Gender Roles and Medical Progress

1. Gender Roles and Medical Progress BY STEFANIA ALBANESI AND CLAUDIA OLIVETTI NBER Working Paper #14873, 2009

2. The Hypothesis Married women’s labor force participation increased from 2.8% in 1890 to 70% in 1990. “We argue that the improvement in maternal health and the diffusion of infant formula were critical to this process.”

3. Female LFP in the 20th Century

4. The Strategy The authors first describe the improvements in medical technology and changes in the availability of infant formula that took place in the first half of the 20th century. How would these changes have affected female LFP? They then develop a structural model that allows them to determine how much of the rise in LFP was due to these changes.

5. Improvements in Maternal Health In 1920, one in 125 live births resulted in death for the mother; the compounded risk of death was 2.9%. Mortality rate fell from over 600 maternal deaths per 100,000 live births in 1920s to fewer than 100 by 1950s. Largely a results of blood banks, improved standard of care, better drugs, and movement of births into hospitals. - Percent of births in hospitals rose from 36.9% in 1935 to 82% in 1946.

6. Trends in Maternal Mortality and Gender Differences in Life Expectancy

7. Trends in Causes of Maternal Deaths

8. Improvements in Maternal Health Maternal morbidity was also very high. Years lost to disability: YLD = Incidence x Duration x Disability Weights where disability weight is an index of degree of disablement. DW for perineal lacerations, toxaemiavery high; 0.22 for healthy pregnancy (compared to .505 for AIDS). YLD is 1.17 from 14-44. Average woman experiences 3.55 pregnancies in 1920, so lost 4.15 productive years to disability.

9. Access to Infant Formula Women nursed for about 1/3 of the time between 23 and 33; 14-17 hours per week. Has to be done at specific times. Authors give interesting history of the development of infant formula, and document decreases in its price. * Cows-milk modifiers in late 1800s * Similac developed in early 1920s. In 1936, the total cost of bottle feeding the median boy was 6-10% of average yearly income for white, male, full-time workers. By 1960, this was less than 1.5%. Let to dramatic declines in rates of breastfeeding.

10. Time Price of Similac This is the cost of buying 1 ounce of formula. Infants typically consume about 25 ounces per day.

11. Trends in Incidence, Duration and Exclusivity of Breastfeeding

12. Structural Models Most of the papers we have read have used a natural experiment, or reduced form approach to estimating causal effects. An alternative is the structural approach, in which the researcher tries to fully model the decision making process. Advantages: • Behavioral and other assumptions fully specified • If modeled correctly, can project out of sample (external validity) • Works when don’t have a natural experiment Disadvantages: • Identification may depend on functional forms for which there is little theoretical/empirical basis • Estimation can be difficult, costly • Less transparent

13. Structural Models “We isolate dimensions of medical progress that disproportionately affect women’s health and incorporate them into a macroeconomic model of household behavior to quantify their impact.” • Over-lapping generations model. • Households, with preferences and budget constraints much like we’ve already seen • Production function for home goods and infant goods (children) Ex: • Households choose level of labor force participation for the husband and wife.

14. Structural Models

15. Structural Models “Calibrate” the model—define parameters like the discount rate, returns to factors in the production function. Do this by choosing parameters that make the model match the data in 1920. Then change variables relating to infant feeding, medical technology, etc., and see how labor force participation changes. Then compare this to the data to see how well the model does.

17. “Experiments”: What does the model predict would have happened to LFP if only fertility had changed?

18. “Experiments”: What does the model predict would have happened if only maternal health & formula had changed?

19. Further Results • Model over-predicts rises in female LFP in earlier years and under-predicts it in later years. • Authors say it’s b/c model omits things like marriage bars, discrimination, attitudes towards women’s work • Infant formula adds 3 to 5 percentage points to female LFP. “If fertility is high and maternal mortality is low, women have an incentive to participate and this is when infant formula appears to be most valuable.” • Advances in home appliances do not do as much as medical progress to explain rises in female LFP pre-1965.

20. Discussion • Why do you think the authors chose a structural rather than natural experiment approach to evaluate the effects of medical progress and infant formula? • What would you need to do an investigation using a natural experiment? • Today, breastfeeding is more common among high-SES women. Does this paper/model give any insight as to why that might be? • Are there any policy implications from these results?

21. Could advances in medical technology have also contributed to the Baby Boom?

22. Could advances in medical technology have also contributed to the Baby Boom? What are our other explanations for the Baby Boom? • Home technology, appliances • WW II How would medical technologies lead to Boom?

23. Could advances in medical technology have also contributed to the Baby Boom? Albanesi and Olivetti (2010) use a structural model and other techniques to see how important the decline in maternal mortality was. • Can explain well-over 50% of the Baby Boom with mortality decline. But then why did fertility fall again, since the mortality rate stayed low? • Declines in mortality can explain over 40% of the rise in women’s educational attainment relative to men. • Can explain over 50% of the Baby Bust