Coverage of Infertility Treatment and Fertility Outcomes: Do Women Catch Up?

Working Paper: CEPR ID: DP8445

Authors: Matilde Pinto Machado; Anna Sanz-de-Galdeano

Abstract: The ageing of first-time mothers and the changes in women's labor market conditions have been accompanied by the introduction and subsequent increase in the use of assisted reproductive therapies (ART) that help extend women's reproductive life. Considering the financial cost of infertility treatments, policy interventions that increase insurance coverage may significantly affect fertility trends, and ultimately, population age structures. However, policies have ignored the overall impact of ART coverage on fertility. In this paper, long-term effects of insurance coverage for infertility on the timing of first births and on total fertility rates are examined. Variation in the enactment of infertility insurance mandates over time and across U.S. states allows the estimation of both the short-term and long-term effects. We concentrate on the effects of the more demanding mandates enacted in six states in the later 80s and 90s. Our results show that the effect of these mandates to cover infertility treatment is positive on the average age at first birth and increases over time. The long-term estimates of the increase in age of first-time mothers range from 3 to 5 months. Importantly, we also show that these mandates do not increase the total fertility rates of women by the end of their reproductive lives.

Keywords: Assisted Reproductive Technologies (ART); Effects of Insurance Coverage for Infertility; Insurance Coverage for Infertility; Insurance Mandates and Total Fertility

JEL Codes: I18; J13

Causal Claims

Cause	Effect
strong infertility insurance mandates (G52)	access to ART (I14)
access to ART (I14)	age at first birth (J13)
delayed motherhood (J13)	age at first birth (J13)
strong infertility insurance mandates (G52)	total fertility rates (J11)
strong infertility insurance mandates (G52)	age at first birth (J13)