Educational gradients in the prevalence of medically assisted reproduction births in a comparative perspective.

OBJECTIVE: To study educational gradients in births after medical assisted reproduction across five countries with different institutional arrangements. DESIGN: We use logistic regression and compute predicted probabilities to estimate the association between education and giving birth after assisted reproduction, before and after adjustment for maternal age at delivery and marital/partnership status, using an overall sample of about 3.9 million live births in five countries. SUBJECTS: This study includes survey or register data containing information on births in five countries: N=61, 564 for Denmark, N= 37,533 for France, N=12,889 for Spain, N= 17,097 for the United Kingdom, and N=3,700,442 for the United States. INTERVENTION (FOR RCT) OR EXPOSURE (FOR OBSERVATIONAL STUDIES): None. MAIN OUTCOME MEASURES: Probability of a child being born after medically assisted reproduction for mothers with a university degree relative to those having less than a university degree. RESULTS: University educated mothers are more likely to give birth after assisted reproduction compared to mothers with lower levels of education. After adjustment for socio-demographic characteristics, educational differences disappear in the United Kingdom and to some extent Spain, whilst they attenuate but persist in the other countries. The United States seems to show a larger educational gradient. CONCLUSION: The results suggest that the institutional setting around assisted reproduction may moderate the gradient. A possible explanation may be access to treatments, as the United States - the context with the lowest subsidization - seems to show larger educational gradients than other contexts. In a context of global postponement of childbearing to older ages, mothers with lower levels of socioeconomic resources might find it more difficult to fully realise their fertility intentions in countries with a less generous subsidization of treatments.

Perinatal health in Spain during and after the Great Recession: Educational selection into fertility as a protective factor in high unemployment contexts.

Higher maternal resources have long been associated with superior birth outcomes. This study analyzes the potentially protective role of maternal educational selection into fertility in adverse macroeconomic contexts. We focus on the case of Spain, a country reaching record-high unemployment levels during the Great Recession starting in 2008. First, we examine whether selection into fertility of more educated mothers took place as province-level unemployment rates rose. Secondly, we assess whether maternal education mitigated the impact of higher unemployment levels on different birth outcomes. The analysis combines register data on the universe of live births with aggregate data on province-level unemployment. We cover the period 2007-2019 to ensure sufficient variability of unemployment rates and perform linear regression and linear probability models with fixed effects to hold constant unobserved heterogeneity across provinces. Findings indicate selection into fertility of mothers with university-level education in times of high unemployment. In addition, while unemployment rates did show an adverse impact on certain birth outcomes -birthweight, the occurrence of low and very low birthweight, and the risk of stillbirth - maternal education mitigated the observed relations. It was itself, moreover, consistently and independently associated with better perinatal health. We thus conclude that fertility selectivity by maternal education cushioned the impact of the adverse economic context derived from the Great Recession through two separate pathways.