Social Gradients in Medically Assisted Reproduction: Treatment Take-Up and Success Rates in Denmark, 2006–2023

While a growing body of research documents that women with high socio-economic status (SES) are more likely to give birth following medically assisted reproduction (MAR), fewer studies have investigated the processes that lead to this overrepresentation. In this study, we contribute to the literature on socio-economic gradients in MAR by providing a multi-stage analysis of social gradients across almost two decades. Specifically, we depict trends in annual education and income gradients in the take-up of MAR treatment, the probability of a MAR treatment leading to a live birth, and the prevalence of MAR involvement in births. We use Danish administrative data covering all births and MAR treatments among women aged 25–45 residing in Denmark from 2006–2023. We employ linear probability models adjusted for age groups, partnership status, and relationship duration, and stratify them by parity, treatment type, and clinic type. We document persistent social gradients in all three stages of the MAR process across parity and treatment type. Gradients in treatment take-up were substantially larger at private than at publicly funded clinics, indicating that financial barriers play a substantial role in access. However, the educational gradient in treatment success persisted at similar levels across both public and private clinics and over time, suggesting that nonpecuniary resources also contribute to SES differences in MAR outcomes. The results were robust across alternative specifications: using income as the SES measure, pooling treatments across types, excluding migrants, and estimating unadjusted models. These gradients persisted in the high-income, low-inequality, and heavily subsidized context of Denmark.