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Growing together: assessing equity and efficiency in a prenatal health program

Author

Listed:
  • Damian Clarke

    (Universidad de Santiago de Chile (USACH)
    IZA)

  • Gustavo Cortés Méndez

    (Universidad de Santiago de Chile (USACH))

  • Diego Vergara Sepúlveda

    (Universidad de Santiago de Chile (USACH))

Abstract

We study the acting mechanism of an early-life social safety net program and quantify its impact on child health outcomes at birth. We consider both the equity and efficiency implications of program impacts and provide a metric to compare such programs around the world. In particular, we estimate the impact of participation in Chile Crece Contigo (ChCC), Chile’s flagship early-life health and social welfare program, using a difference-in-differences style model based on variation in program intensity and administrative birth data matched to social benefits usage. We find that this targeted social program had significant effects on birth weight (approximately 10 grams) and other early-life human capital measures. These benefits are largest among the most socially vulnerable groups but shift outcomes toward the middle of the distribution of health at birth. We show that the program is efficient when compared to other successful neonatal health programs around the world and find some evidence to suggest that maternal nutrition components and increased links to the social safety net are important action mechanisms.

Suggested Citation

  • Damian Clarke & Gustavo Cortés Méndez & Diego Vergara Sepúlveda, 2020. "Growing together: assessing equity and efficiency in a prenatal health program," Journal of Population Economics, Springer;European Society for Population Economics, vol. 33(3), pages 883-956, July.
  • Handle: RePEc:spr:jopoec:v:33:y:2020:i:3:d:10.1007_s00148-019-00761-6
    DOI: 10.1007/s00148-019-00761-6
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    1. Heather Royer, 2009. "Separated at Girth: US Twin Estimates of the Effects of Birth Weight," American Economic Journal: Applied Economics, American Economic Association, vol. 1(1), pages 49-85, January.
    2. Justin Cook, C. & Fletcher, Jason M., 2015. "Understanding heterogeneity in the effects of birth weight on adult cognition and wages," Journal of Health Economics, Elsevier, vol. 41(C), pages 107-116.
    3. Joseph P. Romano & Michael Wolf, 2005. "Stepwise Multiple Testing as Formalized Data Snooping," Econometrica, Econometric Society, vol. 73(4), pages 1237-1282, July.
    4. Alderman, Harold & Lokshin, Michael & Radyakin, Sergiy, 2011. "Tall claims : mortality selection and the height of children," Policy Research Working Paper Series 5846, The World Bank.
    5. Angus Deaton, 2003. "Health, Inequality, and Economic Development," Journal of Economic Literature, American Economic Association, vol. 41(1), pages 113-158, March.
    6. Gerard J. van den Berg & Maarten Lindeboom & France Portrait, 2006. "Economic Conditions Early in Life and Individual Mortality," American Economic Review, American Economic Association, vol. 96(1), pages 290-302, March.
    7. Pedro Carneiro & Emanuela Galasso & Rita Ginja, 2019. "Tackling Social Exclusion: Evidence from Chile," Economic Journal, Royal Economic Society, vol. 129(617), pages 172-208.
    8. James Heckman & Flavio Cunha, 2007. "The Technology of Skill Formation," American Economic Review, American Economic Association, vol. 97(2), pages 31-47, May.
    9. Alderman, Harold & Lokshin, Michael & Radyakin, Sergiy, 2011. "Tall claims: Mortality selection and the height of children in India," Economics & Human Biology, Elsevier, vol. 9(4), pages 393-406.
    10. Damian Clarke & Sonia Oreffice & Climent Quintana-Domeque, 2017. "On the Value of Birth Weight," Working Papers 2017-018, Human Capital and Economic Opportunity Working Group.
    11. Douglas Almond & Joseph J. Doyle & Amanda E. Kowalski & Heidi Williams, 2010. "Estimating Marginal Returns to Medical Care: Evidence from At-risk Newborns," The Quarterly Journal of Economics, Oxford University Press, vol. 125(2), pages 591-634.
    12. Sonia Bhalotra & Damian Clarke, 2019. "Twin Birth and Maternal Condition," The Review of Economics and Statistics, MIT Press, vol. 101(5), pages 853-864, December.
    13. Jonah B. Gelbach, 2016. "When Do Covariates Matter? And Which Ones, and How Much?," Journal of Labor Economics, University of Chicago Press, vol. 34(2), pages 509-543.
    14. Sebastian Calonico & Matias D. Cattaneo & Rocio Titiunik, 2014. "Robust Nonparametric Confidence Intervals for Regression‐Discontinuity Designs," Econometrica, Econometric Society, vol. 82, pages 2295-2326, November.
    15. Hilary Hoynes & Doug Miller & David Simon, 2015. "Income, the Earned Income Tax Credit, and Infant Health," American Economic Journal: Economic Policy, American Economic Association, vol. 7(1), pages 172-211, February.
    16. Hoynes, Hilary & Page, Marianne & Stevens, Ann Huff, 2011. "Can targeted transfers improve birth outcomes?: Evidence from the introduction of the WIC program," Journal of Public Economics, Elsevier, vol. 95(7-8), pages 813-827, August.
    17. Flavio Cunha & James J. Heckman, 2009. "The Economics and Psychology of Inequality and Human DEvelopment," Journal of the European Economic Association, MIT Press, vol. 7(2-3), pages 320-364, 04-05.
    18. Black, Sandra E. & Devereux, Paul J. & Salvanes, Kjell G., 2014. "Does grief transfer across generations? In-utero deaths and child outcomes," Discussion Paper Series in Economics 23/2014, Norwegian School of Economics, Department of Economics.
    19. Flavio Cunha & James J. Heckman & Susanne M. Schennach, 2010. "Estimating the Technology of Cognitive and Noncognitive Skill Formation," Econometrica, Econometric Society, vol. 78(3), pages 883-931, May.
    20. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769, April.
    21. Rossin-Slater, Maya, 2013. "WIC in your neighborhood: New evidence on the impacts of geographic access to clinics," Journal of Public Economics, Elsevier, vol. 102(C), pages 51-69.
    22. Case, Anne & Fertig, Angela & Paxson, Christina, 2005. "The lasting impact of childhood health and circumstance," Journal of Health Economics, Elsevier, vol. 24(2), pages 365-389, March.
    23. Arindam Nandi & Ramanan Laxminarayan, 2016. "The unintended effects of cash transfers on fertility: evidence from the Safe Motherhood Scheme in India," Journal of Population Economics, Springer;European Society for Population Economics, vol. 29(2), pages 457-491, April.
    24. Orazio P. Attanasio & Vincenzo Di Maro & Marcos Vera‐Hernández, 2013. "Community Nurseries and the Nutritional Status of Poor Children. Evidence from Colombia," Economic Journal, Royal Economic Society, vol. 123, pages 1025-1058, September.
    25. A. Colin Cameron & Douglas L. Miller, 2015. "A Practitioner’s Guide to Cluster-Robust Inference," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 317-372.
    26. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, Oxford University Press, vol. 119(1), pages 249-275.
    27. Marianne P. Bitler & Lynn A. Karoly, 2015. "Intended And Unintended Effects Of The War On Poverty: What Research Tells Us And Implications For Policy," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 34(3), pages 639-696, June.
    28. Anderson, Michael L., 2008. "Multiple Inference and Gender Differences in the Effects of Early Intervention: A Reevaluation of the Abecedarian, Perry Preschool, and Early Training Projects," Journal of the American Statistical Association, American Statistical Association, vol. 103(484), pages 1481-1495.
    29. Douglas Almond & Hilary W. Hoynes & Diane Whitmore Schanzenbach, 2011. "Inside the War on Poverty: The Impact of Food Stamps on Birth Outcomes," The Review of Economics and Statistics, MIT Press, vol. 93(2), pages 387-403, May.
    30. Arindam Nandi & Ramanan Laxminarayan, 2016. "The unintended effects of cash transfers on fertility: evidence from the Safe Motherhood Scheme in India," Journal of Population Economics, Springer;European Society for Population Economics, vol. 29(2), pages 457-491, April.
    31. Andrea Bentancor & Damian Clarke, 2017. "Assessing Plan B: The Effect of the Morning After Pill on Children and Women," Economic Journal, Royal Economic Society, vol. 127(607), pages 2525-2552, December.
    32. Barham, Tania, 2011. "A healthier start: The effect of conditional cash transfers on neonatal and infant mortality in rural Mexico," Journal of Development Economics, Elsevier, vol. 94(1), pages 74-85, January.
    33. Hilary Hoynes & Diane Whitmore Schanzenbach & Douglas Almond, 2016. "Long-Run Impacts of Childhood Access to the Safety Net," American Economic Review, American Economic Association, vol. 106(4), pages 903-934, April.
    34. Damian Clarke, 2016. "RWOLF: Stata module to calculate Romano-Wolf stepdown p-values for multiple hypothesis testing," Statistical Software Components S458276, Boston College Department of Economics, revised 08 Jul 2020.
    35. McCrary, Justin, 2008. "Manipulation of the running variable in the regression discontinuity design: A density test," Journal of Econometrics, Elsevier, vol. 142(2), pages 698-714, February.
    36. Prashant Bharadwaj & Katrine Vellesen L?ken & Christopher Neilson, 2013. "Early Life Health Interventions and Academic Achievement," American Economic Review, American Economic Association, vol. 103(5), pages 1862-1891, August.
    37. Jere R. Behrman & Mark R. Rosenzweig, 2004. "Returns to Birthweight," The Review of Economics and Statistics, MIT Press, vol. 86(2), pages 586-601, May.
    38. Fletcher, Jason M., 2011. "The medium term schooling and health effects of low birth weight: Evidence from siblings," Economics of Education Review, Elsevier, vol. 30(3), pages 517-527, June.
    39. Natalie Malak & Md Mahbubur Rahman & Terry A. Yip, 2019. "Baby bonus, anyone? Examining heterogeneous responses to a pro-natalist policy," Journal of Population Economics, Springer;European Society for Population Economics, vol. 32(4), pages 1205-1246, October.
    40. Flavio Cunha & James J. Heckman, 2009. "The Economics & Psychology of Inequality and Human Development," Working Papers 200905, Geary Institute, University College Dublin.
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    More about this item

    Keywords

    Public health; Neonatal health; Social security; Efficiency; Early-life investments;
    All these keywords.

    JEL classification:

    • H23 - Public Economics - - Taxation, Subsidies, and Revenue - - - Externalities; Redistributive Effects; Environmental Taxes and Subsidies
    • O15 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Economic Development: Human Resources; Human Development; Income Distribution; Migration
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • H43 - Public Economics - - Publicly Provided Goods - - - Project Evaluation; Social Discount Rate
    • O38 - Economic Development, Innovation, Technological Change, and Growth - - Innovation; Research and Development; Technological Change; Intellectual Property Rights - - - Government Policy
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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