Essays on Public Policy and Birth Outcomes
Early life health has been shown to influence later socioeconomic and health outcomes. In fact, economists have been leading the way in documenting these effects. The growing interest in the determinants of early life health is not surprising given the wide-ranging implications for public policy. In my dissertation, I focus on a period that is critical to early life health, gestation and birth, and explore how maternal health behaviors during pregnancy and childbirth practices affect newborn health. In the first chapter, "Early Elective Deliveries and Birth Outcomes: Evidence from Oregon's Hard-Stop Policy", I use a statewide policy as a quasi-experiment to examine the effect of early and medically unnecessary cesareans and inductions on birth outcomes. In 2011, Oregon hospitals committed to a voluntary Hard-Stop Policy to eliminate early elective deliveries, resulting in a 30 percent decline in the practice among mothers with the highest risk of having an early elective delivery. This decline is followed by an increase in gestational age and birth weight, however, there was no change in Neonatal Intensive Care Unit (NICU) admissions, the use of assisted ventilation, or the prevalence of low Apgar score after the implementation of the Policy. A key contribution of this paper is the explicit illustration of the behavioral response to the Hard-Stop Policy, a shift in elective cesareans from the 38th to 39th week of pregnancy, which left the overall cesarean rate unchanged and was mainly responsible for the lack of an improvement in the prevalence of neonatal complications. The second chapter, "What to Expect When You're Labeling? Calorie Labeling's Impact on Weight Gain during Pregnancy and Birth Outcomes", is co-authored with Rodrigo Aranda Balcazar, and uses calorie-labeling laws to investigate the effect of information disclosure on health behavior and outcomes in the context of pregnancy and childbirth. We find a 4.6 percent decline in maternal weight gain during pregnancy followed by a decrease in gestational hypertension after the enactment of these laws. We argue that providing mothers with information and raising awareness about the consequences of their choices should be an integral part of maternal and child health policies. The third chapter, "Prescription Drug Monitoring Programs and Newborn Health", is a joint project with Kevin Callison and Abraham Asfaw. The incidence of maternal opioid use has increased dramatically over the past decade, however the consequences for newborn health of policies aimed at curbing opioid misuse are unknown. We estimate the effect of Prescription Drug Monitoring Programs (PDMPs) and pain clinic regulations on newborn health and substance abuse treatment facility admissions for pregnant women. We find only weak evidence that PDMPs affect newborn health and we provide suggestive evidence for one possible mechanism: substitution from opioid use to heroin use.