Fewer children, more employed women: International edition

In the discussion on this post about interpreting historical trends, several people pointed out that the relationship between fertility rates and women’s employment rates is not simple, and has changed, at least in the rich countries. I made some charts using international data about that, which I will show below.

But first a figure from this paper by Rense Nieuwenhuis and colleagues, which he linked from the comments. In that 2012 paper they show that the negative association between motherhood and employment weakened in OECD countries from 1975 to 1999. Still, at the individual level, in almost every country and every year, the odds of being employed are lower for mothers, as this figure shows (dots lower in each box indicate a bigger employment gap between mothers and non-mothers; click to enlarge):


It’s a very interesting paper I should have recommended earlier.

The fact that mothers are less likely to be employed than women without children doesn’t mean that countries — or time periods — with lower fertility rates necessarily have higher women’s employment rates (see Nieuwenhuis’s comment for a few other papers on this). So it’s good to look at individual as well as macro-level patterns.

Anyway, those are all rich countries. What about poorer countries? Because of the unbelievably good archive of census data (freely available, thank gov) at IPUMS International (74 countries, 238 censuses, 544 million records, and counting), it’s possible to ask questions like this.

Looking for censuses that recorded the number of children ever born to women, as well as their employment status, I sampled 10,000 households each from 89 censuses in 29 countries in Latin America or the Caribbean, Asia, and Africa, ranging in time period from 1960 to 2010. I limited the samples to women ages 25-44, and counted their children up to 7. The countries were:

  • Latin America / Caribbean: Argentina, Bolivia, Brazil, Cambodia, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Haiti, Jamaica, Mexico, Nicaragua, Panama, Peru, Uruguay
  • Africa: Burkina Faso, Ghana, Guinea, Kenya, Malawi, Morocco, Rwanda, Senegal, Sierra Leone, South Africa
  • Asia: China, Indonesia, Vietnam

Here’s what I found. Overall there is not a strong correlation at the country level between mean number of children born per women and employment rates (correlation = -.09):


Closer inspection reveals a pretty strong relationship in the Latin America / Caribbean samples, as well as the three Asian countries, but not the African samples. But this scatter doesn’t show the time trends. If I limit it to the 9 countries that have at least 4 censuses (8 from Latina America, plus Indonesia), they almost all show the pattern I started with: falling fertility and rising women’s employment rates. The arrows track each country’s censuses in chronological order, so moving up and to the left fits the historical pattern:

wlfp2The country-level association is not the same as an individual-level association, because it can’t confirm that women with more children themselves are the ones who aren’t employed. To gauge that I estimate a linear regression within each census, measuring the association between number of children ever born and employment, controlling only for age. These are the results from those 89 regressions. The x-axis is still the mean number of children in each sample, but now the y-axis is the statistical effect of each additional child on the probability of being employed: below 0 indicates that having had more children reduces the probability of employment.

wlfp3In 15 of the 89 samples, each additional child is associated with a greater chance the woman is employed, but in 74 samples the effect is negative*. Furthermore, it appears that countries with lower fertility rates have a stronger negative association between children and employment — each kid reduces the odds of employment more. Consider, though, that a reduction of .11 in the probability of employment for each kid has a lower total effect in a country with two children per mother than a reduction of .05 in a country where people have three kids each**.

If we go back to the 9 countries with at least 4 censuses each, we can compare the trends in fertility to the child effect on employment:

wlfp4Most of these countries (Chile, Colombia, Indonesia, Panama, and Mexico) show the pattern in which the child effect strengthened while the fertility rate fell. Uruguay and Argentina show falling child effects and little fertility change.

Two possible conclusions:

  1. Although it may seem prosaic, this reminds me that the long-run, modern movement of women into the paid labor force is closely associated with the decline in fertility (as well as, incidentally, the decline in marriage). I think of that as indicating that women’s labor is increasingly diffused outward from their own children through market (or otherwise socialized) mechanisms. As the prototype, think of a woman with 2 children teaching 30 children in school (while her own kids are in another classroom) instead of spending the day caring for 6 children at home (while growing food, etc.).
  2. The trend toward a smaller employment gap between mothers and non-mothers is a recent, selective, rich-country phenomenon associated with very low fertility rates and (as the Nieuwenhuis et al. paper nicely shows) state policies designed to encourage mothers’ labor force participation (and, they hope, increase fertility).


* I didn’t bother with significance tests because these were arbitrarily small subsamples from each census; we could always go test them with the full samples.

** I could test a total motherhood effect, like Nieuwenhuis et al. did, but in almost all of these are samples 80% or 90% of women have children, so the kid/no-kid comparison is not as salient.

Home birth is more dangerous. Discuss.

How dangerous is too dangerous?

We don’t prohibit all dangerous behavior, or even behavior that endangers others, including people’s own children.

Question: Is the limit of acceptable risks to which we may subject our own children determined by absolute risks or relative risks?

Case for consideration: Home birth.

Let’s say planning to have your birth at home doubles the risk of some serious complications. Does that mean no one should do it, or be allowed to do it? Other policy options: do nothing, discourage home birth, promote it, regulate it, or educate people about the risks and let them do what they want.

Here is the most recent result from a large study reported on the New York Times Well blog, which looks to me like it was done properly, from the American Journal of Obstetrics & Gynecology. Researchers analyzed about 2 million birth records of live, term (37-43 weeks), singleton, vertex (head-first) births, including 12,000 planned home births (that is, not including those where the home birth was accidental). They also excluded those at freestanding birthing centers.

The planned-home birth mothers were generally relatively privileged, more likely to be White and non-Hispanic, college-educated, married, and not having their first child. However, they were also more likely to be older than 34 and to have waited to see a doctor until their second trimester.

On three measures of birth outcomes, the home-birth infants were more likely to have bad results: low Apgar scores and neonatal seizures. Apgar is the standard for measuring an infant’s wellbeing within 5 minutes of birth, assessing breathing, heart rate, muscle tone, reflex irritability and circulation (blue skin). With up to 2 points on each indicator, the maximum score is 10, but 7 or more is considered normal and under 4 is serious trouble. Low scores are usually caused by some difficulty in the birth process, and babies with low scores usually require medical attention. The score is a good indicator of risk for infant mortality.

These are the unadjusted low-Apgar and seizure rates:

homebirthoutcomesThese are big differences considering the home birth mothers are usually healthier. In the subsequent analysis, the researchers controlled for parity, maternal age, race/ethnicity, education, gestational age at delivery, number of prenatal care visits, cigarette smoking during pregnancy, and medical/obstetric conditions. With those controls, the odds ratios were 1.9 for Apgar<4, 2.4 for Apgar<7, and 3.1 for seizures. Pretty big effects.

Two years  ago I wrote about a British study that found much higher rates of birth complications among home births when the mother was delivering her first child. This is my chart for their findings:

Again, those were the unadjusted rates, but the disparities held with a variety of important controls.

These birth complication rates are low by world historical standards. In New Delhi, India, in the 1980s 10% of 5-minute-olds had Apgar scores of 3 or less. So that’s many-times worse than American home births. On the other hand, a number of big European countries (Germany, France, Italy) have Apgar<7 rates of 1% or less, which is much better.

A large proportional increase on a low risk for a high-consequence event (like nuclear meltdown) can be very serious. A large absolute risk of a common low-consequence event (like having a hangover) can be completely acceptable. Birth complications are somewhere in between. But where?

Seems like a good topic for discussion, and having some real numbers helps. Let me know what you decide.

When regular old mothers aren’t old-enough looking

As I wrote about the older-birth-mothers issue recently (first, and then), I didn’t comment on the photo illustrations people are using with the stories. But when an alert reader sent this one to me, from Katie Roiphe’s post in Slate, I couldn’t help it:

roiphe-stock-pageSomething about that picture and “women in their late 30s or 40s” rubbed my correspondent the wrong way, or rather, led her to write, “Late 30s or early 40s?!?”

Since this was from a legit website that credits its stock agency, I was able to visit Thinkstock and search for the photo. Sure enough:

roiphe-stockOf course, it’s not news, so the title “Middle-aged woman holding her newborn grandson” doesn’t make it a less true illustration of the older-mother phenomenon than one captioned “Desperate aging woman clings to feminist myth that it’s OK to delay childbearing.” But it gives you an idea of what the Slate editor was looking for in the stock photo.

I looked around a little, and found one other funny one. Another Slate essay, this one by Allison Benedikt, was reprinted in Canada’s National Post, and they laid it out like this:


When I visited the Getty Images site, I discovered this picture was taken in China. Here’s how it’s presented:


This one, which is a picture of real people, looks like it could be a grandmother, or maybe more likely a caretaker. Regardless, it’s sold as an illustration of a story about China’s elderly having too few grandchildren to take care of them, which is vaguely related to the content of the story, but that’s not what the Post’s caption points to:

It’s true that older parents are more established and experienced but many of those experiences are, from a genetic point of view, negative, says Allison Benedikt.

Anyway, there were others where the women looked pretty old for the story, but I couldn’t find them in the catalogs, so I stopped.

This is all relevant to one of my critiques of these stories, which is that they make it seem like having children at older ages has become more common than it was in the past. That’s true compared with 1980, but not 1960. The difference is it’s more likely to be their first child nowadays. So Benedikt is way off when she writes,

Remember how there was that one kid in your high school class whose parents weresooooo old that it was weird and creepy? That’s all of us now. Oops.

As I showed, 40-year-old women are less likely to have children now than they were when she was a kid. And when Roiphe writes of the “50-year-old mother in the kindergarten class [who] attracts a certain amount of catty interest and disapproval,” she should be aware that the disapproval – which I don’t doubt exists – is not about the increased frequency of older mothers, but about how people think about them.

I guess any of these stories could also have been illustrated with my own photo, from Taiwan, which I used to illustrate a post about low fertility rates — implying this presumed grandmother was happy because she at least has a grandchild. (You’re welcome to use the picture for that purpose, free clip-art searchers of the future, but please don’t describe it was a birth mother and her child.)

Flattering motherhood, still

I offered the first draft of this — for free — to the major newspapers, to no avail. In the meantime, there have been some great short pieces written on the recent motherhood-is-work kerfuffle. I don’t remember them all, but I liked those by Katha PollittNancy FolbreAdia Harvey Wingfield, Barbara Risman, Laura Flanders, Feminist Hulk, and Linda Hirshman. The feminist field on this issue has been crowded, which is great.

* * *

Hopefully we can agree that that the true measure of motherhood is somewhere between “toughest job in the world” and “nothing.”

On the one hand, both President Obama and pundit Hilary Rosen have now called motherhood the world’s hardest job. And with the Romneys flopping onto the all-mothers-work bandwagon, it appears we’re reaching a rare rhetorical consensus.

On the other hand, the majority in both major political parties agrees that poor single mothers and their children need one thing above all – a (real) job, one that provides the “dignity of an honest day’s work.”* For welfare purposes, taking care of children is not only not the toughest job in the world, it is more akin to nothing at all. When Bill Clinton’s endorsed welfare-to-work he famously declared: “The days of something for nothing are over.” President Obama and Mitt Romney both support that welfare reform.

Of course parenthood is work. But it’s really many jobs, not one. And now that more and more of them are also available for a fee — as real jobs — we can see how much the “market” thinks they’re really worth. Answer: not much. When sold as services, the many tasks of parenthood are disproportionately done by women. Some of its core tasks – such as cooking, cleaning, diaper-changing and laundry – are among the lowest-paid, most demeaning, female-dominated occupations.

Source: My calculations from 2010 American Community Survey.

As I wrote before, when it comes to reproductive labor, there’s work and there’s work:

Katha Pollitt made this point more eloquently in her column:

But the brouhaha over Hilary Rosen’s injudicious remarks is not really about whether what stay-home mothers do is work. Because we know the answer to that: it depends. When performed by married women in their own homes, domestic labor is work—difficult, sacred, noble work. … When performed for pay, however, this supremely important, difficult job becomes low-wage labor that almost anyone can do—teenagers, elderly women, even despised illegal immigrants. But here’s the real magic: when performed by low-income single mothers in their own homes, those same exact tasks—changing diapers, going to the playground and the store, making dinner, washing the dishes, giving a bath—are not only not work; they are idleness itself.

Instead of the money men get for their labors, mothers are asked to settle for less money and a rhetorical pat on the head (if they are middle class “moms” instead of merely poor mothers — I think that’s known in economics as a “compensating differential“). As Barbara Ehrenreich put it, nobody ever put motherhood on a pedestal until feminists pointed out that “the pay is lousy and the career ladder is nonexistent.”

Still, the universal agreement that motherhood is “work” marks a genuine moment. Among other possible interpretations, it is a victory of “choice” feminism – which would have us “respect women in all the choices they make,” in the words of the newfound feminist Mrs. Romney. (Work = respect, nowadays in America, though it wasn’t always that way.) But celebrating the choice to do something most women can’t choose is the dangerous outcome of putting motherhood on a pedestal. It divides women according to the value of their motherhood.

Accepting pedestal status instead of equality is a bargain some feminists have refused for a century or more. One of those was Harriet Stanton Blatch (Elizabeth Cady Stanton’s daughter), who wrote in 1908: “Of all the people who block the progress of woman suffrage, the worst are the women of wealth and leisure who never knew a day’s work and never felt a day’s want, but who selfishly stand in the way of those women who know what it means to earn the bread they eat by the sternest toil” (emphasis added).

Parenthood won’t get the respect it deserves – including men embracing it in more equal numbers – until the monetary reward it draws matches the rhetoric of its symbolic value. That means recognizing the real value of parents’ sternest toils – even if they’re not married – from which we all benefit.

*California Gov. Pete Wilson, Washington Times, 12/7/1995, p. A21.

Why are mothers becoming moms?

Listening to the debate about motherhood in the last few days reminded me of something that’s been nagging me for a while: what does it mean that mothers are becoming moms?

On the Republican side, in his NRA speech Friday, Mitt Romney said, “I happen to believe that all moms are working moms.” (The right-wing radio personality Laura Schlesinger always said, by way of introduction, “I am my kids’ mom,” as the most salient piece of her identity.) On the other side, both Hilary Rosen and President Obama used mom as the toughest-job-in-the-world’s title.

Why is it mom? Back in the 90s, poor single women weren’t “welfare moms.”

Here’s the trend in “working mother” versus “working mom” from Google Ngrams – the occurrence of these terms in the Google Books database:


The same pattern appears with just mother versus mom.

I don’t know why this is happening or what it means. Do you?

Study shows home births are not as safe. So?

There’s an interesting example of how to interpret scientific results — and draw policy implications from them — from the world of birth practices and safety.

The subject of the debate is a major new study from the British Medical Journal. The study followed more than 60,000 women in England with uncomplicated pregnancies, excluding those who had planned caesarean sections and caesarean sections before the start of labor. They compared the number of bad outcomes — from death to broken clavicles — for women depending on where they had their births.

One comparison stands out in the results. From the abstract: “For nulliparous women [those having their first birth], the odds of the primary outcome [that is, any of the negative events] were higher for planned home births” than among those planned for delivery in obstetric units. That is, the home births had higher rates of negative events. The difference is large. Here’s a figure to illustrate:

The error bars show 95% confidence intervals, so you can see the difference between home births and obstetric-unit births is statistically significant at that level. These are the raw comparisons, but the home-versus-obstetric comparison was unchanged when the analysts controlled for age, ethnicity, understanding of English, marital or partner status, body mass index, “deprivation score,” previous pregnancies, and weeks of gestation. Further, by restricting the comparison to uncomplicated pregnancies and excluded all but last-minute c-sections, it seems to be a very strong result.

But what to make of it?

In their conclusion, the authors write:

Our results support a policy of offering healthy nulliparous and multiparous women with low risk pregnancies a choice of birth setting. Adverse perinatal outcomes are uncommon in all settings, while interventions during labour and birth are much less common for births planned in non-obstetric unit settings. For nulliparous women, there is some evidence that planning birth at home is associated with a higher risk of an adverse perinatal outcome.

But in what way do the results “support a policy”? The “higher risks” they found for planned home births are still “uncommon,” by comparison, with those in poor countries, for example. But the home birth risk is 2.7-times greater.

The Skeptical OB, who is a reliable proponent of modern medical births, titled her post, “It’s official: homebirth increases the risk of death.” She added some tables from the supplemental material, showing the type of negative events and conditions that occurred. Her conclusion:

“In other words, any way you choose to look at it, no matter how carefully you slice and dice the data, there is simply no getting around the fact that homebirth increases the risk of perinatal death and brain damage.”

I guess the policy options might include include whether home births should be encouraged, more regulated, covered by public and/or private health insurance, banned, penalized or (further) stigmatized.

Home birth seems safer than letting children ride around unrestrained in the back of pickup trucks, which is legal in North Carolina — as long as they’re engaged in agricultural labor. On the other hand, we have helmet laws for kids on bicycles in many places. And if a child is injured in either situation, hopefully an ambulance would take them to the hospital even if the accident were preventable.

In other words, I don’t think policy questions can be resolved by a comparison of risks, however rigorous.

Birthweight and infant mortality inequality

Birthweight drives the Black-White gap.

Here’s a look at birthweight patterns and their effects on the difference in infant mortality rates between Black and White children.

A new report from the Centers for Disease Control, based on 2007 data, shows the distribution of birthweights and mortality outcomes by the race/ethnicity of mothers. Here is a story in three figures.

1. The infant mortality rate gap is large

In the figures below I focus on White (non-Hispanic), Black (non-Hispanic), and Hispanic. Since White and Hispanic infants have such similar rates, the issue I’m most concerned with is the Black-White gap.

2. Infant mortality rates are drastically affected by birthweight. But at each birthweight the race/ethnic gap is small.

The Black mortality rates are higher among the high-birthweight infants, but there are very few deaths out there (note the log scale, which is necessary to even see those gaps).

3. Black mothers are much more likely to have very-lowbirthweight infants.

Again, because of the log scale, you can see the gaps clearly even though there are very few births at the very low end. Still, 1.8% of Black women’s infants are born below 1,000 grams, where a large portion of infants don’t survive.

So what explains the higher infant mortality rates among Black women’s infants? The overwhelming issue is birthweight. If they had the same mortality rates at each birthweight, I calculate, the gap would close by 10%. But if they had the same birthweight distributions, the gap would close by 88%.

In previous posts, I reported that women who experienced childhood hardships are more likely to have low-birthweight babies. And I described the weathering hypothesis, which suggests delaying first births only improves outcomes for infants if their mothers’ health is not already deteriorating in their 20s, as it more often is with Black women. With this evidence, it is clear that the major problem driving the infant-mortality gap is not care of newborn infants itself, but rather the long-term health of Black women.

U.S. bucks the trend on maternal mortality

Worldwide, the news is good. The U.S. is the exception.

The big news from The Lancet is that maternal mortality — the number of women who die in pregnancy and childbirth, per 100,000 live births — has fallen worldwide, from 422 in 1980, to 320 in 1990, and all the way down to 251 by 2008.

Unmentioned in much of the news coverage was the trend reported for the United States, which shows up on the map of rates of change in maternal mortality for each country:

Yearly rate of decline in maternal mortality ratio, 1990–2008

The red states, so to speak, are those with increases in maternal mortality rates from 1990 to 2008. The U.S. is joined by a cluster of sub-Saharan countries in Africa, Afghanistan, and a few other small ones. Big improvements were concentrated in Asia, North Africa and Latin America.

Maybe the U.S. maternal mortality rate was already so good in 1980 that it had nowhere to go but up? Not so. Among countries that already had low rates — below 50 per 100,000 in 1980 — all groups showed continuing improvement except the U.S.

Maternal mortality ratio per 100, 000 live births, low MMR regions

That light blue line for “North America, High Income,” is for the U.S. and Canada. The upward part of the trend is driven entirely by the U.S. (Numbers for each country are in supplemental materials behind the Lancet‘s pay wall.)

This reversal in the U.S. was recently seen in California, where maternal deaths tripled in the last decade. Explanations for that are not clear. Obesity, fertility treatments and older birth mothers all contribute, but can’t explain the whole pattern. Increased C-sections and induced pre-term births are suspected culprits.

Given that the rest of the already-well-off world found ways to improve over the last three decades, I can’t think of a good excuse for the U.S.’s poor showing.

I’m not an expert on this issue in general, but this is what I learned today, FYI: In poor countries, maternal mortality has been shown to fall with increases in women’s overall empowerment and education, access to health care and clean water, and trained delivery personnel — factors that help differentiate sub-Saharan countries that have seen progress from those that haven’t. Overall higher consumption levels help, too, naturally — and within poor countries, the poorest mothers face much higher risks for the same reasons whole countries have it worse (education, sanitation and health care). Finally, economic dependence among poor countries, especially multinational corporate investment, is associated with higher levels of maternal mortality.

Educated motherhood

More educated moms get all the credit, everyone feels the heat.

More news on inequality for children according to the education levels of their mothers. Do more educated parents do it better, or are there other things about these homes, families, neighborhoods, friends, schools, etc., that account for this pattern? If education really is the issue, it’s a big part of how families transmit inequality — how rich parents produce rich children, and poor kids turn out poor.


For example, preschool-aged children are more likely to be obese if they (a) watch more TV, (b) don’t eat regular dinners with their families, and (c) don’t get enough sleep. That pattern holds in an analysis that controls statistically for a host of demographic variables, including family structure, race/ethnicity and socioeconomic status.

OK, so TV is bad and sleep and family dinners are good. Maybe educated parents do that better — because of their know-how or other resources. But the effect of those daily routine factors is not as great as the association  between obesity and mothers’ education:


According to a recent study in Pediatrics, failure to reach the public health goal of 90% of mothers using breastfeeding exclusively for 6 months leads to 900 deaths per year in the U.S. We know that mothers with more education are much more likely to breastfeed.

In this case, we have some pretty good ideas about the barriers to breastfeeding for poorer women, including inflexible workplaces and commutes, in addition to the know-how issue — which is why new rules in the health care bill are supposed to make breast pumping more accessible for working mothers. That doesn’t stop people from beating up on poor mothers who don’t breastfeed. (The Pediatrics analysis estimates every death costs more than $10 million in lost productivity and other costs. Which I don’t get. If that’s true, how much does it cost to not have children in the first place?)


Time with children also substantially favors more educated women:

Before 1995, mothers spent an average of about 12 hours a week attending to the needs of their children. By 2007, that number had risen to 21.2 hours a week for college-educated women and 15.9 hours for those with less education.

That accords with an earlier study, in which several colleagues and I found inequality in childcare time by parents’ education. But parents spend more time with their children than they did in the 1970s, and there was no increase in the college-noncollege gap.

Whether childcare time is actually beneficial for children — rather than being just another cultural craze — depends on the quality of parenting, family relationships, and the quality of the alternative arrangements available. But in other areas, parenting behavior has clear effects. For example, mothers who don’t know about the back-to-sleep thing are more likely to put their babies to sleep on their stomachs or sides, which increases the risk of sudden infant death.

The more things change

The parenting madness — if madness is what it is — is cyclonic, with news (and blogs) like this feeding the practices that they report on. And this at least contributes to the decisions by some high-end working women to scale back or drop out of their careers. Once no longer employed, these overachievers apply their many skills to parenting, ratcheting up the pressure on everyone else.

This all might seem new. But education for perfect parenting — in the modern era — goes back more than a century.  A great online exhibit at Cornell University’s library traces the history of its Home Economics program from 1900 to 1969. I didn’t know till a recent NYT Book Review that they used practice babies — real babies — to train college students to be mothers:

Cornell secured infants through area orphanages and child welfare associations. Babies were nurtured by the students according to strict schedules and guidelines, and after a year, they were available for adoption. Prospective adoptive parents in this era desired Domecon babies because they had been raised according to the most up-to-date scientific principles.

Now the better-parenting treadmill doesn’t stop at the Ivy League door. The curriculum is available everywhere: