Gac Sanit. 2020;34(3):238–244 Original article Decline in fertility induced by economic recession in Spain Vanessa Puig-Barrachinaa , Maica Rodríguez-Sanzb,c , María Felicitas Domínguez-Berjónd , Unai Martíne , Miguel Ángel Luquef , Miguel Ruizg , Glòria Pereza,c,h,i,∗ a Health Information Systems Service, Barcelona Agency of Public Health, Barcelona, Spain b Area of Research and Teaching, Public Health Agency of Barcelona, Barcelona, Spain c Department of Experimental and Health Sciences, University Pompeu Fabra, Barcelona, Spain d Health and Research Report Service, General Directorate of Public Health, Department of Health, Autonomous Community of Madrid, Madrid, Spain e Department of Sociology II, University of País Vasco UPV/EHU, Leioa, Bizkaia, Spain f Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom g Department of Health, Autonomous Community of Andalucia, Sevilla, Spain h Biomedical Research Institute Saint Pau, Barcelona, Spain i CIBER of Epidemiology and Public Health (CIBERESP), Spain a r t i c l e i n f o a b s t r a c t Article history: Objective: To describe trends in fertility in Spain before (pre-recession; 1998-2008) and during (reces- Received 20 December 2018 sion period; 2009-2013) the economic crisis of 2008, taking into account women’s age and regional Accepted 3 May 2019 unemployment in 2010. Available online 19 October 2019 Method: The study consisted of a panel design including cross-sectional ecological data for the 17 regions of Spain. We describe fertility trends in Spain in two time periods, pre-recession (1998-2008) and Keywords: recession (2009-2013). We used a cross-sectional, ecological study of Spanish-born women to calcu- Economic recession late changes in fertility rates for each period using a linear regression model adjusted for year, period, Fertility Unemployment and interaction between them. Statistical regression Results: We found that compared to the pre-recession period, the fertility rate in Spain generally Spain decreased during the economic recession. However, in some regions, such as the Canary Islands, this decrease began before the onset of the recession, while in other regions, such as the Basque country, the fertility rate continued to grow until 2011. The effects of the recession on the fertility rate are clearly observed in women aged 30-34 years. Conclusions: The current economic recession has disrupted the positive trend in fertility that began at the start of this century. Since Spain already had very low fertility rates, the further decline caused by the economic recession could jeopardize the sustainability of welfare-state systems. © 2019 SESPAS. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Disminución de la fertilidad inducida por la crisis económica en España r e s u m e n Palabras clave: Objetivo: Describir las tendencias de la fecundidad en España en la época precrisis (1998-2008) y durante Crisis económica la crisis (2009-2013) económica, teniendo en cuenta la edad de las mujeres y el desempleo regional en Fecundidad 2010. Desempleo Método: Se utiliza un diseño panel que incluye datos ecológicos transversales para las 17 comunidades Modelos de regresión autónomas de España. Se describen las tendencias de fecundidad en los dos periodos. Para calcular los España cambios en las tasas de fecundidad se utiliza un modelo de regresión lineal ajustado por año, periodo e interacción de ellas. Resultados: En comparación con el periodo anterior, la tasa de fecundidad global en España disminuyó durante la crisis económica. Sin embargo, en algunas comunidades, como las Islas Canarias, esta disminu- ción comenzó antes del inicio de la crisis, mientras que en otras, como el País Vasco, la tasa de fecundidad continuó creciendo hasta 2011. Los efectos de la crisis en la fecundidad se observan claramente en mujeres de 30 a 34 años. Conclusiones: La crisis económica actual ha interrumpido la tendencia positiva en la fecundidad que comenzó a principios de este siglo. Dado que España ya tenía tasas de fecundidad muy bajas, el descenso causado por la crisis económica podría poner en peligro la sostenibilidad de los sistemas de bienestar social. © 2019 SESPAS. Publicado por Elsevier España, S.L.U. Este es un artı́culo Open Access bajo la licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/). ∗ Corresponding author. E-mail address: gperez@aspb.cat (G. Perez). https://doi.org/10.1016/j.gaceta.2019.05.011 0213-9111/© 2019 SESPAS. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc- nd/4.0/). V. Puig-Barrachina et al. / Gac Sanit. 2020;34(3):238–244 239 Introduction periods: 1998-2008 and 2009-2013. We analysed government vital statistics for new births, and the 2010 Economically Active Popula- The decision to have children is conditioned by many factors at tion Survey for unemployment rates. All data were obtained from the level of the individual and/or couple, their social relationships the Spanish National Institute of Statistics.11 and networks, and the cultural and institutional setting.1 Economic uncertainty has a profound impact on forming a family and deciding Variables and indicators whether to have more children. Several studies link unemployment and precarious employment to delaying long-term commitments The main outcome (dependent variable) in our study was fertil- such as parenthood.2 ity rate, the number of live births in a given year per 1000 women Various theories relate economic context to fertility response, aged 15-49 years. To compare fertility rates between autonomous with most evidence supporting the idea that fertility responds regions during the two study periods, we calculated the stan- negatively to economic downturn. Studies have generally found dardized fertility rate (SFR) using the direct method. Standard a pro-cyclical relationship between fertility and economic growth population was calculated adding the number of women for all in high-income countries. In other words, recession, which leads year in the period of study in each age group. We also calculated to delayed childbearing, especially of the first child,3 is followed age-specific fertility rates as the number of births per 1000 women by a compensatory period in times of economic prosperity.4 In within specific age groups. We computed these rates for the reces- contrast, other theories suggest a counter-cyclical relationship sion and pre-recession periods. We also determined age-specific between economic growth and fertility, albeit with less evidence. fertility rates for autonomous regions grouped into quartiles of the In line with this latter theory, increasing the level of employment 2010 unemployment rate. among women would induce a decline in fertility.5 We considered the following stratification variables: Spain is one of the European countries that has been most 1) mother’s age, grouped into seven intervals of five years directly affected by the international financial crisis. The Span- (15-19, 20-24, 25-29, 30-34, 35-39, 40-44, and 45-49 years); 2) ish economy entered recession in the last quarter of 2008, when autonomous region, grouping the 17 regions according to quartiles the GDP fell for two consecutive quarters, with negative growth of the 2010 unemployment rate (for statistical interest given the of ∼1.5%. In the first quarter of 2010, unemployment increased sparsity of the data); 3) year, from 1998 to 2013; and 4) time rapidly to 20%, with over 43% of the unemployed population being period, either pre-recession (1998 to 2008) or recession (2009 to under 25 years of age, being young unemployment rate the high- 2013). est rate in the European Union.6 There were marked differences in unemployment across the country, ranging from 31.7% in Southern regions to 13.6% in Northern regions (Fig. 1). The Spanish gov- Statistical analysis ernment responded with a radical program of social services cuts and labor market reforms. Together with further internationaliza- First, we described the SFR trends in 15 to 49-year-old women tion of production and the labor market, this has led to changes separately for each autonomous region, and for all years between in employment and working conditions towards an increase in 1998 and 2013. Second, we obtained age-specific fertility rates, labor flexibility and precarious work.7 The level of social cuts var- and fertility rates for autonomous regions grouped by unemploy- ied markedly between the various autonomous regions because, ment quartile. To explain the annual change in fertility rate, we under the system of regional decentralization, each region has adjusted fixed-effects linear regression models for balanced panel some sovereignty to implement social cuts and protection poli- data (see online Appendix). Since our observations depended on cies, including healthcare.8 Consequently, the Spanish population the autonomous region, we clustered the standard errors of the is suffering increased impoverishment and inequality. coefficient estimates for possible dependence in the residuals. Spain has had a low fertility rate since the last decades of the We include the following explanatory variables in the models: 20th century9 compared with other countries with a similar eco- year, period (pre-recession versus recession), and the interaction nomic situation, fertility initially declined in upper social classes, between year and period. We used the coefficients of the interac- and later in the manual social class.10 tion term, their 95% confidence intervals (95% CI), and the p-values Here, we hypothesized that the economic recession would affect to estimate the annual change in fertility rate. We fit three dif- fertility all of Spain’s autonomous regions, and that regions with ferent models: 1) fertility rate in women aged 15 to 49; 2) age a higher unemployment rate would be most affected. The aim of group-stratified fertility rate in autonomous regions grouped by our study is to describe trends in fertility in Spain before (pre- unemployment quartiles; and 3) fertility rate in each autonomous recession; 1998-2008) and during (recession period; 2009-2013) region. the economic crisis of 2008, taking into account women’s age and All statistical analyses were performed using Stata 11. regional unemployment in 2010. Results Methods The average number of births per year in Spain between 1998 and 2013 was 367,593. In almost all the autonomous regions of Design, study population and data sources Spain, SFR increased until 2008 and decreased thereafter until 2013. Similarly, the fertility rate in women aged 15-49 years significantly This study is part of a coordinated project examining the effects increased before the economic recession but decreased signifi- of the economic crisis on health and health inequalities in Spain. The cantly during the economic recession (pre-recession 0.52; 95% CI: study design was based on panel data including cross-sectional eco- 0.31-0.73; recession 0.40; 95% CI: -0.54 -0.25). logical unemployment rates and longitudinal fertility rates for the With respect to age, young women showed a significant 17 autonomous regions of Spain. The study population consisted decrease in fertility during the recession period. Similarly, middle of women 15- to 49-year-old women of Spanish nationality who aged women (30 to 34 and 35 to 39 year old), who have the highest were resident in Spain between 1998 and 2013. Residents of the fertility rate) showed a significant increase in fertility before the two autonomous cities (Ceuta and Melilla) were excluded from our recession but an opposite effect during the recession period– in study. The study focused on the fertility rates during two distinct the first group is positive and in the other negative (Table 1). The 240 V. Puig-Barrachina et al. / Gac Sanit. 2020;34(3):238–244 Figure 1. Distribution of unemployment in Spain’s autonomous regions according to quartiles of the 2010 unemployment rate. Data source: National Institute of Statistics, Spain. Table 1 Change in fertility rate in Spain during the pre-recession (1998 to 2008) and recession (2009-2013) periods as a function of age group and autonomous regions grouped by quartile of unemployment. Indicators Pre-recession period Recession period Annual change in FRa 95% CI p Annual change in FRa 95% CI p b All ages (15-49 years) 0.52 0.31 0.73 0.000 − 0.40 − 0.54 − 0.25 0.000 15-19 years 0.081 − 0.01 0.17 0.078 − 0.353 − 0.51 − 0.20 < 0.001 20-24 years − 0.06 − 0.25 0.03 0.522 − 0.76 − 1.00 − 0.52 < 0.001 25-29 years − 1.14 − 1.45 -0.84 0.000 − 1.48 − 1.85 − 1.11 0.135 30-34 years 1.45 1.16 1.75 0.000 − 1.74 − 2.04 − 1.44 < 0.001 35-39 years 2.41 2.14 2.68 0.000 0.63 0.28 0.98 < 0.001 40-44 years 0.47 0.39 0.55 0.000 0.85 0.73 0.97 < 0.001 45-49 years 0.04 0.03 0.04 0.000 0.025 0.004 0.05 0.202 Women of all ages Regions in lowest quartile of unemployment (Q1) 0.68 0.35 1.01 0.007 − 0.15 − 0.59 0.29 0.36 Regions in unemployment (Q2) 0.62 0.47 0.77 0.001 − 0.21 − 0.57 0.14 0.152 Regions in unemployment (Q3) 0.45 − 0.08 0.97 0.075 − 0.58 − 0.76 − 0.40 0.002 Regions in highest quartile of unemployment (Q4) 0.40 0.00 0.81 0.051 − 0.59 − 0.79 − 0.392 0.001 Women aged 30-34 years old Regions in lowest quartile of unemployment (Q1) 1.60 0.82 2.38 0.003 − 1.40 − 1.92 − 0.88 0.003 Regions in unemployment (Q2) 1.36 0.92 1.80 0.001 − 1.71 − 2.82 − 0.60 < 0.001 Regions in unemployment (Q3) 1.34 0.48 2.19 < 0.001 − 2.00 − 2.62 − 1.38 < 0.001 Regions in highest quartile of unemployment (Q4) 1.51 0.34 2.68 0.012 − 1.84 − 2.38 − 0.85 0.007 95% CI = 95% confidence interval; FR: fertility rate (number of births per 1000 women). a Coefficients of the interaction term. b Coefficient of the interaction term of the first model for overall age-standardized fertility rate. fertility rate of women in the older age groups increased during unemployment quartile the decrease in global fertility rate also both periods. generally started in 2008. In contrast, the rate in the Canary Islands In some autonomous regions, mainly the northern regions, began to decrease even before the recession. Notably, the regions where unemployment is generally lower (Fig. 1), global SFR contin- in the fourth unemployment quartile showed the highest global ued to increase increased until the end of the pre-recession period. SFR (Fig. 2). The global SFR varied markedly between autonomous regions. In All four unemployment quartiles showed an increase in the 2008, for example, the SFR in Murcia (in the south) was 46.69, while global fertility rate for the pre-recession period, but a decrease dur- that in Asturias (in the north) was 31.76. This variability in SFR ing the recession, with the largest decrease in regions in the fourth between regions was slightly greater at the start of the study period quartile (Table 1). The pattern of fertility rates among women aged (1998) than in 2008 or 2013 (Table 2). 30 to 34 years (the age group with the highest fertility) is consistent Figure 2 shows the evolution of global fertility rates in with that for all ages, albeit with less variability. autonomous regions grouped by unemployment quartile. Except The linear regression analyses for each autonomous region show for the Basque country, the global fertility rates of the autonomous a general annual increase in fertility rates during the pre-recession regions in the first (lowest) unemployment quartile began to period, except for the Canary Islands, which has experienced declin- decrease in 2008 with the onset of the economic recession. In ing fertility since 1998, and Extremadura. Interestingly, both of the Basque Country, the rate continued to increase until 2011, these regions are in the highest quartile of unemployment. The after which it decreased only slightly. In the fourth (highest) highest annual increase in fertility rates during the pre-recession V. Puig-Barrachina et al. / Gac Sanit. 2020;34(3):238–244 241 Table 2 Age-standardized fertility rate in women aged 15 to 49 in 1998, 2008, and 2013, and the 2010 unemployment rate in Spain’s autonomous regions. Autonomous regions 1998 2008 2013 2010 Live births (N) FRa Live births (N) FRa Live births (N) FRa Unemployment (%) Andalucía 75,342 38.49 88,250 45.47 72,195 40.04 27.90 Aragon 8,963 32.12 10,190 38.96 9,070 37.83 15.05 Asturias 6,255 23.72 7,555 31.76 6,129 28.74 15.98 Balearic Islands 7,533 36.63 8,601 39.14 7,434 35.14 20.21 Canary Islands 16,110 33.64 16,677 34.01 13,083 29.41 28.79 Cantabria 3,752 28.33 5,073 38.05 4,256 34.98 13.74 Castilla-León 16,746 28.28 18,041 34.42 15,586 33.41 15.92 Castilla-La Mancha 15,539 36.90 17,395 40.45 14,972 36.61 21.33 Catalonia 53,242 34.39 64,135 42.20 52,449 37.82 17.79 Comunidad Valenciana 35,799 34.68 43,478 41.68 35,602 37.40 22.94 Extremadura 9,871 37.08 9,947 41.04 8,276 36.52 23.07 Galicia 18,168 27.22 21,456 33.32 18,407 31.38 15.45 Madrid 45,525 33.81 58,048 42.15 51,222 38.91 15.95 Murcia 12,549 41.55 14,305 46.69 12,456 43.05 22.95 Navarra 4,839 36.23 5,593 42.11 5,036 40.52 11.94 Basque country 15,969 29.24 18,540 38.02 16,468 38.01 10.75 La Rioja 2,074 32.35 2,441 38.52 2,136 36.28 14.23 95% CI: 95% confidence interval; FR: fertility rate (number of births per 1000 women). Coefficient of variation for 1998 = 14%; for 2008 = 11%; for 2013 = 11%. recession. However, in some regions, such as the Canary Islands (high unemployment rate region), this decrease began before the onset of the recession, while in other regions, such as the Basque country (low unemployment rate region), the fertility rate contin- ued to grow until 2011. The effects of the recession on the fertility rate are clearly observed in women aged 30-34 years. Our results are similar to those obtained in other studies, where fertility rates in other European countries stopped increasing after 2008.12 Moreover, as in Spain, recession-related unemploy- ment has been linked to reduced fertility rates in other European countries.13 Spain is known to have unstable job entry patterns, and the recession has further exacerbated the problems young Spanish people face.14 In previous economic crises, fertility rates are known to have decreased mainly because of labor uncertainty, which hinders plan- ning. A poor economic situation can postpone starting a family through generating higher unemployment, lower employment sta- bility, greater uncertainty about the future, changes in the housing market, prolonged enrolment in education, and delayed union formation.15 These adverse economic conditions and high levels of unem- ployment significantly reduce fertility rates, especially in women in the manual social class.16 Furthermore, the recovery of fertil- ity rates is associated with access to labor markets and/or entry into cohabiting unions.17 The impact of uncertainty, however, is mediated by regional factors, such as how much welfare protection young adults receive,18 and also by individual factors, including the mother’s level of education or women income.19 Family and other Figure 2. Trends in global fertility rates in women aged 15-49 years old in welfare policies also have an effect on fertility rates. autonomous regions grouped by unemployment quartiles, Spain 1998-2013 (pop- Since recovering democracy in 1977, Spain has progressively ulation of 11,016,410 women aged 15-49). evolved into a low birth-rate country, possibly because of greater Quartile 1 - Autonomous regions with the lowest unemployment levels Quartile 4 - Autonomous regions with the highest unemployment levels. access to education for women, a massive incorporation of women into the labor market, and a gradual increase in the use of contra- ception. This new structural situation for women contrasts with period were observed in the Basque country, La Rioja and Catalonia the “traditional family policy model” defined by Korpi.20 In this (Fig. 3). In contrast, we observe a decrease in the annual fertility traditional model, the gender division of labor and preservation rate in all regions during the recession, although this trend was not of traditional family patterns is encouraged by high levels of fam- statistically significant for the Basque Country, a region that has ily support and inadequate approval for female participation in been growing more than the rest (Fig. 3). the labor force. Spain continues to have a traditional gender divi- sion of labor, with men acting as the breadwinners and women Discussion as the main caregivers and secondary earners. Scarce provision of childcare and other services compel women to take care of This study shows that, compared to the pre-recession period, their own children, especially during the pre-school years, as the the fertility rate in Spain generally decreased during the economic 242 V. Puig-Barrachina et al. / Gac Sanit. 2020;34(3):238–244 Figure 3. Change in fertility rate trends among women aged 15-49 years old in Spainś autonomous regions during the pre-recession (1998 to 2008) and recession (2009-2013) periods. public schooling system for children under 3 has insufficient cov- Consequently, there has been an ideological retreat favoring regres- erage. Thus, Spanish women tend to have fewer children than they sion to traditional, backward-looking gender roles.27 Together with desire. The difficulty in establishing an independent household and declining family incomes, this has caused the recession to mainly in combining motherhood and employment appear to be respon- affect women (e.g., eating more frequently at home and removing sible for the delay in having the first child and often even the children from expensive nurseries). second.21 Furthermore, the regions of Spain that experience higher unem- In Scandinavian European countries, governments generally ployment tend to show a greater decline in fertility (not statistically spend more on family policies than in other parts of Europe, notably significant) while fertility rates in Spain are still higher in the reces- Spain. It has also been shown that fertility trends are influenced by sion period in the regions with lowest unemployment. With regards family income as well as by the direct and indirect costs of hav- to these lower fertility rates, the regional differences in gender pol- ing children.22 These factors could also influence the low fertility icy cuts can be attributed not only to differences in political ideology rates seen in Spain.23 However, this argument might only be valid but also in regional wealth.28 Also, in the specific case of the cur- for Spanish women, as the fertility pattern for women of foreign rent recession, its impact on European countries as a whole has nationality residing in Spain differs, in that it is mainly character- been described, highlighting its greater effect on Spain, as well as ized by higher fertility rates and lower income.24 the role that different policies can play in mitigating or increasing With the onset of the economic recession, the Spanish gov- this impact.29 ernment implemented a social policy aimed at boosting Spain’s One of the limitations of this study is that we only used unem- population. Although it had no effect on fertility, between 2007 ployment to measure the effects of the economic crisis. There are, and 2010 the so-called’baby chequeẃas a direct payment given to however, other consequences of economic recession such as cuts the mothers of newborn babies. Some of the initiatives in family in welfare policies, which we have not considered. Nevertheless, policies coincided with increasing concerns in European countries global unemployment is a good indicator of the impact of economic about low fertility and the sustainability of Welfare-state systems. crisis on society, a common indicator of the labor market situation, These concerns revived debates about family policies as a remedy and has been used as such in many of the studies referenced above. against fertility decline and its presumed consequences. Further We used unemployment levels from 2010 as a fixed effect in our findings suggest that policies directed at employment and income analysis of longitudinal fertility rates. While the unemployment maintenance, gender equality, and care support may be more rate in 2010 was higher than in other years, its distribution among conducive to fertility increases in Europe than explicitly fertility- the autonomous regions shows the same pattern consistently over focused family policies.25 time. At the same time, however, Spain was one of the European Union Another limitation of our study is that we did not explore the countries that adopted austerity policies with large cuts in public relationship between fertility and labor market. Furthermore, we spending and public sector reforms. It has recently been pointed out did not examine the effect of youth unemployment on fertility rate. that, compared to European Union countries who opted for fiscal In this sense, there is a notable positive relationship between fertil- stimulus, these austerity measures adversely affected the economic ity and some productive sectors, such as the public sector, which is recovery of countries who applied them.26 mainly composed of women. It would also be interesting to exam- Moreover, the policies implemented in response to the ine how fertility is affected by eliminating civil servant positions.30 economic crisis have been highly gender-biased. Austerity mea- Finally, we did not evaluate whether the recession affects fertility sures undermined important employment and social protection patterns among immigrants differently to those among Spanish- programs, with the effect of prolonging gender inequality. born women. V. Puig-Barrachina et al. / Gac Sanit. 2020;34(3):238–244 243 Other indicators could also be used as the Synthetic Fertility collection, analysis and interpretation of the data. All authors revis- Index. It expresses the number of children that a hypothetical ing the manuscript critically for important intellectual content and woman would have at the end of her fertile life, if, during the same given final approval of the version to be published. period, her behavior corresponded, at each age, with that which reflects the series of specific fertility rates by age. This indicator is Funding not influenced by the irregularities of women of childbearing age. One of the most important criticisms of the use of the Synthetic This study was partially supported by the Instituto de Salud Car- Fertility Index is that its calculation is influenced by the delay of los III (cofinanced by the European Regional Development Fund) having children as occurs in Spain. It use would need important in the Acción estratégica en salud 2013-2016 (PI13/02292), and the corrections of intensity, calendar and variance effects. social determinants of health program of the CIBER of Epidemiology As strengths, it is worth noting the significant number of years and Public Health (CIBERESP). used in the pre-crisis period from 1998 to 2008. Also, since it is the official source of the country’s birth data, the data used are of good quality and exhaustive. Another strength is the use of standard- Conflicts of interest ization to calculate the fertility which is not usual in demographic context. Standardized fertility rate allows us to compare fertility None. between regions of the country along the study years. Acknowledgments Conclusion We thank Dr. Gavin Lucas and colleagues at ThePaperMill for The current economic recession has disrupted the positive trend critical reading and editing of this paper. in fertility that began at the start of this century. Since Spain already had very low fertility rates, the further decline caused by the eco- Appendix A. Supplementary data nomic recession jeopardizes the future of the country’s welfare system. Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.gaceta.2019.05.011. References What is known about the topic? 1. Balbo N, Billari FC, Mills M. Fertility in advanced societies: a review of research. There is evidence supporting the idea that fertility responds Eur J Popul. 2013;29:1–38. negatively to economic downturn in a pro-cyclical although 2. Breen R. Risk, recommodification and stratification. J Br Sociol Assoc. 1997;31:473–89. other theories suggest a counter-cyclical relationship between 3. Neels K. Temporal variation in unemployment rates and their association economic growth and fertility, albeit with less evidence. with tempo and quantum of fertility: some evidence for Belgium, France and the Netherlands. In: Population Association of America Annual Meet- What does this study add to the literature? ing, Dallas, Texas, 2010:38. (Accessed September 2018.) Avalaible from: https://paa2010princetonedu/papers/101064 4. Comolli CL, Bernardi F. The causal effect of the great recession on childlessness The current economic recession has disrupted the positive of white American women. IZA J Labor Econ. 2015;4:21. trend in fertility that began at the start of this century. The 5. Butz WP, Ward M. The emergence of countercyclical U.S. fertility. Am Econ Rev. regions of Spain that experience higher unemployment tend 1979;69:318–28. to show a greater decline in fertility. Since Spain already had 6. EUROSTAT. Employment and unemployment (LFS)DataDatabase. Database very low fertility rates, the further decline caused by the eco- of European Statistics. 2017. (Accessed September 2018.) Available from: nomic recession jeopardizes the future of the country’s welfare http://ec.europa.eu/eurostat/web/lfs/data/database 7. Benach J, Tarafa G, Recio A. Sin trabajo, sin derehos, sin miedo. Las reformas system. laborales y sus efectos sobre el trabajo y la salud. Barcelona: Icaria; 2014. p. 110. (Accessed September 2018.) Available from: http://cbueg-mt.iii.com/iii/encore/ record/C Rb6099463 sintrabajo,sinderechos Ff:facetfields:title:title:T% 2525C3%2525ADtol:: Orightresult X6?lang=cat&suite=def 8. Bacigalupe A, González-Rábago Y, Font R, et al. Crisis económica y políticas Editor in charge públicas: diferencias en la respuesta política a la crisis entre comu- nidades autónomas, 2008-2014. OPIK-Working papers/Lan koadernoak 1. 2016. (Accessed September 2018.) Available from: http://www.ehu.eus/documents/ Mercedes Carrasco Portiño. 3638427/5511490/Clasificacion-politicas-sociales-OPIK.pdf 9. Eurostat. Fertility statistics. 2014. (Accessed July 2018.) Available from: http://ec.europa.eu/eurostat/statistics-explained/index.php/Fertility statistics Transparency declaration 10. Dribe M, Bras H, Breschi M, et al. Socioeconomic status and fertility: insights from historical transitions in Europe and North America. Popul Stud (NY). The corresponding author on behalf of the other authors guar- 2016;0:1–19. 11. Instituto Nacional de Estadística (INE). Inebase. 2017. (Accessed July 2018.) antee the accuracy, transparency and honesty of the data and Available from: http://www.ine.es/dyngs/INEbase/en/ information contained in the study, that no relevant information 12. Sobotka T, Skirbekk V, Philipov D. Economic recession and fertility in the devel- has been omitted and that all discrepancies between authors have oped world: a literature review. 2010;7:36. (Accessed July 2018.) Available from: file:///C:/Users/stuartb/Downloads/RN2009 Economicrecessionandfertility V3 been adequately resolved and described. April2010 (5).pdf. 13. Goldstein J, Karaman Örsal DD, Kreyenfeld M, et al. Fertility reactions to the Authorship contributions Great Recession in Europe. Demogr Res. 2013;29:85–104. 14. International Labour Organization. ILO Global estimate of forced labour. 2012:1–48. (Accessed July 2018.) Available from: http://www.ilo.org/global/ V. Puig-Barrachina, M. Rodríguez-Sanz and G. Perez have made topics/forced-labour/publications/WCMS 182004/lang–en/index.htm substantial contributions to conception, design, analysis and inter- 15. Sobotka T, Skirbekk V, Philipov D. Economic recession and fertility in the devel- oped world. Population and Development Review. 2011;67:267–306. pretation of data. V. Puig-Barrachina, G. Perez and M.A. Luque have 16. Schneider D, Hastings OP. Socioeconomic variation in the effect of economic been involved in drafting the manuscript. M.F. Domínguez-Berjón, conditions on marriage and nonmarital fertility in the United States: evidence U. Martín and M. Ruiz have made substantial contributions, to the from the Great Recession. Demography. 2015;52:1893–915. 244 V. Puig-Barrachina et al. / Gac Sanit. 2020;34(3):238–244 17. Neels K, Theunynck Z, Wood J. Economic recession and first births in Europe: 24. Luque Fernández MA, Bueno-Cavanillas A. La fecundidad en España, 1996-2006: recession-induced postponement and recuperation of fertility in 14 European mujeres de nacionalidad extranjera frente a españolas. Gac Sanit. 2009;23 (Supl countries between 1970 and 2005. Int J Public Health. 2013;58:43–55. 1):67–71. 18. Mills M, Blossfeld H, Klijzing E. Becoming an adult in uncertain times. A 14- 25. Neyer G. Family policies and fertility in Europe: fertility policies at the inter- country comparison of the losers of globalization. In: Blossfeld HP, Klijzing E, section of gender policies, employment policies and care policies, Max Planck Mills M, Kurz K, editors. Globalization, uncertainty and youth in society. London, Institute for Demographic Research: working paper. 2006;Vol. 49. New York: Routledge; 2005. p. 393–411. 26. International Monetary Fund. World Economic Outlook. Vol. 2012, World Eco- 19. Kreyenfeld M. Uncertainties in female employment careers and the postpone- nomic and Financial Surveys. 2012. (Accessed July 2018.) Available from: ment of parenthood in Germany. Eur Sociol Rev. 2009;26:351–66. http://www.imf.org/external/pubs/ft/weo/2012/02/pdf/text.pdf 20. Korpi W. Faces of inequality: gender, class, and patterns of inequalities in dif- 27. Puig-Barrachina V, Ruiz ME, García-Calvente MM, et al. How to resist austerity: ferent types of welfare states. Soc Polit. 2000;7:127–91. the case of the gender budgeting strategy in Andalusia. Gender. Work Organ. 21. Bernardi F. Public policies and low fertility: rationales for public intervention 2016;24(1) and a diagnosis for the Spanish case. J Eur Soc Policy. 2005;15:123–38. 28. Paleo N, Alonso A. ¿Es solo una cuestión de austeridad? Crisis económica y 22. Galloway TA, Hart RK. Effects of income and the cost of children on políticas de género en España. Investig Fem. 2015;5:36–68. fertility. Quasi-experimental evidence from Norway. Statistics Norway. 29. Larrañaga I, Martín U, Bacigalupe A. Salud sexual y reproductiva, y crisis 2015. (Accessed July 2018.) Avalaible from: https://www.ssb.no/en/forskning/ económica en España. Gac Sanit. 2014;28 (Supl 1):109–15. discussion-papers/effects-of-income-and-the-cost-of-children-on-fertility 30. Adsera A. Changing fertility rates in developed countries. J Popul Econ. 23. Rindfuss RR, Guilkey DK, Morgan SP, et al. Child-care availability and fertility in 2004;17:1–27. Norway. Popul Dev Rev. 2010;36:725–48.