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Culture War Roundup for the week of March 13, 2023

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The quality contributions roundup has a lot of discussion of fertility. I found it pretty disconcerting to read, since it all seemed to assume that the only way to get women to have kids is to enforce a top down dystopia. This is not my personal experience in my social surroundings★, but of course I live in Israel so I don't count‡.

Anyway, here is my follow-up question:

If you had the ability to set policies that will encourage increased fertility, what policies would you be implement across the board for both men and women simultaneously?

In other words, not "women can't be allowed access to higher education until they've had at least two children", but "people of child-bearing age can't be allowed access to higher education until they've had at least two children". Or "new parents of children are given twenty additional paid vacation days", or whatever. Are there any such policies you think could actually be effective?


★ if anything what I see is women regretting not being able to have more kids

‡ In Israel, fwiw, having kids is simply by default assumed to be a shared responsibility of men, women, and society. It is expected that men take (government paid) sick days to stay home with sick kids. It is not blinked at for the manager to show up to a meeting remotely with a sick kid in his lap. It is expected that men will leave work early several times a week to pick up kids from school — at least in all the places in Israel I have lived I have seen reasonably close sex splits of the parents at pickup/dropoff. I am not clear on whether or not this is equally the case in America — I don't get that impression, but as my knowledge of America is limited to TV and internet discussions, I could be wrong. But I see fathers at the park supervising their kids all the time, and the internet discourse re America is about men getting assumed to be pedophiles for being around kids... So I assume there must be some difference...

Israel has a great many advantages in terms of parenting that we can export to the rest of the world! Not just culturally, but also in terms of policy:

  1. A healthcare system using the voucher system, paid by the government, rather than tied to employment. This is more related to the US than anything.

  2. A voucher system for maternity wards. Hospitals compete to get the most births, and as a result the maternity ward in most hospitals is really nice.

  3. Healthcare includes a large battery of tests & information kits during pregnancy.

  4. Facilities to monitor & help with babies' and toddlers' growth, and vaccinations (Family Health Centers / Tipat Halav).

  5. Pre-school and elementary school operates 6 days a week, leaving parents with 1 day / morning a week to make more kids.

  6. We don't do this in Israel, but it's really important - build more housing units. High prices seem a-priori bad for fertility.

Hospitals compete to get the most births, and as a result the maternity ward in most hospitals is really nice.

Huh. Interesting. This made me wonder if Israel might have unusually high quality of maternity care as regards how birthing mothers are treated on a personal level. Looking it up, the country apparently has the lowest rate of C-sections per 1,000 live births. Impressive. This is a potentially under-rated way of increasing birth rates, in that people with less birth trauma are more likely to give birth again.

I agree. It is also worth noting that doctors will recommend limiting births after a c-section, since a woman can only have a limited number of them (2-3, depending on doctor and the hospital's policy from my limited experience) and one c-section increases the chance of needing another c-section dramatically. Some places don't even risk vaginal birth after c-section (VBAC) and will automatically schedule a c-section for women that already had one. On the margin, I do expect a higher c-section rate to decrease TFR, then, even divorced from birth trauma - which is also very very real.

However, I'm not sure how much of that can be credited to the healthcare system, rather than other factors. C-sections IIRC are more commonly needed for older mothers. In Israel, a large portion of births are from the ultra-orthodox community which starts very young. That alone can explain some of the difference. Some more of it might be explained by the stricter monitoring pregnant women undergo here, but I'm not familiar of any data on that specifically.

There is definitely policy-level pressure to reduce c-section rates/hospitals proudly citing their low C-section rates/other things going in with the C-section rate aside from younger mothers. And lots of support for VBAC and even for VBA2C