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Did Smallpox Cause Stillbirths? Maternal Smallpox Infection, Vaccination and Stillbirths in Sweden, 1780-1839

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  • Schneider, Eric
  • Edvinsson, Sören
  • Ogasawara, Kota

Abstract

Woods (2009) argued that smallpox was an important cause of stillbirths in the past. While there is strong evidence that maternal smallpox infection could lead to fetal loss, it is not clear whether smallpox infections were a demographically important source of stillbirths. In this paper, we use parish-level data from the Swedish Tabellverket dataset from 1780 to 1839 to test the effect of smallpox on stillbirths quantitatively. We use two empirical strategies: dynamic panel regressions that test the instantaneous effect of smallpox epidemics on stillbirths; and a continuous treatment difference-in-difference strategy to test whether the reduction in smallpox prevalence following vaccination led to a larger decrease in the stillbirth rate in parishes where smallpox was more prevalent before vaccination. We find very little evidence that smallpox infection was a major cause of stillbirths in history. Our coefficients are largely insignificant and close to zero. This is because the vast majority of women contracted smallpox as children and therefore were no longer susceptible during pregnancy. We do find a small, statistically significant effect of smallpox on stillbirths from 1820-39 when waning immunity from vaccination put a greater share of pregnant women at risk of contracting smallpox. However, the reduced prevalence of smallpox limited the demographic impact. Thus, smallpox was not an important driver in historical stillbirth trends and did not contribute to in utero scarring effects for cohorts born when smallpox prevalence was high.

Suggested Citation

  • Schneider, Eric & Edvinsson, Sören & Ogasawara, Kota, 2022. "Did Smallpox Cause Stillbirths? Maternal Smallpox Infection, Vaccination and Stillbirths in Sweden, 1780-1839," CEPR Discussion Papers 17274, C.E.P.R. Discussion Papers.
  • Handle: RePEc:cpr:ceprdp:17274
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    1. Philipp Ager & Casper Worm Hansen & Peter Sandholt Jensen, 2018. "Fertility and Early-Life Mortality: Evidence from Smallpox Vaccination in Sweden," Journal of the European Economic Association, European Economic Association, vol. 16(2), pages 487-521.
    2. Romola J. Davenport & Jeremy Boulton & Leonard Schwarz, 2016. "Urban inoculation and the decline of smallpox mortality in eighteenth-century cities—a reply to Razzell," Economic History Review, Economic History Society, vol. 69(1), pages 188-214, February.
    3. Jonas Helgertz & Tommy Bengtsson, 2019. "The Long-Lasting Influenza: The Impact of Fetal Stress During the 1918 Influenza Pandemic on Socioeconomic Attainment and Health in Sweden, 1968–2012," Demography, Springer;Population Association of America (PAA), vol. 56(4), pages 1389-1425, August.
    4. Brian Beach & Ryan Brown & Joseph Ferrie & Martin Saavedra & Duncan Thomas, 2022. "Reevaluating the Long-Term Impact of In Utero Exposure to the 1918 Influenza Pandemic," Journal of Political Economy, University of Chicago Press, vol. 130(7), pages 1963-1990.
    5. Tommy Bengtsson, 1999. "The Vulnerable Child. Economic Insecurity and Child Mortality in Pre-Industrial Sweden: A Case Study of Västanfors, 1757--1850," European Journal of Population, Springer;European Association for Population Studies, vol. 15(2), pages 117-151, June.
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    More about this item

    Keywords

    Stillbirth; Fetal death; Smallpox; Vaccination; Historical demography;
    All these keywords.

    JEL classification:

    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • N34 - Economic History - - Labor and Consumers, Demography, Education, Health, Welfare, Income, Wealth, Religion, and Philanthropy - - - Europe: 1913-

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