The Effects of Unemployment on Childbearing

Are recessions good for pregnancy? In this paper, I investigate the relationship between unemployment fluctuations, prenatal care utilization, and infant and maternal health. Analyzing the US Natality Detail Files data for the period 1989-99 aggregated by county, year, and race, I find the overall effects of unemployment to be beneficial but conclude that at least some of the apparent benefits may be attributable to the Medicaid 'safety net'.Unemployment; Prenatal Care; Infant and Maternal Health

The economics of childbearing: Three essays

Expenditure programs, business cycles, and government interventions can affect many decisions surrounding the birth of a child. For example, public insurance programs such as Medicaid have the potential to increase the utilization of prenatal care. This, in turn, may lead to better infant and maternal health outcomes. Given the high and increasing number of pregnant women covered by Medicaid, the effectiveness of the program in promoting prenatal care use and improving health needs to be evaluated. Also, the impacts of business cycles on childbearing are of interest to policymakers. For example, does unemployment substantially affect the decision to conceive a child or the ability to obtain appropriate medical services? And, if so, are infant and maternal health outcomes compromised during economic downturns? A well-informed government can design policies to help deal with issues such as these. Government interventions, however, can have unintended (and potentially harmful) consequences as well. For example, several recent economics papers have demonstrated that fiscal policies may affect fertility and the timing of delivery. Understanding the incentives embedded in government programs and assessing the responsiveness of individual behavior to these incentives is therefore key. My dissertation consists of three essays in which I investigate an important understudied aspect of the Medicaid program, inform policymakers about the impacts of unemployment on prenatal care use, infant and maternal health, and add to our understanding of the unintended effects of government interventions on the timing of births

What About Mom? The Forgotten Beneficiary of the Medicaid Expansions

This paper contributes to evidence regarding the effectiveness of the Medicaid expansions by focusing on a key beneficiary - the mother - who has previously been overlooked. Using the Natality Detail Files for 1989-96, we estimate the relationship between Medicaid eligibility and maternal health outcomes for several treatment groups and a control group. Potential biases caused by improved reporting are addressed by using a 'straw man' maternal complication not preventable with prenatal care. Our results suggest that increased Medicaid eligibility lead to fewer preventable maternal complications among women most likely to have benefited from the Medicaid expansions.Maternal health; Medicaid; Prenatal care

Paternity Deferments and the Timing of Births: U.S. Natality During the Vietnam War

During the conflict in Vietnam, married men with dependents could obtain a deferment from the draft. In 1965, following President Johnson's Executive Order 11241 and a subsequent Selective Service System announcement, the particulars of this policy changed substantially in a way which provided strong incentives for childless American couples to conceive a first-born child. This study examines the effects of the intervention on the decision to start a family. In my empirical analysis, I extract data from the Vital Statistics for the period 1963-1968 and employ a difference-in-differences methodology. The estimated magnitude of the effect is substantial.Timing of Births; Draft; Vietnam War

Local Alcohol Policies in New Zealand: An overview of their implementation and effects on crime

We document the implementation of local alcohol policies in New Zealand and then study their impacts on crime. A key contribution of our study is that we construct a detailed data set on local alcohol policies applicable across territorial authorities between July 2014 and January 2019. To our knowledge, we are the first ones to provide such a comprehensive overview. In a subsequent analysis, we find that local alcohol policies as recently implemented in New Zealand do not appear to have reduced crime. This result holds for specific policy dimensions and their stringency (e.g., closing times and geographic restrictions on issuing new licences), and is reasonably robust across crime types, days/times of occurrence, and socioeconomic subgroups. Our failure to identify significant reductions in crime following the imposition of local alcohol policies may partly reflect the policies being non-binding in some cases: for example, licensed premises had sometimes already operated within the restricted trading hours specified by a local alcohol policy

Maternal Stress and Birth Outcomes: Evidence from an Unexpected Earthquake Swarm

We examine the impact of a major earthquake that unexpectedly affected the Canterbury region of New Zealand on a wide-range of birth outcomes, including birth weight, gestational age and an indicator of general newborn health. We control for observed and unobserved differences between pregnant women in the area affected by the earthquake and other pregnant women by including mother fixed effects in all of our regression models. We extend the previous literature by comparing the impact of the initial unexpected earthquake to the impacts of thousands of aftershocks that occurred in the same region over the 18 months following the initial earthquake. We find that exposure to these earthquakes reduced gestational age, increased the likelihood of having a late birth and negatively affected newborn health - with the largest effects for earthquakes that occurred in the first and third trimesters of pregnancy. Our estimates are similar when we focus on just the impact of the initial earthquake or, in contrast, on all earthquakes controlling for endogenous location decisions using an instrumental variables approach. This suggests that the previous estimates in the literature that use this approach are likely unbiased and that treatment effects are homogenous in the population. We present supporting evidence that the likely channel for these adverse effects is maternal stress

The incidence and costs of sepsis and pneumonia before and after renal transplantation in the United States.

Abstract We compared the graft survival and accumulative costs associated with sepsis and pneumonia pre- and post-transplantation. We analyzed 44 916 first kidney transplants from 1995 to 2001 USRDS where Medicare was the primary payer. We drew five cohorts for each disease from the baseline population: patients who had a disease onset in the first or second years pre-transplantation (cohorts 1 and 2) or post-transplantation (cohorts 3 and 4) and patients who were disease-free (cohort 5). For each cohort, we calculated graft survival and average accumulated Medicare payments (AAMPs) for the two pre- and post-transplantation years. Graft survival: new-onset sepsis and pneumonia both significantly (p \u3c0.01) lowered graft survival during the year of onset. AAMPs: the AAMPs incurred by sepsis- (pneumonia-) free patients during the first and second years post-transplantation were $50 000 and 13 000 ($51 100 and 13 500), respectively. Patients with a sepsis (pneumonia) onset post-transplantation cost on average $48 400 ($38 400) extra (p\u3c0.01). Episodes of sepsis and pneumonia have a strong and independent impact on graft survival and costs