Essays in Health Economics: Maternal and Infant Health

Abstract

This dissertation consists of three papers that examine the impact of policies and shocks to healthcare on the take-up of care and the health of mothers, infants, and reproductive-aged women. The first chapter studies the effect of increasing access to healthcare providers on birthing location decisions and health. Home births in the US have increased twofold since the early 2000s, yet little is known about the policies that have driven the increase. In this chapter, I use natality data from 1989 to 2021 to estimate relative changes in the prevalence of home birth and subsequent health outcomes before and after state legislation licensing non-nurse midwives. Staggered difference-in-differences estimates indicate a 20-30 percent increase in home births when states increase provider choice through non-nursing midwifery licensing. I find the change in access is most salient for college-educated women, low-risk pregnancies, and those who pay out of pocket. Overall, I find little evidence of an effect on infant or maternal health measures. The second chapter studies how increasing access to contraceptives for low-income women affects childbearing. We focus on the setting of the Virginia Contraceptive Access Initiative (CAI), which provided funding for family planning clinics to offer no-cost long-acting reversible contraceptives (LARCs) and other contraceptive devices to low-income women in Virginia from 2018 to 2023. We show that when more Virginia clinics had funding to provide free contraceptive devices, LARC take-up increased. Then, using difference-in-differences, we show that implementing the CAI in Virginia, a state with existing low consumer-facing prices and high baseline LARC take-up rates, reduced birth rates by approximately 2.2 percent, with larger effects for women over the age of 25. In the third chapter of my dissertation, I estimate the impact of changes to care quality during pregnancy on maternal and infant health. Specifically, I study state implementation of Perinatal Quality Collaboratives (PQCs) that aim to improve health through interventions at hospitals within the state. I provide evidence that PQCs improve the quality of care received by non-Hispanic Black mothers, evident by decreased rates of eclampsia and ICU admissions.