Impact of child health and disability on subsequent maternal fertility

Abstract

The prevalence of chronic conditions among children has been rising in the past four decades. Despite the policy relevance and plausible mechanisms through which child disability and severe early life health conditions can impact subsequent maternal reproductive behavior, there has been limited investigation of this question particularly in the US. Child disability or severe early life health problems such as very preterm birth (VPTB) and very low birth weight (VLBW) can constrain household resources to have another child but may also increase parental demand for healthy children and modify allocation of resources between children. Empirical assessment of this question is complicated by unobservables such as maternal health and preferences. We examine whether giving birth to a child with disabilities or severe adverse birth outcomes including VPTB and VLBW impacts subsequent maternal fertility. We employ a mother fixed-effect duration model for maternal fertility over time as a function of the proportion of previously born children with disabilities/health conditions in order to account for time-invariant unobservables, using merged data from the 1993 National Health Interview Survey and 1995 National Survey of Family Growth. We find no evidence that having disabled children reduces subsequent live births when using the mother fixed-effect model, in contrast to the classical model using within and between mother variation which suggests a fertility decline. Similarly, we find no evidence that having VPTB or VLBW children reduces fertility. Overall, our findings indicate no impact of child disability or health conditions on subsequent maternal fertility. Additional analyses excluding women who may qualify for AFDC show overall a similar pattern of results, suggesting that the findings may be generalizable post the AFDC. Time-varying unobservables may still be at work, but they likely result in an opposite (negative) bias toward reduction in fertility.