Effects of Increased Access to Infertility Treatment on Infant and Child Health Outcomes: Evidence from Health Insurance Mandates

This paper examines the association between use of infertility treatment and infant and child health outcomes. Infertility treatment makes conception possible for many couples who otherwise would have been unable to reproduce. Access to subsidized infertility treatment varies across states over time because some states have insurance mandates compelling insurers to cover, or offer to cover, infertility treatment. Many infertility treatments also increase the chances of having multiple births. Using birth certificate data, we find the infertility mandates are associated with a statistically significant 10 percent increase in the twin birth rate among older mothers. Twin pregnancies are typically more dangerous (and costly) than singleton pregnancies. Thus, even if the only effect of the mandates is to increase twin birth rates, they have likely had a negative effect on infant health. For twins born to older mothers, the mandates are also associated with small but statistically significant negative effects on birth weight, gestation, and the 5-minute Apgar score. Effects for singletons born to older mothers are smaller in magnitude but still negative. Using Census data, we find more mixed evidence about longer-term effects of the mandates on child health. Our findings for twin birth outcomes suggest that the positive effects of investment by older mothers in their pregnancies are outweighed by the negative effects of the infertility treatments themselves or by the selection into pregnancy of women with reduced fecundity.