Newborn health and the business cycle: The role of birth order

Perinatal health in Spain during and after the Great Recession: Educational selection into fertility as a protective factor in high unemployment contexts

Higher maternal resources have long been associated with superior birth outcomes. This study analyzes the potentially protective role of maternal educational selection into fertility in adverse macroeconomic contexts. We focus on the case of Spain, a country reaching record-high unemployment levels during the Great Recession starting in 2008. First, we examine whether selection into fertility of more educated mothers took place as province-level unemployment rates rose. Secondly, we assess whether maternal education mitigated the impact of higher unemployment levels on different birth outcomes. The analysis combines register data on the universe of live births with aggregate data on province-level unemployment. We cover the period 2007-2019 to ensure sufficient variability of unemployment rates and perform linear regression and linear probability models with fixed effects to hold constant unobserved heterogeneity across provinces. Findings indicate selection into fertility of mothers with university-level education in times of high unemployment. In addition, while unemployment rates did show an adverse impact on certain birth outcomes -birthweight, the occurrence of low and very low birthweight, and the risk of stillbirth - maternal education mitigated the observed relations. It was itself, moreover, consistently and independently associated with better perinatal health. We thus conclude that fertility selectivity by maternal education cushioned the impact of the adverse economic context derived from the Great Recession through two separate pathways.

The "Quiet Revolution" and the cesarean section in the United States

This paper estimates how changes in family structure and women's labor market attachment during the last fifty years have affected the incidence of cesarean delivery in the United States. Both sets of factors are strongly related to cesarean utilization, and have generally changed so as to increase the rate of cesarean delivery over time. Altogether, changes in these factors, complemented by demographic changes, raised the U.S. cesarean section rate by eleven percentage points since the late 1970s, nearly two-thirds of the increase over that period. Today's elevated cesarean section rate is in part a social phenomenon.

Does unemployment worsen babies' health? A tale of siblings, maternal behaviour, and selection

We study in-utero exposure to economic fluctuations on birth outcomes by exploiting geographical variation in the unemployment rate across local areas in England, and by comparing siblings born to the same mother. Using rich individual data from hospital administrative records for 2003-2012, babies' health is found to be strongly pro-cyclical. This overall result masks marked differences between babies born in the most affluent areas whose health at birth improves in a recession, and babies born in the average-to-lowest income deprived areas whose health deteriorates. Maternal alcohol consumption, smoking, and delay in the first antenatal care assessment - combined with parental income loss, are found to drive the results. While differences in maternal risky behaviours can explain the heterogenous effects.

Business Cycle and Public Health: The Moderating Role of Health Education and Digital Economy

The cyclicality of public health in the emerging market is underexplored in existing literature. In this study, we used a fixed effect model and provincial data to document how public health varies with the business cycle in China over the period of 2010-2019. The estimated results showed that the business cycle is negatively correlated with the mortality of infectious disease, a proxy variable of public health, thus indicating that public health exhibits a countercyclical pattern in China. Furthermore, we investigated the potential moderating role of public health education and digital economy development in the relationship between business cycle and public health. Our findings suggested that public health education and digital economy development can mitigate the damage of economic conditions on public health in China. Health education helps the public obtain more professional knowledge about diseases and then induces effective preventions. Compared with traditional economic growth, digital economy development can avoid environmental pollution which affects public health. Also, it ensures that state-of-the-art medical services are available for the public through e-health. In addition, digitalization assures that remote working is practicable and reduces close contact during epidemics such as COVID-19. The conclusions stand when subjected to several endogeneity and robustness checks. Therefore, the paper implies that these improvements in public health education and digitalization can help the government in promoting public health.

Postpartum medical utilization: The role of prenatal economic activity and living costs

This study is the first to explore the extent to which prenatal economic fluctuations affect postpartum outpatient care utilization during three-month, six-month, and one-year postpartum periods in Taiwan and to document their counter-cyclical patterns for economic activity and pro-cyclical patterns for the CPI change rate. We present evidence that medical care utilization occurring during the postpartum period is sensitive to economic activity within the first trimester of pregnancy and the CPI change rate within the second trimester. The findings herein reveal that negative prenatal economic shocks lead to a higher probability of cesarean section, more outpatient visits for depressive disorders, hypertension, gestational diabetes, and anemia in the pregnancy period, and a lower number of prenatal care visits that could deteriorate postpartum maternal health. Moreover, our results are consistent with low-salary and private-sector-employed mothers who face credit constraints and experience the risk of losing their job, respectively, during a decline in economic activity and who subsequently suffer from nutritional deficits and maternal stress that lead to postpartum health deterioration. Conversely, high-salary mothers do not face credit constraints and have greater coping ability to deal with stress and nutritional problems, while public-sector-employed mothers are affected only by nutrition.

The Effect of Business Cycles on Health Expenditure: A Story of Income Inequality in China

Using the panel data of 31 regions in China from 2002 to 2018, this study aims to investigate the effect of business cycles on health expenditure from the role of income inequality. We find that health expenditure experiences a change from pro-cyclical to counter-cyclical with business cycles. Specifically, business cycles have a different influence on health expenditure before and after the financial crisis in 2008. Our findings also show that income inequality can moderate the impact of business cycles on health expenditure in China. More importantly, the role of income inequality in the above issue varies from different regions. We conclude that the government should try to take active steps to control health expenditure by decreasing income inequality.

Does Economic Overheating Provide Positive Feedback on Population Health? Evidence From BRICS and ASEAN Countries

This paper explores the relationship of real GDP per capita with cancer incidence applying panel threshold regression model in BRICS and ASEAN countries. The empirical results highlight that the business cycle has an inverted-U correlation with population health indicators and a non-linear single threshold effect. In BRICS countries, the health-promoting effect of economic growth is significantly weaker when exceeding the threshold. Similarly, economic growth in ASEAN countries, even worsens population health, after the turning point. These asymmetric effects are strongly related to the response of regional economic globalization health policies. Changes in economic expansion and overheating may have serious adverse effects on health care systems in emerging economies. Governments should adopt more aggressive health care policies during economic overheating, to avoid wasting health care resources.

Political instability and birth outcomes: Evidence from the 1981 military coup in Spain

We study the effect of exposure to political instability in-utero on health at birth. We exploit the coup d'état that took place in Spain on February 23, 1981. Although short-lived and unsuccessful, the event generated stress and fear among the population, especially in areas that had suffered more repression during the Civil War and the recent dictatorship. We follow a difference-in-differences strategy and compare birth outcomes before and after the coup, in areas that were differentially "affected". We find that children who were in utero during the coup in more affected areas were born with significantly lower birth-weight (around 9 g lighter), especially if they were exposed to the coup in the first or second trimester of pregnancy. We contribute to the literature on the effects of maternal stress by focusing on an acute (and relatively common) source of distress that is unlikely to have affected newborn health via other channels.

When children have children: The effects of child marriages and teenage pregnancies on early childhood mortality in Bangladesh

This paper examines the adverse effects of adolescent childbearing on early childhood mortality in Bangladesh in mother-fixed-effects regressions using individual mortality outcomes of 300,000 children. Children born to young mothers (child brides in Bangladesh) suffer from higher mortality in the first year of life than their siblings born later. The survival chances of children born to mothers aged 15-49 years are 48-81 % higher in infant period as compared to their siblings born in mother's early adolescence (10-14 years). In poor households, these survival effects extend up to the fifth birthday, especially in the poorest households or among uneducated mothers. This evidence points towards a biological channel, probably low birth weight, as the main contributing factor in the first year of life. In the post-infant period, favorable socio-economic factors (wealth, education) seem to compensate the biological disadvantage of adolescent births. Adolescent pregnancies lead annually to estimated 18,700 under-5 deaths in Bangladesh.

The effect of budget cuts on C-section rates and birth outcomes: Evidence from Spain

Using data from Spain, we show the impact of significant health-sector budget cuts introduced in 2012 on the rates of cesarean sections and on infant health outcomes at birth, which we use as a proxy for the quality of birth centers. Exploiting a difference-in-differences fixed-effects approach at the hospital level, we estimate a 3% increase in C-sections as a result of the budget restrictions, with no significant consequences on health outcomes at birth. Given the additional evidence in the literature on the negative short- and long-term effects of non-medically indicated C-sections, our paper provides important policy implications for population health.

•

We show the impact of significant budget cuts in the health sector.

•

The outcomes we focus on are the rate of c-sections and infant health at birth.

•

We estimate a 3% increase in cesarean sections as a result of the budgetary cuts.

•

We find no significant consequences on health outcomes at birth.

Beyond the healthy immigrant paradox: decomposing differences in birthweight among immigrants in Spain

Background

The healthy immigrant paradox refers to the unexpected health advantages of immigrant groups settled in host countries. In this population-based study we analyze immigrant advantages in birthweight decomposing differences between infants born to immigrant mothers from specific origins.

Method

Using publicly available data from Spanish Vital Statistics for the period 2007–2017, differential birthweights among several groups of immigrants were estimated with an ordinary least squares regression. The Oaxaca–Blinder regression-based decomposition method was then applied to identify the extent to which differences in birthweight between groups corresponded to compositional disparities or to other factors.

Results

Our analysis of singleton live births to migrant mothers in Spain between 2007 and 2017 (N = 542,137) confirmed the healthy immigrant paradox for certain immigrant populations settled in Spain. Compared with infants born to mothers from high-income countries, the adjusted birthweight was higher for infants born to mothers from non-high- income European countries (33.2 g, 95% CI: 28.3–38.1, P < 0.01), mothers from African countries (52.2 g, 95% CI: 46.9–57.5, P < 0.01), and mothers from Latin American countries (57.4 g, 95% CI: 52.9–61.3, P < 0.01), but lower for infants born to mothers from Asian non-high-income countries (− 31.4 g, 95% CI: − 38.4 to − 24.3, P < 0.01). Decomposition analysis showed that when compared with infants born to mothers from high-income countries, compositional heterogeneity accounts for a substantial proportion of the difference in birthweights. For example, it accounts for 53.5% (95% CI: 24.0–29.7, P < 0.01) of the difference in birthweights for infants born to mothers from non-high-income European countries, 70.9% (95% CI: 60–66.7, P < 0.01) for those born to mothers from African countries, and 38.5% (95% CI: 26.1–29.3, P < 0.01) for those born to mothers from Latin American countries.

Conclusions

Our results provide strong population-based evidence for the healthy immigrant paradox in birthweight among certain migrant groups in Spain. However, birth outcomes vary significantly depending on the origins of migrant subpopulations, meaning that not all immigrant groups are unexpectedly healthier. A significant portion of the perinatal health advantage of certain immigrant groups is only a by-product of their group composition (by age, parity, marital status, socioeconomic status, and citizenship of mother, age and migratory status of father and type of delivery) and does not necessarily correspond to other medical, environmental, or behavioral factors.