MEASURING THE BENEFIT OF PRENATAL CARE IN A LESS-DEVELOPED COUNTRY: SEMI-PARAMETRIC ESTIMATES FROM URUGUAY by ProQuest

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This study extends extant research on prenatal care and birthweight to the South American country of Uruguay. The data represent a population of poor women from a less-developed country with a health care system that provides both prenatal and obstetric care free of charge. We find a positive effect of increased prenatal care use on birthweight, with a small marginal effect that is similar to that found in studies using US data. The results highlight the usefulness of existing methodologies for estimating the effect of prenatal care on birthweight and the importance of extending these methodologies to data from developing countries. [PUBLICATION ABSTRACT]

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									    MEASURING THE BENEFIT OF PRENATAL
    CARE IN A LESS-DEVELOPED COUNTRY:
     SEMI-PARAMETRIC ESTIMATES FROM
                 URUGUAY
                                       R. Todd Jewell*
                                University of North Texas, USA
                                        Jeffrey J. Rous
                                University of North Texas, USA


ABSTRACT

This study extends extant research on prenatal care and birthweight to the South American country
of Uruguay. The data represent a population of poor women from a less-developed country with a
health care system that provides both prenatal and obstetric care free of charge. We find a positive
effect of increased prenatal care use on birthweight, with a small marginal effect that is similar to
that found in studies using US data. The results highlight the usefulness of existing methodologies
for estimating the effect of prenatal care on birthweight and the importance of extending these
methodologies to data from developing countries.

JEL Classifications: I12, J13, C14
Keywords: Infant Health, Prenatal Care, Birthweight, Uruguay, Unobserved Heterogeneity
Corresponding Author’s Email Address: tjewell@unt.edu

INTRODUCTION

This paper presents an analysis of the effect of prenatal care on birthweight in Uruguay, a
country located in the southern cone of South America. The data are gathered from the
Perinatal Information System (Sistema Informático Perinatal, SIP), which is
administrated by the Latin American Center for Perinatology and Human Development
(Centro Latinoamericano de Perinatología y Desarrollo Humano, CLAPDH), and
represent a sample of all births in the years 1995 to 2003 that occurred in a public
hospital in the capital city of Montevideo. Several aspects of this data make them unique.
For women in Uruguay, both prenatal and obstetric care may be accessed free of charge;
also, the data come from a single public hospital that serves the poor women of
Montevideo, home to approximately one-half the country’s population. The data,
therefore, allow for a study that concentrates on poor women, in a population that faces
zero out-of-pocket costs for health care. In addition, these data represent mothers from a
developing country, a group that has not been extensively studied.
          Numerous empirical studies have indicated that the expanded use of prenatal
medical care leads to increases in birthweight, a commonly used proxy for infant health
(Institute of Medicine, 1986; McCormick, 1985). Unfortunately, estimating the
relationship between birthweight and prenatal care is problematic, since measures of
prenatal care use are endogenous if there are unobservable factors that determine the
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mother’s prenatal care behavior as well as the infant’s birthweight. For instance, women
with inferior health endowments, an exogenous health component unobservable to the
researcher, may expect problematic pregnancies (which may lead to lower birthweight)
and thereby seek more prenatal care. In this case, neglecting endogeneity may either
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