The impact of diabetes insurance mandates on infant health

Among the factors thought to contribute to lagging improvements in infant health in recent years are increasing obesity and diabetes prevalence among women of childbearing age. This article uses a difference‐in‐difference‐in‐difference empirical strategy to investigate the impact of mandated insurance coverage for diabetes on adverse pregnancy outcomes. Among educated women, who have high rates of coverage through private insurance that is subject to insurance mandates, diabetes mandates are associated with a reduction in low birth weight and premature birth prevalence. These gains are concentrated among older women and are larger for African‐Americans. There is a weaker effect on the prevalence of high birth weight, potentially because of the deleterious effects of an increased probability of pregnancy weight gain in excess of 35 pounds among diabetic women in states with mandates.     

Hispanic Self-identification and Birth Weight Outcomes among U.S.- and Foreign-born Blacks

Black infants are more likely to suffer from poor health at birth compared to non-blacks. However, most existing infant health research focuses solely on non-Hispanic blacks and fails to consider the role of ethnic self-identification on infant health disparities. Using 2002 Vital Statistics Natality Data, this paper investigates whether Hispanic ethnicity is related to birth weight among U.S.- and foreign-born black mothers. The results from regression analyses suggest that Hispanic blacks give birth to heavier infants than non-Hispanic blacks. Maternal behaviors such as prenatal care and smoking fail to explain these birth weight differences. However, the observed within-group birth weight differences among blacks are far more modest compared to the black-white birth weight disparities identified in the extant literature. Thus, while it is important to pay attention to within-group differences among blacks, it is still critical to address the needs of black Hispanics with respect to racial disparities in infant health outcomes.     

The Declining Contribution of Socioeconomic Disparities to the Racial Gap in Infant Mortality Rates, 1920-1970

This article examines the racial gap in infant mortality rates from 1920 to 1970. Using state-level panel data with information on income, urbanization, women's education, and physicians per capita, we can account for a large portion of the racial gap in infant mortality rates between 1920 and 1945. The educational gap between white and nonwhite women was especially important in this regard. In the postwar period, socioeconomic characteristics account for a declining portion of the racial infant mortality gap. We discuss the postwar experience in light of trends in birth weight, maternal characteristics, smoking and breast-feeding behavior, air pollution, and insurance coverage.     

Demographic consequences of maternal-leave programs in industrial countries: evidence from fixed-effects models

The authors measure the effects of paid maternity leave upon infant mortality, the labor force participation of women during their prime childbearing years, and fertility rates. To reach their conclusions, they constructed a simultaneous-equations model using the individual fixed-effects method and a data set comprising 17 OECD countries and four time periods. The extension of maternal leave programs, measured in terms of duration of paid leave, is shown to reduce infant mortality, to raise rates of labor force participation for women in the prime childbearing ages, and to increase birth rates. The direct plus indirect impacts of extending maternity leave programs, as revealed by the reduced-form parameters of the authors' models, however, produce a different picture. The total impacts upon both infant mortality and female labor force participation conform closely to the structural estimates, but the impact upon birth rates almost disappears. It seems that the indirect effects of the maternal leave variable, via infant mortality and women's labor force participation, offset the directly pronatal influence. From a policy perspective, the benefits of paid maternal leave programs would seem to be unconditionally positive with respect to lowering infant mortality, and also positive with respect to raising female labor force participation. One should not, however, expect higher birth rates from such programs. The findings also suggest that maternal leave programs can facilitate some increases in women's labor force participation without incurring the reductions in fertility which would otherwise be experienced.     

Evolution of the Infant Health Production Function

Michael Grossman's seminal publication on the demand for health and health production (Grossman 1972) has spawned a substantial body of research focusing on the production of infant health. This article provides a systematic review of the published literature to date on infant health production and how it has evolved over the past 3–4 decades as data have become more available, computing has improved, and econometric methods have become more sophisticated. While empirical research in most fields has expanded in corresponding ways, the infant health production research has become an important part of the broader and inherently multidisciplinary literature on intergenerational health. The strongest and most robust findings are that policies matter for infant health, particularly those affecting access to health care, and that prenatal smoking and other chemical exposures substantially compromise infant health. Promising directions for future research include elucidating relevant pathways, reconciling the largely inconsistent estimated effects of nutrition and education, and exploring the roles of preconceptional and lifetime health care, paternal factors, social support, housing, complementarity and substitutability of inputs, factors that modify effects of inputs, and evolving medical technologies.     

Does the Length of Maternity Leave Affect Maternal Health?

The objective of this paper is to investigate the impact of the length of maternity leave on maternal health in a sample of working mothers. Two measures of depression and a measure of outpatient health visits are used to represent maternal health. Ordinary least squares models provide baseline estimates, and instrumental variables models account for the potential endogeneity of the return-to-work decision. The findings suggest that returning to work later is associated with a reduction in the number or frequency of depressive symptoms. There is suggestive but inconclusive evidence that longer maternity leave is associated with a lower probability of being a likely case of clinical depression and a lower likelihood of having frequent outpatient visits during the first six months after childbirth. These findings contribute to the literature on maternal leave policy, which focuses primarily on the benefits of leave for child health and development, by evaluating the influence of longer maternal leave on the health of mothers.     

Prenatal Smoking Cessation and Infant Health: Evidence from Sibling Births

This article uses a large data set of sibling births to examine when mothers must quit smoking in pregnancy to deliver healthy babies. It applies sibling fixed effects models to provide robust evidence that smoking cessation in the first trimester has a negligible effect on infant health, but cessation as late as second trimester or smoking throughout pregnancy is associated with substantially lower birth weights and higher risks of delivering low birth weight babies. In particular, about two thirds of the total detrimental smoking impact on birth outcomes occurs in the second trimester. Therefore, reallocating resources on prenatal smoking cessation towards the first trimester can lead to a significant efficiency gain. This study also shows when the timing information of prenatal smoking cessation is improperly used, it will introduce a new nontrivial downward bias in estimating the causality between the conventionally used group measure “prenatal smoker” and infant health.     

What about Mom? The Forgotten Beneficiary of the Medicaid Expansions

This paper contributes to evidence regarding the effectiveness of the Medicaid expansions by focusing on a key beneficiary—the mother—who has previously been overlooked. Using the Natality Detail Files for 1989-1996, we estimate the relationship between Medicaid eligibility and maternal health outcomes for several treatment groups and a control group. Potential biases caused by improved reporting are addressed by using a “straw man” maternal complication not preventable with prenatal care. Our results indicate that increased Medicaid eligibility may have led to fewer preventable maternal complications among women most likely to have benefited from the Medicaid expansions.     

Ghana's national health insurance,free maternal healthcare and facility‐based delivery services

Ghana implemented the National Health Insurance Scheme (NHIS) in 2005 and introduced free maternal healthcare (FMH) into the scheme in 2008. These reforms aimed at improving the utilization of healthcare, especially for expectant mothers. Using data from the 2008 and 2014 Ghana Demographic and Health Surveys (GDHS) with a sample of 8,081, this study employed multivariate probit and conditional mixed process (CMP) estimators to analyze the NHIS enrolment and the use of facility‐based delivery services among expectant mothers within the context of Sustainable Development Goal 3 in Ghana. The influence of birth order on these policies has also been explored. Before and after analysis was used for the effect of the FMH on NHIS enrolment and the use of delivery services while CMP was used for the effect of NHIS on delivery services. It is concluded that higher birth order reduces the likelihood of NHIS enrolment and health facility delivery. Moreover, the FMH policy has improved both NHIS enrolment and facility‐based delivery. Finally, the NHIS policy proves to be a reliable factor to induce utilization of facility‐based delivery services. It is recommended that maternal health education at antenatal care visits should be enriched with potential consequences and complications associated with multiple births. The National Health Insurance Authority (NHIA) should provide registration desks for expectant mothers at health facilities.     

Industrialization,indoor and ambient air quality,and elderly mental health

The health risks from indoor and ambient air pollution create a considerable burden to global economic development and health, especially in economies within an aging society. Previous research has established the adverse effects of air pollution on health. However, most studies do not focus on the simultaneous effect of indoor and ambient air pollution nor its health risks to the older population. This study examines the impact of exposure to both indoor and ambient air pollution for the same individuals over time on mental health by using a nationally representative longitudinal survey for middle-aged and elderly individuals in China. We find that both indoor and ambient air pollution have an adverse effect on elderly mental health and significantly increases the likelihood of having depressive symptoms. We provide evidence that the effect of indoor and ambient air pollution is associated more with less educated and females.     

Does birth spacing affect female labor market participation? Evidence from urban China

This paper investigates the impact of birth spacing on female labor market participation in urban China. Employing household panel surveys between 1989 and 2011 and exploiting variations in time intervals between the first and second child, we find that spacing births at longer intervals significantly increases female labor market participation. The effects of birth spacing are robust to various examinations that consider nonlinear specifications, selection on observed and unobserved variables, and the plausibly exogenous instrument. The heterogeneous analysis suggests that the effects of birth spacing are more pronounced in women with a daughter as the first birth, women with late first birth, and less-educated women. We examine potential mechanisms and document that women with longer birth intervals are likely to invest more in continuing education and have better health status.     

Why Do Differences in Provincial Incomes Persist in Indonesia?

Despite 20 years of sustained economic growth that saw provincial GDPs rise and inequalities in per capita provincial GDPs fall, per capita income disparities among provinces persist. In this paper we present evidence that poor provinces have tended to catch up with middle- and high-income provinces, hut that regions at the top and bottom of the distribution in 1975 finished. In similar positions in 1993 lnvestments in human capital (education and health) seem to be the most effective way of increasing provincial incomes and reducing the disparities in provincial GDP per capita. The poorer provinces and rural areas can grow faster than the richer ones because they can gain the most from better health and education, they have the highest rates of illiteracy, fertility, and infant, child and maternal mortality.     

Overpopulation and unemployment in Zimbabwe

The size of Zimbabwe's African population has grown dramatically over the past 50 years, with 5.7 children on average being born per woman. The following factors are responsible for the rapid population growth in Zimbabwe: the country's economic prosperity during the period of the Central African Federation from 1953 to 1963, and its successful food policy before and after independence; the success of the health system, also in both periods; and the fact that women have not been incorporated into the economy as wage-earners. A brief historical overview is presented, followed by sections on the food policy and health system, reasons for the persistence of large families, and the relationship between wage-earning by women and the birth rate. The author also describes some of the problems caused by overpopulation. Engaging more women in regular wage-earning employment is the key to controlling the birth rate in Zimbabwe. Current government policies encouraging female employment in government services and the economy in general, along with the expansion of contraceptive services, could influence female fertility over the long term.     

Determinants of fertility in developing countries

The contribution of agricultural modernization to changes in fertility in developing countries was examined. A model for the determinants of both fertility and infant mortality--hypothesized to be positively related--was specified and applied to cross-sectional data for 75 developing countries for the year 1971. The infant mortality rate, productivity per unit of labor and land, and density of population for agricultural land were highly correlated with the crude birth rate. The only other exogenous variables highly correlated with each other were productivity per unit of labor and infant mortality, and productivity per unit of land and population density for agricultural areas. The coefficient of population density of agricultural areas suggested a negative impact of density on fertility. The infant mortality rate, productivity per unit of land and labor, and density of population of agricultural areas explained 85% of the intercountry variation in fertility. The infant mortality rate, productivity of land, and productivity of labor were of descending order of importance in determining the crude birth rates in the countries analyzed. 68% of the intercountry variation in infant mortality was explained by fertility, adult literacy, per capita energy consumption, gini-coefficient of income distribution, population per hospital bed, and protein supply. Adult literacy, crude birth rates, population per hospital bed, per capita energy consumption, per capita protein supply, and gini-coefficient of income distribution were of descending order of importance in determining infant mortality rates. All of the variables that affected infant mortality directly affected fertility indirectly; conversely, all the variables that affected fertility directly affected infant mortality indirectly. Overall, these results confirm that agricultural modernization does exert an effect on fertility. The task in developing countries is to break the vicious cycle of infant mortality and fertility. This can be achieved both through family planning programs and the diffusion of health programs to lower infant mortality.     

Co-Morbidity and Other Complexities Affecting Black Women’s Health

This paper presents some of the major health concerns that affect black women, and examines how various individual health problems co-exist and coincide to create complex health concerns for women. It posits the idea that to effectively address a Black woman’s health, her mental, emotional, social, economic and even spiritual health must be considered as well as her physical condition. The paper focuses largely on the information from individual health-related research presentations at “The Invisible Woman” conference held at Bennett College in March 18–19, 2011 in Greensboro, North Carolina. At this event, scholars presented new research on HIV, obesity and mental health—three areas of critical concern for African–American women—examining ways in which these conditions affect Black women. The paper also addresses the role of health care access and policy in addressing these and other health concerns among women and within the black community. The review of the literature highlights the importance of examining health—perhaps especially Black women’s health—from social, cultural, behavioral, environmental and economic perspectives. It also points out the continued need for research that includes women and people of color.     

Child Health and Mortality: Does Health Knowledge Matter?

This paper studies factors that influence child health in Bissau,the capital of Guinea-Bissau. This environment is characterisedby high infant mortality, but not by malnutrition. We show thatalthough maternal education is important in determining childhealth and mortality this effect diminishes or disappears whenhealth knowledge is introduced as an explanatory variable. Itemerges that health knowledge has large and positive effectson both child mortality and health when instrumented for tocapture endogeneity.     

Does Maternity Leave Induce Births?

Alleviating the tension between the conflicting responsibilities women may face as mothers and as workers is a topic of current policy interest. Expansion of guaranteed maternity leave to all employed women in the United States is suggested as one possible “family-friendly” solution. Controversy surrounding the issue of increased maternity leave centers around the potential cost to firms of widespread access to leave. One specific concern is that the availability of maternity leave will actually increase births among eligible working women. In this paper we use data from the National Longitudinal Survey of Youth to examine the impact of maternity leave on fertility. We explore two possible routes through which maternity leave may influence fertility. We first estimate the impact of desired fertility on the probability of being in a job offering maternity leave. We then estimate the impact of maternity leave and desired fertility on the probability of a birth. We find no evidence that women sort by fertility desires into firms on the basis of their maternity leave policy. We do find that the probability of a birth increases as a result of maternity leave, and that the fertility effect of maternity leave increases with birth parity.     

Patterns of infant mortality in rural England and Wales, 1850–1910†

The study of nineteenth‐century infant mortality in Britain has neglected the rural dimension to a surprising degree. This article maps the change in infant mortality rate (IMR) between the 1850s and the 1900s at registration district (RD) level. Latent trajectory analysis, a longitudinal model‐based clustering method, is used to identify the clusters into which rural RDs fell, based on their IMR trajectories. Relationships between IMR and population density, fertility, female tuberculosis mortality, female illiteracy, male agricultural wages, and distance from London are examined in a longitudinal study. The tuberculosis (maternal health), illiteracy (education), and distance variables had the most effect. IMR responded most strongly to improving health and education in the east, less in the central area, and least in the north and west. The eastern zone's higher‐than‐average mid‐century infant mortality therefore declined faster than the national average. A central and southern zone had slightly lower IMR in mid‐century but did not keep up with the rate of decline in the east. The peripheral north and west had the lowest mid‐century rates but their decline was overtaken by the other zones. The interpretation of these findings and their relevance to the wider study of infant mortality are discussed.     

The village midwife program and infant mortality in Indonesia

Indonesia introduced over 50,000 midwives into villages in the 1990s to provide primary care to women lacking easy access to health facilities. It seems plausible to argue that the significant reduction in infant mortality that occurred from about 1993–94 was a consequence of this. The paper estimates the village midwife program's impact on infant mortality, using data from the Indonesia Family Life Survey. Regressing mortality outcomes against choice of services would lead to biased estimates because of the correlation between service choice and unobserved individual characteristics. Furthermore, non-random placement of midwives could bias estimates of their impact on infant mortality. This study overcomes such endogeneity problems by aggregating mortality outcomes and program prevalence at district level and taking account of district fixed effects in estimating the program's impact. Surprisingly, the results do not support the hypothesis that the midwife program was responsible for the observed decline in infant mortality.     

The Effect of Health and Poverty on Early Childhood Cognitive Development

Although evidence of a link between socioeconomic status and child health has been researched extensively, much less attention has been devoted to studying the link between child health and cognitive development. This paper seeks to determine whether early childhood illnesses and poverty significantly impede cognitive development. The empirical model attempts to control for observed and unobserved heterogeneity through the use of panel data models. Results indicate that a child’s cognitive development is not directly related to health problems acquired after birth or socioeconomic standing. Rather, cognitive development is primarily influenced by unobserved child- and family-specific factors that happen to be correlated with health and socioeconomic status. On the other hand, birth weight appears to affect cognitive performance later in childhood, even after taking unobserved heterogeneity into account.