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Notes -
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:
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.
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.
Healthcare includes a large battery of tests & information kits during pregnancy.
Facilities to monitor & help with babies' and toddlers' growth, and vaccinations (Family Health Centers / Tipat Halav).
Pre-school and elementary school operates 6 days a week, leaving parents with 1 day / morning a week to make more kids.
We don't do this in Israel, but it's really important - build more housing units. High prices seem a-priori bad for fertility.
As a counterexample, Finland has equally good policies in the field of healthcare/childcare, but their TFR is abysmal. I get closer and closer to the conclusion that it's the Jewish memeplex that preserves Israel's TFR, not anything else.
There are probably more examples of low TFR with good healthcare than high TFR with good healthcare. Other than Israel, I can't even think of any for the latter.
That said, I think the general direction of causation is both (modern country/culture) --> (low TFR) AND (modern country/culture) --> (good healthcare), rather than (good healthcare) --> (low TFR). I do think you can increase TFR with better healthcare policy, but I admit I have no empirical data to back that up, only personal experience. I'm also not familiar enough with the actual workings of European healthcare, so I don't know if their policies actually match my suggestions or not.
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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
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It both reduces birth trauma and reduces health risks of further births — once you have a cesarean section it becomes progressively more and more dangerous to get pregnant with each subsequent c-section. (This is why some people try to have vaginal birth after c-sections)
.... In writing this comment, it occurs to me to wonder if this is an underappreciated factor in lower fertility rates in modern times. One reason Israel tries hard to avoid c-sections is because they assume it will be upsetting to mothers to have their fertility curtailed by having them. My understanding from people I know in the states is the attitude towards c-sections is much more cavalier, since it's no big deal it ends up meaning you can't have more than one kid after this. This must obviously have at least some depressing effect on birth rates...
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