But Bryan errs a bit. He neglects that we also could be putting too much effort into antenatal care. Sure sure, there's a big left tail that are screwing up horribly on that front. But that tail isn't reading economics blogs or parenting books written by economists. Instead, the folks who do read econ blogs are busily beating themselves up for having a bit of soft cheese or sneaking a sip of wine during pregnancy. If we are erring in making pregnancy far more costly for our wives than it really needs to be, then we're really screwing up: no matter how convinced we are about Bryan's arguments, if pregnancy is really unpleasant, that up-front cost can kill our future potential unrealised children.*
Emily Oster's forthcoming book then will be a beautiful complement to Bryan's work. Amazon should sell them as a bundle. Doctors, midwives, and right-thinking-tut-tutting-jerks give us all kinds of advice about what good people do. A lot of those really just seemed to be nonsense.
Take alcohol. When we were expecting, none of the advice on alcohol seemed to make sense. Sure, getting drunk seemed a really bad idea. But the dose always makes the poison. So I went and checked the literature and concluded that light drinking during pregnancy was effectively harmless. So Susan had the occasional glass of wine; we were also big fans of Harrington's SobeRing Thought - the low alcohol beer that local brewer Harrington's made for the Lord of the Rings.** And I blogged a bit on how the risks of alcohol during pregnancy seem overstated: if anything, public health folks' warnings that there's no safe level of drinking seem a noble lie intended to dissuade those pregnant women who'd otherwise drink a bottle of scotch in an evening.
If you can't have a glass of wine with dinner every other night during pregnancy, then pregnancy is less fun than it otherwise would be. And so the kind of people who listen to this kind of advice are having too few kids.
Oster seems to have been as annoyed as we were. But she's done something far more constructive about it - she's compiled the evidence for those of us who care about evidence. From the Amazon blurb:
When Oster was expecting her first child, she felt powerless to make the right decisions for her pregnancy. How doctors think and what patients need are two very different things. So Oster drew on her own experience and went in search of the real facts about pregnancy using an economist’s tools. Economics is not just a study of finance. It’s the science of determining value and making informed decisions. To make a good decision, you need to understand the information available to you and to know what it means to you as an individual.The tut-tutters are doing real harm here. Lower decile groups hear the "drink nothing" warnings, dismiss them entirely as nonsense, and go on to drink way too much while pregnant, doing real harm. High decile groups hear the "drink nothing" warnings and, adding that to all the other advice they're given about all the other costly-and-useless rituals they must follow during pregnancy, rationally decide to have fewer kids. This is a bad equilibrium. Shame that Oster's book won't be out for another year - the current equilibrium is costly, and the faster we can start fixing it, the better.
Take alcohol. We all know that Americans are cautious about drinking during pregnancy. Official recommendations call for abstinence. But Oster argues that the medical research doesn’t support this; the vast majority of studies show no impact from an occasional drink. The few studies that do condemn light drinking are deeply flawed, including one in which the light drinkers were also heavy cocaine users.
Expecting Better overturns standard recommendations for alcohol, caffeine, sushi, bed rest, and induction while putting in context the blanket guidelines for fetal testing, weight gain, risks of pregnancy over the age of thirty-five, and nausea, among others.
* As clarification: there's some optimal number of kids that each couple will decide to have. If the actual cost of having one more kid is lower than the cost parents think they have to face, or the cost they mistakenly decide to impose upon themselves, then optimal family size is a bit larger than the deciding-couple thinks. The deadweight costs of kids who optimally would be born from the parents' perspective but aren't born because of parental cost misperceptions is the problem - I don't think I'm pushing into Parfit territory here. But the problem is my wording, now clarified. Thanks
** Yeastie Boys and Kelly Ryan brewed the beers in this year's Hobbit film.