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Quantile effects of prenatal care utilization on birth weight in Argentina

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  • George L. Wehby

    (Deptartment of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA)

  • Jeffrey C. Murray

    (Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, IA, USA)

  • Eduardo E. Castilla
  • Jorge S. Lopez-Camelo

    (ECLAMC at Imbice, La Plata, Argentina)

  • Robert L. Ohsfeldt

    (Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA)

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    Abstract

    The effects of prenatal care utilization on birth weight (BW) may vary by unobserved fetal health endowments. This heterogeneity will be masked by estimating the effects at BW mean but can be evaluated by estimating the effects at BW quantiles as fetal health endowment is a strong correlate with the BW quantile order. We estimated the effects of prenatal care visits and delay before prenatal care initiation, on BW mean and quantiles using a sample of infants from Argentina. Self-selection into prenatal care was modeled using 2SLS and instrumental variable quantile regression. Results suggest that the 'mean' effect of prenatal care utilization largely underestimates the effects at lower BW quantiles. About 35 and 77 g increase in BW mean and 0.1 quantile respectively, per visit and about 30 and 139 g decrease in BW mean and 0.1 quantile respectively, per week delayed, were estimated. Ignoring self-selection into prenatal care resulted in underestimation of mean and quantile effects. Results highlight the limitation of analyses focused on 'mean effects' in the presence of treatment heterogeneity and emphasize the importance of identifying women at risk for having infants at lower BW quantiles as they may benefit most from earlier and more intensive prenatal care. Copyright © 2009 John Wiley & Sons, Ltd.

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    File URL: http://hdl.handle.net/10.1002/hec.1431
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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 18 (2009)
    Issue (Month): 11 ()
    Pages: 1307-1321

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    Handle: RePEc:wly:hlthec:v:18:y:2009:i:11:p:1307-1321

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    Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    References

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    1. Chernozhukov, Victor & Hansen, Christian, 2006. "Instrumental quantile regression inference for structural and treatment effect models," Journal of Econometrics, Elsevier, vol. 132(2), pages 491-525, June.
    2. Theodore Joyce, 1995. "Self-Selection, Prenatal Care, and Birthweight Among Blacks, Whites and Hispanics in New York City," NBER Working Papers 3549, National Bureau of Economic Research, Inc.
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    8. Omar Arias & Kevin F. Hallock & Walter Sosa Escudero, 1999. "Individual Heterogeneity in the Returns to Schooling: Instrumental Variables Quantile Regression using Twins Data," Department of Economics, Working Papers 016, Departamento de Economía, Facultad de Ciencias Económicas, Universidad Nacional de La Plata.
    9. Warner, Geoffrey L, 1995. "Prenatal Care Demand and Birthweight Production of Black Mothers," American Economic Review, American Economic Association, vol. 85(2), pages 132-37, May.
    10. Chernozhukov, Victor & Hansen, Christian, 2008. "The reduced form: A simple approach to inference with weak instruments," Economics Letters, Elsevier, vol. 100(1), pages 68-71, July.
    11. R. Todd Jewell & Patricia Triunfo, 2006. "The impact of prenatal care on birthweight: the case of Uruguay," Health Economics, John Wiley & Sons, Ltd., vol. 15(11), pages 1245-1250.
    12. R. Todd Jewell, 2007. "Prenatal care and birthweight production: evidence from South America," Applied Economics, Taylor & Francis Journals, vol. 39(4), pages 415-426.
    13. Chernozhukov, Victor & Hansen, Christian & Jansson, Michael, 2007. "Inference approaches for instrumental variable quantile regression," Economics Letters, Elsevier, vol. 95(2), pages 272-277, May.
    14. Jason Abrevaya, 2001. "The effects of demographics and maternal behavior on the distribution of birth outcomes," Empirical Economics, Springer, vol. 26(1), pages 247-257.
    15. Victor Chernozhukov & Christian Hansen, 2004. "The Effects of 401(K) Participation on the Wealth Distribution: An Instrumental Quantile Regression Analysis," The Review of Economics and Statistics, MIT Press, vol. 86(3), pages 735-751, August.
    16. Conway, Karen Smith & Deb, Partha, 2005. "Is prenatal care really ineffective? Or, is the 'devil' in the distribution?," Journal of Health Economics, Elsevier, vol. 24(3), pages 489-513, May.
    17. Jeffrey J. Rous & R. Todd Jewell & Robert W. Brown, 2004. "The effect of prenatal care on birthweight: a full-information maximum likelihood approach," Health Economics, John Wiley & Sons, Ltd., vol. 13(3), pages 251-264.
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    Cited by:
    1. Ana Inés Balsa & Patricia Triunfo, 2012. "¿Son los cuidados prenatales efectivos? Un enfoque con datos individuales de panel," Documentos de Trabajo (working papers) 0612, Department of Economics - dECON.
    2. Ana I. Balsa & Patricia Triunfo, 2012. "The Effectiveness of Prenatal Care in a Low Income Population: A Panel Data Approach," Documentos de Trabajo/Working Papers 1204, Facultad de Ciencias Empresariales y Economia. Universidad de Montevideo..
    3. Maksym Obrizan & George L. Wehby, 2012. "Health Expenditures And Life Expectancy Around The World: A Quantile Regression Approach," Discussion Papers 47, Kyiv School of Economics.
    4. Wehby, George L. & Castilla, Eduardo E. & Lopez-Camelo, Jorge, 2010. "The impact of altitude on infant health in South America," Economics & Human Biology, Elsevier, vol. 8(2), pages 197-211, July.
    5. Mansour, Hani & Rees, Daniel I., 2012. "Armed conflict and birth weight: Evidence from the al-Aqsa Intifada," Journal of Development Economics, Elsevier, vol. 99(1), pages 190-199.
    6. Wehby, George L. & Courtemanche, Charles J., 2012. "The heterogeneity of the cigarette price effect on body mass index," Journal of Health Economics, Elsevier, vol. 31(5), pages 719-729.
    7. Sanglestsawai, Santi & Rejesus, Roderick M. & Yorobe, Jose M., 2014. "Do lower yielding farmers benefit from Bt corn? Evidence from instrumental variable quantile regressions," Food Policy, Elsevier, vol. 44(C), pages 285-296.
    8. Wehby, George L. & Murray, Jeffrey C. & Wilcox, Allen & Lie, Rolv T., 2012. "Smoking and body weight: Evidence using genetic instruments," Economics & Human Biology, Elsevier, vol. 10(2), pages 113-126.

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