High rates of pregnancy and childbirth-related mortality in developing countries have been linked to high rates of use of informal sources of childbirth care. Many of these deaths are believed to be preventable, leading to large investments in programs designed to promote use of formal care at the time of childbirth. These policies range from the benign, such as the distribution of cash transfers, to the punitive, such as government bans on the use of informal birth attendants. There is a contentious debate about the extent to which these policies will affect mortality. This paper sheds light on this question by examining the marginal returns to an institutional birth. To identify causal effects we exploit random variation in weather around the time of birth. The hypothesized channel is that inclement weather at the time of birth will deter some women from traveling to a health institution to give birth. We leverage unpredictability about the weather and unpredictability about the timing of birth. To implement this strategy we merge weather data from the University of Delaware’s Center for Climatic Research with birth outcomes data from the India District Level Household Survey. We show that as predicted, rainfall shocks reduce the probability of an institutional birth (by about one percentage point). We show that, consistent with the hypothesized channel, this effect is present only in the month of birth and is observed only for women who live further away from a hospital. Using rainfall shocks as an instrument we find that women who have an institutional birth are 60 percentage points less likely to experience a post-delivery health complication. This effect is large and robust to various specification changes. To put the magnitude of this effect into context, we estimate that increasing the rate of institutional deliveries in India by 50% would decrease post-delivery complications by 11 percentage points and decrease maternal mortality by about 12%.
About the Speaker:
Dr. Okeke is a researcher at the RAND Corporation and a Faculty member at the Pardee RAND Graduate School. He is a health and development economist with current interests in three main areas: investments in maternal and child health, the economics of preventive care use, and health worker labor markets. His work has been funded by the Russell Sage Foundation, the International Initiative for Impact Evaluation, and the National Institutes for Health. He is currently leading an NCI-funded randomized trial that studies the role of social networks in the formation of beliefs about the prevalence of cervical cancer and thereby on the adoption of screening, and a five-year experimental study in Nigeria funded by the National Institute of Child Health and Human Development that examines the link between health provider skill, quality, and health outcomes of. Prior to joining RAND, Dr. Okeke was an Assistant Professor in Health Economics and Policy at the London School of Hygiene and Tropical Medicine. He holds an M.D. from Nnamdi Azikiwe University, Nigeria, an M.A. in Applied Economics, and a Ph.D. in Health Policy (Economics) from the University of Michigan.