CAREER: Family Behavior, Health Technologies, and Government Policy: Research and Training

The recent decades have seen a dramatic acceleration of innovation that has laid the groundwork for a revolution in fertility-related medicine. Assisted reproductive technologies are transforming millions of couples’ ability to conceive, and prenatal screening technologies are allowing parents to gain precise information about fetal health during pregnancy. These technologies have the potential to fundamentally alter family structure and family wellbeing. Further, as they are often expensive, their arrival may introduce novel health inequities, which underscores the role of public policies that regulate their accessibility and affordability. Understanding the consequences of assisted reproductive and prenatal screening technologies for family decisions, family outcomes, and inequality is essential for informing public fertility-related policies, and thereby advancing national health, prosperity, and welfare. This CAREER research program combines population-wide Swedish administrative data – which has uniquely detailed information on individual-level use of these technologies – with experimental and theoretical research methods to better understand their effects on families. Specifically, the research project will study how assisted reproductive and prenatal screening technologies affect family decisions, as well as whether these technologies serve to widen or narrow inequalities across families. This proposal's education plan centers on training students in how to access and use big administrative data for research – knowledge that is often passed through personal connections – to help level the playing field in the profession for the next generation of researchers. The results of this research project will have profound influence on the conduct of public fertility policy, and hence the well-being of Americans.

This CAREER research project has four components. The first project is motivated by sharp differences in utilization of assisted reproductive technologies (ARTs) across the socioeconomic spectrum. The project will exploit age thresholds in public health insurance coverage of ARTs to investigate the role of affordability in driving this inequality; further, it will examine the longer-run consequences of ART uptake on the health and well-being of the women who use them and their families. The second project will study the arrival of a new and superior – but expensive – screening technology for identifying chromosomal abnormalities. The project will combine reduced-form evidence leveraging insurance eligibility thresholds with a theoretical model of parents’ prenatal testing decisions to examine the implications of the superior technology on parents’ testing choices, ultimate birth outcomes, and measures of aggregate population health. The third part focuses on a particular type of ARTs, In Vitro Fertilization (IVF). The project will depart from the observation that IVF with donated gametes (sperm and oocytes) decouples a baby’s environment in utero from the baby’s genetic material. Using data that contains information about children born after IVF with donated gametes, this project will bring novel evidence to the debate on the importance of “nature” versus “nurture” in the association between parents’ socioeconomic standing and children’s health. The fourth component is a mentoring workshop that aims to reduce inequality among students in access to information about the use of large-scale administrative data in research.