Prenatal care demand and its effects on birth outcomes by birth defect status in Argentina

George L Wehby; Jeffrey C Murray; Eduardo E Castilla; Jorge S Lopez-Camelo; Robert L Ohsfeldt

doi:10.1016/j.ehb.2008.10.001

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Prenatal care demand and its effects on birth outcomes by birth defect status in Argentina

Journal article

Open access

Peer reviewed

Prenatal care demand and its effects on birth outcomes by birth defect status in Argentina

George L Wehby, Jeffrey C Murray, Eduardo E Castilla, Jorge S Lopez-Camelo and Robert L Ohsfeldt

Economics and human biology, Vol.7(1), pp.84-95

2009

DOI: 10.1016/j.ehb.2008.10.001

PMCID: PMC2680816

PMID: 19059012

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Abstract

Our objective was to identify determinants of prenatal care demand and evaluate the effects of this demand on low birth weight and preterm birth. Delay in initiating prenatal care was modeled as a function of pregnancy risk indicators, enabling factors, and regional characteristics. Conditional maximum likelihood (CML) estimation was used to model self-selection into prenatal care use when estimating its effectiveness. Birth registry data was collected post delivery on infants with and without common birth defects born in 1995–2002 in Argentina using a standard procedure. Several maternal health and fertility indicators had significant effects on prenatal care use. In the group without birth defects, prenatal care delay increased significantly LBW and preterm birth when accounting for self-selection using the CML model but not in the standard probit model. Prenatal care was found to be ineffective on average in the birth defect group. The self-selection of higher risk women into earlier initiation of prenatal care resulted in underestimation of prenatal care effectiveness when using a standard probit model with several covariates. Large improvements in birth outcomes are suggested with earlier initiation of prenatal care for pregnancies uncomplicated with birth defects in Argentina, implying large opportunity costs from the long waiting time observed in this sample (about 17 weeks on average). The suggested ineffectiveness for pregnancies complicated with common birth defects deserves further research.

South America

Argentina

Preterm birth

Birth outcomes

Low birth weight

Health production

Conditional maximum likelihood

Prenatal care

Details

Title: Subtitle: Prenatal care demand and its effects on birth outcomes by birth defect status in Argentina
Creators: George L Wehby - Department of Health Management and Policy, College of Public Health, University of Iowa, E204, GH, Iowa City, IA 52242, USA
Jeffrey C Murray - University of Iowa, College of Medicine, Department of Pediatrics, Iowa City, IA, USA
Eduardo E Castilla - ECLAMC (Latin American Collaborative Study of Congenital Malformations) at CEMIC, Buenos Aires, Argentina, ECLAMC at Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
Jorge S Lopez-Camelo - ECLAMC at Imbice, La Plata, Argentina
Robert L Ohsfeldt - Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
Resource Type: Journal article
Publication Details: Economics and human biology, Vol.7(1), pp.84-95
DOI: 10.1016/j.ehb.2008.10.001
PMID: 19059012
PMCID: PMC2680816
NLM abbreviation: Econ Hum Biol
ISSN: 1570-677X
eISSN: 1873-6130
Publisher: Elsevier B.V
Language: English
Date published: 2009
Academic Unit: Preventive and Community Dentistry; Anatomy and Cell Biology; Health Management and Policy; Stead Family Department of Pediatrics; Epidemiology; Economics; Pediatric Dentistry; Craniofacial Anomalies Research Center; Public Policy Center (Archive); Dental Research
Record Identifier: 9984025335002771

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