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Self-Selection, Prenatal Care, and Birthweight Among Blacks, Whites and Hispanics in New York City

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  • Theodore Joyce

Abstract

Most research on birth outcomes has found a direct relationship between appropriate prenatal care and increased birthweight. Researchers concede, however, that without a randomized design, which is clearly unethical, one cannot determine how much of the association is due to the medical intervention and how much is due to the characteristics of the women receiving the care. In short, the degree of selection bias is unknown and potentially substantial. In this paper we test for selection bias and estimate its direction and magnitude. We find that adjusted mean differences in birthweight between women who obtain intermediate as opposed to inadequate prenatal care substantially underestimate the effects of care that would be observed under random assignment. In particular, ordinary least squares estimates indicate that the gains to intermediate care are 113 grams for black infants, 76 grams for white infants and 92 grams for Hispanic infants. Under random assignment, black infants would experience gains of 130 grams, whites 234 grams, and Hispanics 183 grams. The gains for adequate as opposed to intermediate care are relatively minor. The results point to adverse selection in the demand for prenatal care.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 3549.

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Date of creation: Dec 1990
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Publication status: published as Journal of Human Resources, Vol. 29, no. 3, Summer 1994, pp. 762-794
Handle: RePEc:nbr:nberwo:3549

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  1. Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, National Bureau of Economic Research, Inc, number gros72-1.
  2. Hope Corman & Theodore J. Joyce & Michael Grossman, 1985. "Birth Outcome Production Functions in the U.S," NBER Working Papers 1729, National Bureau of Economic Research, Inc.
  3. Thomas Mroz, . "The Sensitivity of an Empirical Model of Married Women's Hours of Work to Economic and Statistical Assumptions," University of Chicago - Population Research Center, Chicago - Population Research Center 84-8, Chicago - Population Research Center.
  4. Heckman, James J, 1979. "Sample Selection Bias as a Specification Error," Econometrica, Econometric Society, Econometric Society, vol. 47(1), pages 153-61, January.
  5. Newey, W.K. & Powell, J.L. & Walker, J.R., 1990. "Semiparametric Estimation Of Selection Models: Some Empirical Results," Working papers, Wisconsin Madison - Social Systems 9001, Wisconsin Madison - Social Systems.
  6. Mark R. Rosenzweig & T. Paul Schultz, 1982. "The Behavior of Mothers as Inputs to Child Health: The Determinants of Birth Weight, Gestation, and Rate of Fetal Growth," NBER Chapters, National Bureau of Economic Research, Inc, in: Economic Aspects of Health, pages 53-92 National Bureau of Economic Research, Inc.
  7. Hope Corman & Theodore J. Joyce & Michael Grossman, 1987. "Birth Outcome Production Function in the United States," Journal of Human Resources, University of Wisconsin Press, vol. 22(3), pages 339-360.
  8. Jeffrey E. Harris, 1982. "Prenatal Medical Care and Infant Mortality," NBER Chapters, National Bureau of Economic Research, Inc, in: Economic Aspects of Health, pages 13-52 National Bureau of Economic Research, Inc.
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Cited by:
  1. Michael Grossman, 1999. "The Human Capital Model of the Demand for Health," NBER Working Papers 7078, National Bureau of Economic Research, Inc.
  2. Resul Cesur & Inas Rashad, 2008. "High Birth Weight and Cognitive Outcomes," NBER Working Papers 14524, National Bureau of Economic Research, Inc.
  3. George L. Wehby & Jeffrey C. Murray & Eduardo E. Castilla & Jorge S. Lopez-Camelo & Robert L. Ohsfeldt, 2009. "Quantile effects of prenatal care utilization on birth weight in Argentina," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 18(11), pages 1307-1321.
  4. Nastis, Stefanos A. & Crocker, Thomas D., 2012. "Valuing mother and child health: The intrauterine environment," Economics & Human Biology, Elsevier, Elsevier, vol. 10(3), pages 318-328.
  5. Robert Kaestner & Theodore Joyce & Hassan Wehbeh, 1996. "The Effect of Maternal Drug Use on Birth Weight: Measurement Error in Binary Variables," NBER Working Papers 5434, National Bureau of Economic Research, Inc.
  6. Conway, Karen Smith & Deb, Partha, 2005. "Is prenatal care really ineffective? Or, is the 'devil' in the distribution?," Journal of Health Economics, Elsevier, Elsevier, vol. 24(3), pages 489-513, May.
  7. Adjiwanou, Vissého & LeGrand, Thomas, 2013. "Does antenatal care matter in the use of skilled birth attendance in rural Africa: A multi-country analysis," Social Science & Medicine, Elsevier, Elsevier, vol. 86(C), pages 26-34.
  8. Habibov, Nazim N. & Fan, Lida, 2011. "Does prenatal healthcare improve child birthweight outcomes in Azerbaijan? Results of the national Demographic and Health Survey," Economics & Human Biology, Elsevier, Elsevier, vol. 9(1), pages 56-65, January.
  9. Ellen Meara, 2001. "Why is Health Related to Socioeconomic Status?," NBER Working Papers 8231, National Bureau of Economic Research, Inc.
  10. O'Neill June E & O'Neill Dave M, 2008. "Health Status, Health Care and Inequality: Canada vs. the U.S," Forum for Health Economics & Policy, De Gruyter, De Gruyter, vol. 10(1), pages 1-45, April.
  11. Michele Ploeg, 2009. "Do Benefits of U.S. Food Assistance Programs for Children Spillover to Older Children in the Same Household?," Journal of Family and Economic Issues, Springer, Springer, vol. 30(4), pages 412-427, December.
  12. Wehby, George L. & Murray, Jeffrey C. & Castilla, Eduardo E. & Lopez-Camelo, Jorge S. & Ohsfeldt, Robert L., 2009. "Prenatal care demand and its effects on birth outcomes by birth defect status in Argentina," Economics & Human Biology, Elsevier, Elsevier, vol. 7(1), pages 84-95, March.
  13. Evans, William N. & Lien, Diana S., 2005. "The benefits of prenatal care: evidence from the PAT bus strike," Journal of Econometrics, Elsevier, Elsevier, vol. 125(1-2), pages 207-239.

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