The reciprocal relationship between public attitudes and reproduction policy: an agenda for an uncharted research field

Khan, Rohan Book Part — Published Version The reciprocal relationship between public attitudes and reproduction policy: an agenda for an uncharted research field Provided in Cooperation with: WZB Berlin Social Science Center Suggested Citation: Khan, Rohan (2024) : The reciprocal relationship between public attitudes and reproduction policy: an agenda for an uncharted research field, In: Zagel, Hannah (Ed.): Reproduction Policy in the Twenty-First Century. A Comparative Analysis, ISBN 978-1-0353-2416-3, Edward Elgar Publishing, Cheltenham, Nothampton, MA, pp. 103-118, https://doi.org/10.4337/9781035324163.00016 This Version is available at: https://hdl.handle.net/10419/307474 Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. 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The reciprocal relationship between public attitudes and reproduction policy: an agenda for an uncharted research field Rohan Khan PUBLIC ATTITUDES: A MISSING PIECE IN COMPARATIVE REPRODUCTION POLICY RESEARCH Governments must be responsive to public attitudes for policies to gain acceptance (Brooks & Manza, 2007). Simultaneously, policies shape people's attitude-formation by impacting their lived experience (Pierson, 1993). These links have rarely been studied in the context of reproduction policy. However, they are crucial for understanding dynamics of liberalization and backlash in this policy domain across fields, countries and over time. Reproduction policy consists of all state interventions in the biological and social processes of human reproduction. States employ diverse instruments to regulate reproduc tion. These include legalizing and actively providing certain services, as well as criminalizing and not regulating others. Exemplary reproductive services are the provision of abortion and medically assisted reproduction treatment (Griessler et al., 2022; Levels, 2011). Policies in this domain affect citizens' ability to realize individual decisions regarding whether, when and how to pro create (Jackson, 2001). They are also relevant to social stratification, because state support for reproductive decision-making varies across social groups (Becker, 2023). Given the impact of this policy domain on people's lives, a systematic anal ysis of the reciprocal relationship between public attitudes and reproduction policy is overdue. Public attitudes refer to views held by citizens, which impact processes of policymaking, and vice versa (Busemeyer, 2022). They function as input in the policymaking process by conveying demands for regulatory action on a subject and subsequently holding governments accountable. For example, citizens' growing acceptance of abortion procedures was a key driver in enacting more permissive abortion regulations (Camobreco & Barnello, 103 104 Reproduction policy in the twenty-first century 2008). At the same time, public attitudes are also an outcome of policies, as they are shaped by policies' resource allocation and signalled norms. For instance, women's higher support for abortion can be attributed to them being the primary recipients of abortion services (Lizotte, 2015). Furthermore, the designs of reproduction policies communicate various norms, including norms about ideal reproductive life-courses, the extent of women's reproductive autonomy and the ethical status of foetuses (Joffe & Reich, 2015). Public attitudes can be distinguished into values and policy preferences. Values denote people's normative beliefs on how different aspects of life should be structured (Inglehart et al., 2017). Policy preferences result from these values and reflect citizens' ideas on how concrete policies should be designed (Busemeyer et al., 2020: 6). This distinction is often neglected in research but it is of particular importance in the domain of reproduction policy. Considering this difference helps to investigate multidimensionality in citizens' views regarding how different values are impacted by (contradictory) norma tive signals of reproduction policies. Furthermore, the distinction also allows one to examine how different values people hold on reproduction-related matters translate into specific policy preferences. Investigating the reciprocal relationship between public attitudes and repro duction policy requires a comparative perspective for three reasons. First, cross-policy comparison helps to illuminate how the same attitudes can drive policymaking in similar or contradictory directions across policy fields. For example, individuals emphasizing the importance of motherhood might advo cate for decreasing abortion accessibility while simultaneously supporting the expansion of pregnancy care. Second, a comparative angle allows one to investigate how different reproduction policies jointly shape citizens' views on reproduction-related matters. One question could be how topics covered in sexuality education and coverage of costs for contraceptives influence adolescents' conceptions of sexuality. Third, cross-country and over-time comparisons also accentuate how differences in political systems, state/market configurations and historical legacies impact the relationship between citizens' attitudes and reproduction policy. In this chapter, I provide a research agenda for the systematic analysis of the reciprocal relationship between public attitudes and reproduction policy. First, I summarize existing research on attitudes towards reproduction policies and show how it neglects the policy context. Subsequently, I outline how public attitudes are conceptualized in the morality policy, social policy and family policy literatures. I describe how research on attitudes towards reproduction policy differs from these bodies of research and highlight their beneficial insights. Second, I explain the theories of government responsiveness and policy feedback. Together they provide a holistic framework to analyse the reciprocal relationship between public attitudes and policy context. Studies on The reciprocal relationship between public attitudes and reproduction policy 105 government responsiveness analyse under which conditions public attitudes impact policymaking. Policy feedback literature investigates how policy contexts impact citizens attitude-formation. Third, I use the case of Germany to illustrate the potential of these theories for explaining the role of public attitudes across reproduction policy fields. I look at the fields of sexuality education, contraception, abortion, medically assisted reproduction (MAR) and pregnancy care. The chapter closes with an outlook on how this research agenda can be expanded. PUBLIC ATTITUDES IN MORALITY POLICY, SOCIAL POLICY AND FAMILY POLICY RESEARCH Research on attitudes towards reproduction policy has mainly been undertaken in two ways. Health policy scholarship has concentrated on describing vari ation in citizens' attitudes towards sexuality education in school (Barr et al., 2014), contraceptive usage (Rocca & Haiper, 2012), abortion permissibility (Learman et al., 2005), MAR procedures (Bangsb0ll et al., 2004) and prena tal testing (Seror et al., 2019). In contrast, public attitudes researchers have focused on how socio-demographic traits and ideological positions impact citizens' views on abortion (Adamczyk et al., 2020; Osborne et al., 2022) and MAR (Mohamed, 2018; Szalma & Djundeva, 2020). In which ways attitudes relate to the reproduction policy context has thus far only been investigated for the field of abortion. Studies provide evidence for associations between citi zens' support for abortion and the permissiveness of abortion regulations (Loll & Hall, 2019). For the US, literature also indicates that governments respond to the abortion preferences of voters (Kreitzer, 2015). This research field is lacking a systematic analysis of the reciprocal relationship between public atti tudes and the policy context beyond abortion, considering the broader domain of reproduction policy. The conceptualization of public attitudes in research on morality policy, social policy and family policy holds beneficial insights for addressing this gap from a comparative angle. Morality Policy The morality policy literature investigates policy fields in which value judge ments are more relevant for policymaking than socio-economic considerations (Heichel et al., 2013). Examples include the fields of euthanasia and prosti tution. The main interest of morality policy scholarship is on how different political systems regulate these policy fields (Knill et al., 2015). Abortion and MAR policy are central subjects of morality policy research because they concern questions of life and death (Engeli, 2009). Most studies view diverg ing values within the public as an indication for which topics are contested 106 Reproduction policy in the twenty-first century (Budde & Heichel, 2015; Nebel, 2015). The assumption is that public contes tation necessitates government action. Scholars primarily focus on institutional features to explain how political systems respond to value conflicts. Findings suggest that the number of institutional veto players (Schwartz & Tatalovich, 2009), the relevance of Christian democratic parties (Adam et al., 2020), and the specific church-state relationship (Minkenberg, 2002) contribute to explaining differences in the regulation of abortion and MAR. The role of public attitudes in morality policy scholarship draws attention to how the legitimacy of certain reproductive procedures is challenged based on people's values. However, the contribution of this scholarship is confined to policies that face public contestation. In the domain of reproduction policy this mainly applies to regulations in the fields of abortion and MAR. Furthermore, morality policy scholarship does not investigate which concrete policy prefer ences follow from the values citizens hold. An exemplary question would be, what are the abortion or MAR policy design preferences among people who believe in the importance of parenthood. Social Policy The most extensive research on the reciprocal relationship between public attitudes and policy context has been conducted in the field of social policy. This policy domain comprises benefits that are intended to support citizens in economic risk situations (Hausermann, 2023), such as pensions and unem ployment benefits. Social policy is to a large extent based on redistribution of resources between different societal groups. Thus, social policy scholars are primarily interested in citizens' attitudes regarding what the welfare state should provide and which social groups deserve state support (Mau, 2004). The government responsiveness literature focuses on what citizens consider to be responsibilities of the welfare state (Brooks & Manza, 2007). For instance, whether people expect the state to provide for a certain standard of living to the unemployed. These studies indicate that states adjust their welfare spending according to citizens' social policy attitudes (Kang & Powell, 2010). The complementary policy feedback literature consists of two strands. One strand revolves around how social policy designs generate support or opposi tion among the public towards them. Support for social policies is explained by material benefits that certain societal groups gain from specific social policies (Gingrich & Ansell, 2012). For example, people benefiting from policies that lend economic support to students are also most in favour of it (Garritzmann, 2015). Support for social policy designs also results from individuals adapting their attitudes to the normative signals of the welfare state in which they grow up (Lindh, 2015). Mirroring these explanations for social policy support, studies on citizens' opposition to policies highlight that people disapprove of The reciprocal relationship between public attitudes and reproduction policy 107 policy designs if they experience socio-economic losses from them, or if the design is contrary to their pre-existing attitudes. For example, progressive tax systems primarily receive opposition from high-income earners and people with fiscally conservative opinions (Roosma et al., 2016). Another strand of policy feedback literature examines how social policies impact citizens' attitudes on deservingness to state support of different social groups. This research argues that the way social policy designs address target groups signals to citizens how deserving they are of institutionalized solidarity. In tum, people adapt their views on these target groups (van Oorschot & Meuleman, 2014). Studies demonstrate for instance that workfare policies, which install a work-first logic, lead to more negative positions towards unemployed people (Hom et al., 2023). The conceptualization of attitudes in terms of what the welfare state should provide and which social groups deserve state support is an underdeveloped perspective in research on reproduction policies. Adopting this angle accentu ates the question of which reproductive services are viewed as a responsibility of the welfare state. Further, the concept of deservingness draws attention to citizens' attitudes towards whose reproductive decisions are considered worthy of state support. Finally, social policy research also often fails to distinguish between values and policy preferences, which can brush over complexities and contradictions in citizens' attitudes towards policy matters. Family Policy Reproduction policy is closely related to family policy, as both address aspects of family dynamics. Family policy structures the relationship between paid and unpaid work by (not) providing people with support to manage their care responsibilities (Daly, 2021 ). Examples of family policies are parental leave and care allowances. Family policy also shapes gender relationships because care work is mainly done by women. Owing to this gendered nature of family policy, scholars have focused on how citizens' attitudes towards the division of paid and unpaid work between men and women relate to policy contexts (Davis & Greenstein, 2009). Studies on government responsiveness in this context have mainly looked at citizens' values rather than preferences. They indicate for example that people's beliefs regarding maternal employment are a driver of childcare expansion (Ferragina & Seeleib-Kaiser, 2015). The policy feedback literature regarding family policy follows two main strands. First, studies on policy preferences suggest that the affordability of childcare influences citizens' support or opposition to these policies on the bases of their socio-economic positions (Neimanns & Busemeyer, 2021). There is also evidence for preference adaptation in that citizens' preferred family policy designs correspond to current childcare schemes (Chung & 108 Reproduction policy in the twenty-first century Meuleman, 2017). Second, policy feedback has been investigated in its impact on citizens' values regarding the division of paid and unpaid work. This research demonstrates, for example, that the expansion of policies fos tering a dual-earner/dual-caregiver model affects gender egalitarianism values (Jozwiak, 2022). Reproduction policy research benefits from the insight of family policy scholars that citizens' attitudes towards gender, sexuality, and family are interrelated with policy contexts. However, even though both policy domains deal with intimate lives, their foci diverge. A family policy focus presupposes the presence of family relationships and subsequently concentrates on gender role attitudes regarding the division of paid and unpaid work within families. In contrast, reproduction policy addresses processes of conceiving and not conceiving children, which highlights different sets of attitudes, such as the importance of family formation. Overall, family policy research operates most consistently with the distinction between values and policy preferences, which helps to uncover multidimensionality in citizens' gender attitudes. PUBLIC ATTITUDES AS INPUT AND OUTCOME IN THE POLICYMAKING PROCESS In democratic political systems, governments are supposed to adhere to public attitudes; simultaneously, policy contexts also shape citizens' attitudes by allo cating resources and communicating social norms (Busemeyer, 2022). Two connected strands of literature deal with the reciprocal relationship between public attitudes and policy contexts. First, government responsiveness research investigates under which conditions citizens' attitudes function as input in the policymaking process. This work highlights the relevance of issue salience and congruence of public attitudes. Second, the literature on policy feedback examines how individuals' attitudes are an outcome of policy contexts. Central concepts in this body of work are resource feedback and normative feedback. Neither strand of research specifies the distinction between values and policy preferences. Government Responsiveness: Issue Salience and Congruence of Public Attitudes Government responsiveness is about how issue salience and congruence of public attitudes are relevant factors affecting whether and how policymakers react to citizens' demands. Issue salience refers to citizens attributing substan tial importance to a topic and demanding government action on it (Burstein, 2003). The concept implies that, via elections, citizens hold governments accountable on policy questions that matter to them. Following from these The reciprocal relationship between public attitudes and reproduction policy 109 assumptions, the prediction is that governments are particularly responsive to salient issues because they want to prevent electoral losses. If an issue lacks salience, governments are less inclined to address it, as it is not electorally important. According to this literature, if an issue is salient, congruence of public attitudes predicts how governments react to citizens' demands by considering how uniform the public is on the issue (Busemeyer et al., 2020: 42). High con gruence of public attitudes entails that a majority of the public holds the same interests on an issue. Low congruence, on the other hand, suggests that citizens have diverging perspectives. The argument is that policymakers most closely follow the demands of the public in cases of issue salience and high congru ence of public attitudes. This is because it is electorally the most effective way to gain support from a majority of the population. In contrast, if issue salience is high but congruence of public attitudes rather low, governments become partisan and respond to the demands of their core voter base, because they are the most relevant for their re-election. The regulations of abortion in Ireland and the US serve as a useful illustration for the theoretical assumptions of government responsiveness theory. In both countries, abortion is a very salient issue. However, in Ireland, the outcome of the 2018 abortion referendum indicated high congruence of public attitudes for a more permissive abortion regulation, which was then closely implemented by the government (Field, 2018). In contrast, the salience of abortion goes along with the low congruence of public attitudes in the US. Consequently, Democrats and Republicans act in a partisan way in the state legislatures and regulate abortion according to the presumed policy preferences of their core voter base (Kreitzer, 2015). Policy Feedback: Resource Feedback and Normative Feedback The majority of policy feedback research concentrates on how policies impact citizens' attitudes towards supporting or opposing them. Another strand of literature examines how policies' normative underpinnings influence people's beliefs on different topics. Two mechanisms through which policies affect public attitudes can be distinguished: resource feedback and normative feed back. The concept of resource feedback is based on the premise that policies benefit specific groups of citizens and disadvantage others (Pierson, 1993). For example, states may regulate access to MAR treatments inclusively by making them available to all people with a wish to have a child or they can restrict it to specific groups. Referring to individuals' material self-interest, resource feedback suggests that citizens benefiting from a policy will support it, whereas people experiencing disadvantages from the policy will oppose it (Jacobs & Weaver, 2015). For instance, if MAR treatments were exclusively 110 Reproduction policy in the twenty-first century accessible to heterosexual couples, primarily these couples would support this policy, while same-sex couples would likely oppose it. Normative feedback presumes that policies contain norms about which services are legitimate and how societies should be structured (Svallfors, 2012: 11 ). For instance, permissive abortion policies are grounded on the normative bases that abortions are legitimate procedures and women should have the pos sibility to pursue their reproductive preferences. Normative feedback suggests that policies signal their norms to citizens, which they adapt to (Campbell, 2012). The assumption is that people develop support for existing policies because they are signalled as legitimate and the policy context is perceived as normality. However, the degree of adaption is dependent on people's life-stage (Svallfors, 2010). Younger people are considered to be more receptive to policy signals because they are still in the life-stage where attitudes are formed. Older individuals on the contrary might disregard normative signals or react with opposition to policies if the communicated norms are conflicting with their existing attitudes. PUBLIC ATTITUDES ACROSS REPRODUCTION POLICY FIELDS IN GERMANY The regulation of reproduction policy differs strongly across countries and over time. In the following, I use the case of Germany since 2010 to illustrate the potential of government responsiveness and policy feedback theories in explaining the reciprocal relationship between public attitudes and reproduc tion policy. In a comparative perspective between reproduction policy fields, I consider political events, such as particular parliamentary debates, to explain issue salience and congruence of public attitudes in each field. Furthermore, I also consider how potential normative feedbacks impact attitudes regarding state support for different reproductive decisions. Each section ends with describing how the respective reproduction policy field in conjunction with other fields might shape citizens' values on reproduction-related matters. Sexuality Education Sexuality education in Germany is provided by the federal states. 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