Journal article
Obstetric Unit Closure Effects on Child Academic Achievement, Infant Health, and Maternal Care
Maternal and child health journal, Vol.29, pp.825-834
06/12/2025
DOI: 10.1007/s10995-025-04112-8
PMCID: PMC12206179
PMID: 40506613
Appears in UI Libraries Support Open Access
Abstract
To examine effects of obstetric unit closures on children's academic achievement, infant health, and maternal care outcomes.
This retrospective cohort study employs 1994-2009 birth certificate data from Iowa linked to school test scores for grades 2-11 through 2017-2018. Regressions based on two-way fixed effects (TWFE) and Callaway and Sant'Anna (C&S) difference-in-differences models estimate the effects of maternal residence in counties that had obstetric unit closures within 5 years before birth year. Outcomes are national percentile rankings (NPRs) on math and reading, gestational age, preterm birth, birthweight, low birthweight, prenatal visits, cesarean delivery, and labor induction.
The sample included 2,414,393-2,424,184 child-grade observations and 379,772-381,228 children depending on the outcome. TWFE estimates were - 0.66 (95% CI: - 1.48, 0.15) NPRs for math and - 0.86 (95% CI: - 1.93, 0.21) NPRs for reading. C&S estimates were - 0.88 (95% CI: - 4.48, 2.72) NPRs for math and 0.30 (95% CI: - 4.93, 5.52) NPRs for reading. Closure associations with gestational age were - 0.1 (95% CI: - 0.17, - 0.028) and - 0.09 weeks (95% CI: - 0.28, 0.09) in the TWFE and C&S models, respectively; associations with birthweight were - 33 g (95% CI: - 59, - 7) and - 2 g (95% CI: - 57, 54), respectively. Associations with other infant health and maternal outcomes were small and not statistically significant.
There is overall little evidence that obstetric unit closure within 5 years before birth impact children's math and reading scores and infant health and maternal care outcomes. Future research can evaluate how closures affect care continuity and access and potential heterogeneity including by maternal health risks and pregnancy complications.
Details
- Title: Subtitle
- Obstetric Unit Closure Effects on Child Academic Achievement, Infant Health, and Maternal Care
- Creators
- George L Wehby - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Maternal and child health journal, Vol.29, pp.825-834
- DOI
- 10.1007/s10995-025-04112-8
- PMID
- 40506613
- PMCID
- PMC12206179
- NLM abbreviation
- Matern Child Health J
- ISSN
- 1573-6628
- eISSN
- 1573-6628
- Publisher
- Springer Nature
- Grant note
- Bill and Melinda Gates Foundation The author thanks Dr. Timothy Ansley, Dr. Steven Dunbar, Mr. Fred Ullrich, and Dr. Catherine Welsh for invaluable assistance with data access and linkages. Dr. Wehby had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
- Language
- English
- Date published
- 06/12/2025
- Academic Unit
- Preventive and Community Dentistry; Health Management and Policy; Economics
- Record Identifier
- 9984830611902771
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