female body and reproducing the Czech national community in the mid-nineteenth century

An 1850 article “Uzavírání sňatku” (“Marriage”) by Czech physician Jan Špott outlined the requirements for those who considered themselves part of the Czech national community. Špott stressed that those concerned with the future national existence had to educate themselves and each other to create healthy offspring. I examine Špott’s article with regard to contemporary ideas about fitness, the role of women, the need to discipline the female body, as well as the importance of education in reproducing the community. This article’s analysis - set in the broader context of the history of women, medicine, and nationalisms - shows that nation-oriented education could be perceived as a way to ensure the nation’s future existence while simultaneously emphasizing the responsibility of individuals, and particularly women, for the reproduction of the community. Špott’s propositions are significant to other nineteenth-century national movements and to postnational contexts where national fitness is a concern.

Economic recession and fertility in the developed world

This article reviews research on the effects of economic recessions on fertility in the developed world. We study how economic downturns, as measured by various indicators, especially by declining GDP levels, falling consumer confidence, and rising unemployment, were found to affect fertility. We also discuss particular mechanisms through which the recession may have influenced fertility behavior, including the effects of economic uncertainty, falling income, changes in the housing market, and rising enrollment in higher education, and also factors that influence fertility indirectly such as declining marriage rates. Most studies find that fertility tends to be pro-cyclical and often rises and declines with the ups and downs of the business cycle. Usually, these aggregate effects are relatively small (typically, a few percentage points) and of short durations; in addition they often influence especially the timing of childbearing and in most cases do not leave an imprint on cohort fertility levels. Therefore, major long-term fertility shifts often continue seemingly uninterrupted during the recession—including the fertility declines before and during the Great Depression of the 1930s and before and during the oil shock crises of the 1970s. Changes in the opportunity costs of childbearing and fertility behavior during economic downturn vary by sex, age, social status, and number of children; childless young adults are usually most affected. Furthermore, various policies and institutions may modify or even reverse the relationship between recessions and fertility. The first evidence pertaining to the recent recession falls in line with these findings. In most countries, the recession has brought a decline in the number of births and fertility rates, often marking a sharp halt to the previous decade of rising fertility rates.

Births: final data for 2008

OBJECTIVES

This report presents 2008 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal demographic characteristics including age, live-birth order, race and Hispanic origin, marital status, attendant at birth, method of delivery, and infant characteristics (period of gestation, birthweight, and multiple births). Birth and fertility rates by age, live-birth order, race and Hispanic origin, and marital status also are presented. Selected data by mother's state of residence are shown, as well as data on age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.

METHODS

Descriptive tabulations of data reported on the birth certificates of the 4.25 million births that occurred in 2008 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census.

RESULTS

A total of 4,247,694 births were registered in the United States in 2008, 2 percent less than in 2007. The general fertility rate declined 1 percent to 68.6 per 1,000. The teenage birth rate declined 2 percent to 41.5 per 1,000. Birth rates for women aged 20 to 39 years were down 1-3 percent, whereas the birth rate for women aged 40-44 rose to the highest level reported in more than 40 years. The total fertility rate declined 2 percent to 2,084.5 per 1,000 women. All measures of unmarried childbearing reached record levels-40.6 percent of births were to unmarried women in 2008. The cesarean delivery rate rose again to 32.3 percent. The preterm birth rate declined for the second consecutive year to 12.3 percent; the low birthweight rate was down very slightly. The twin birth rate increased 1 percent to 32.6 per 1,000; the triplet and higher-order multiple birth rate was stable.

State disparities in teenage birth rates in the United States

In 2008, state-specific teenage birth rates varied widely, from less than 25.0 per 1,000 15-19 year olds to more than 60.0. Rates for non-Hispanic white and Hispanic teenagers were uniformly higher in the Southeast and lower in the Northeast and California. The highest rates for non-Hispanic black teenagers were reported in the upper Midwest and in the Southeast. The race and Hispanic origin-specific birth rates by state as well as the population composition of states by race and Hispanic origin contribute to state variations in overall teenage birth rates.

Births: final data for 2007

OBJECTIVES

This report presents 2007 data on U.S. births according to a wide variety of characteristics; preliminary 2008 data are also referenced on key measures where available. Final 2007 data are presented for maternal demographic characteristics including age, live-birth order, race and Hispanic origin, marital status, and educational attainment; maternal lifestyle and health characteristics (medical risk factors, weight gain, and tobacco use); medical care utilization by pregnant women (prenatal care, obstetric procedures, characteristics of labor and/or delivery, attendant at birth, and method of delivery); and infant characteristics (period of gestation, birthweight, Apgar score, congenital anomalies, and multiple births). Birth and fertility rates by age, live-birth order, race and Hispanic origin, and marital status also are presented. Selected data by mother's state of residence are shown, as well as data on month and day of birth, sex ratio, and age of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.

METHODS

Descriptive tabulations are presented of data reported on the birth certificates of the 4.3 million births that occurred in 2007. Preliminary 2008 data are based on 99.9 percent of births occurring in 2008. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census.

RESULTS

A total of 4,316,233 births were registered in the United States in 2007, the largest number of births ever reported. The general fertility rate increased 1 percent to 69.5 per 1,000. Birth rates increased for women in nearly all age groups. The rate for teenagers rose 1 percent for the year and is up 5 percent from 2005. The total fertility rate increased 1 percent to 2,122.0 births per 1,000 women. Preliminary data for 2008, however, suggest a decline in the number and rate of births overall, and for most age groups under age 40 years. All measures of unmarried childbearing reached record levels in 2007. The cesarean delivery rate rose to another all-time high--31.8 percent. Preterm and low birthweight rates declined slightly, and twin and triplet and higher-order multiple birth rates were essentially unchanged. Preliminary findings for 2008 suggest that these trends continued for cesarean delivery, unmarried childbearing, and preterm births.

East Asian childbearing patterns and policy developments

Childbearing behavior in East Asian countries has changed rapidly during the past half century from an average of five to seven children per family, to replacement-level fertility, and subsequently to unprecedentedly low levels, the lowest in the world. This article analyzes fertility trends in Hong Kong, Japan, singapore, south Korea, and Taiwan using cohort fertility data and methods, then examines social and economic causes of the childbearing trends, and surveys policies pursued to reverse the fertility trends. Postponement of childbearing started in the 1970s with continuously fewer delayed births being "recuperated," which resulted in ultra-low fertility. A rapid expansion of education and employment among women in a patriarchal environment has generated a stark dilemma for women who would like to combine childbearing with a career. Policy responses have been slow, with a more serious attempt to address issues in recent years. Thus far public and private institutions are not devoting sufficient attention to generating broad social change supportive of parenting.

Reexamining the Dominance of Birth Cohort Effects on Mortality

The association between birth cohort and subsequent mortality has been of interest especially following publication of studies around 1930 of cohorts born up to the latter part of the nineteenth century, particularly for England and Wales. Updated results are presented for this population, together with those for two other cohorts, twentieth-century Japanese and British populations born about 1930, which have been identified as having particularly clear-cut birth cohort patterns, and which are used to underpin incorporation of cohort effects in both British official and actuarial mortality forecasts. Graphical methods used to identify cohort patterns are discussed. A number of limitations and difficulties are identified that mean that the conclusions about the predominance of cohort effects are less robust than often assumed. It is argued that alternative explanations should be considered and that the concentration on birth cohorts with particularly advantaged patterns may distort research priorities.

Fertility trends, marriage patterns, and savant typologies in Albanian context

In this article, the author focuses on the speculative literalism and typologism in current scholarship to construct a taken-for-granted view, taking issue especially with many points raised in the literature on the subject that have associated fertility rates in Albania more closely with the existence of patriarchal cultural traits. This leads the author to argue that the specific rationale for the myth of many children, high fertility rates, and complex family structures in Albanian context, as elsewhere in patrilineal societies, is an ideological elaboration of patriarchy. Methodologically, the analysis of the standard view of childbearing, based on standard ethnographic methods, traditional historical sources and aggregate demographic data, is aimed to illustrate the inadequacy of the historical-ethnographic paradigm against the available empirical evidence. In turn, understanding how ideological elements are emphasized in cultural activism should lead, against current scholarship claims, to an understanding of the way in which the urgent need for male children must have been to hide away other more troubling reasons.

Mapping the Timing, Pace, and Scale of the Fertility Transition in Brazil

Between 1960 and 2000, fertility fell sharply in Brazil, but this transition was unevenly distributed in space and time. Using Bayesian spatial statistical methods and microdata from five censuses, we develop and apply a procedure for fitting logistic curves to the fertility transitions in more than 500 small regions of Brazil over this 40-year period. Doing so enables us to map the main features of the Brazilian fertility transition in considerable detail. We detect early declines in some regions of the country and document large differences between early and late transitions in regard to both the initial level of fertility and the speed of the transition. We also use our results to test hypotheses regarding changes in the level of development at the onset of the fertility transition and identify a temporary stall in the Brazilian transition that occurred in the late 1990s. A web site with project details is at http://schmert.net/BayesLogistic.

China's below-replacement fertility: government policy or socioeconomic development?

The article challenges the notion that below-replacement fertility and its local variation in China are primarily attributable to the government's birth planning policy. Data from the 2000 census and provincial statistical yearbooks are used to compare fertility in Jiangsu and Zhejiang, two of the most developed provinces in China, to examine the relationship between socioeconomic development and low fertility. The article demonstrates that although low fertility in China was achieved under the government's restrictive one-child policy, structural changes brought about by socioeconomic development and ideational shifts accompanying the new wave of globalization played a key role in China's fertility reduction.

All connected? Geographies of race, death, wealth, votes and births

In January 2010 we learnt that within London the best-off 10th of the population each had recourse to 273 times the wealth of the worse-off 10th of that population (Hills et al. 2010, An anatomy of economic inequality in the UK Report of the National Equality Panel, Government Equalities Office, London). It is hard to find any city in an affluent country that is more unequal. This wealth gap did not include the assets of the UK super-rich, who mostly live in or near London. In April 2010 the Sunday Times newspaper reported the wealth of the richest 1000 people in the UK had risen by an average of £77 million each in just one year, to now stand at £335.5 billion. Today in the UK we are again as unequal as we were around 1918. For 60 years we became more equal, but for the last 30 years, more unequal. Looking at inequality trends it is very hard, initially, to notice when the party of government changed. However, closer inspection of the time series suggests there were key times when the trends changed direction, when the future was much less like the past and when how people voted and acted appeared to matter more than at other times. With all three main parties offering what may appear to be very similar solutions to the issue of reducing inequality it seems unlikely that voting in 2010 will make much of a difference. However, today inequalities are now at unsustainable extremes. Action has been taken such that some inequalities, especially in education, have begun to shrink. The last two times that the direction of trends in inequalities changed, in the 1920s and 1970s, there were several general elections held within a relatively short time period. Inequality is expensive. The UK is not as well-off as it once was. It could be time for a change again. Which way will we go?

How personal is the political? Democratic revolution and fertility decline

Existing theory has identified the capacity of political revolutions to effect change in a variety of social institutions, although relationships between revolution and many institutions remain unexplored. Using historical data from twenty-two European and four diaspora countries, the author examines the temporal relationship between timing of revolution and onset of fertility decline. The author hypothesizes that specific kinds of revolutionary events affect fertility by engendering ideological changes in popular understandings of the individual's relationship to society and ultimately the legitimacy of couples' authority over their reproductive capacities. Results demonstrate that popular democratic revolutions -- but not institutionalized democratic structures -- predict the timing of the onset of fertility decline.

Changing patterns of nonmarital childbearing in the United States

Childbearing among unmarried women has been the subject of intense public policy and public health concern for decades, much of it reflecting concerns about the impact on family structure and the economic security of children. Nonmarital births are at higher risk of having adverse birth outcomes such as low birthweight, preterm birth, and infant mortality than are children born to married women. Children born to single mothers typically have more limited social and financial resources. This report examines data on nonmarital births from the National Vital Statistics System (NVSS). The principal measures reviewed are the number of births to unmarried women, the birth rate for unmarried women, and the percentage of all births to unmarried women. The most recent data available are from the 2007 preliminary birth file. Data for 2006 are shown where the 2007 data are not available. Comparisons are also made with selected earlier years reflecting key points of change.