Childbirth technologies and women's career and family outcomes.
Since the early 1980s, medical technology has significantly improved the treatment of infertility. As a result, many women who would have been unable to have a child naturally are now mothers. At the same time, physicians have been increasing their use of cesarean sections. Because childbirth is such an important event in the life-cycle, these changes should affect not only the birth process but other aspects of women's lives as well, including career decisions. The first chapter of this thesis examines the effect that access to infertility treatments has had on birth outcomes such as the incidence of multiple births and the timing of births. I use state time-series/cross-section variation in insurance coverage for infertility treatments to show that improved access to the technologies does result in changes in fertility behavior. Most notably, I find that improved access increases the average age of mothers at first birth. In the second chapter, I present a simple model which illustrates the conditions under which the opportunity to delay career interruptions might lead to increased lifetime wages and increased human capital investment. I then look for changes in women's labor force participation and lifetime wage profiles as a result of improved access to infertility treatments. Mandating insurance coverage increases labor force participation for women under 35, and decreases participation for women over 35. Furthermore, access to infertility treatments significantly increases wages for working women of all ages. Therefore, it appears that extending the biological window for childbearing does improve the career-family tradeoff for women by making delay less costly. Finally, in the third chapter I use geographic variation in the use of cesarean delivery to understand the extent to which high rates reflect inappropriate procedure use. Additionally, I explore the effect of higher usage on infant and maternal mortality. I find that in areas that do more cesareans, the marginal cesarean delivery is medically less appropriate for the procedure, and that area cesarean rates are not associated with improved infant or maternal survival.