Media Briefings

RECESSIONS HARM HEALTH OF NEWBORNS: Evidence from England

  • Published Date: March 2018

Researchers from the University of Oxford find that recessions in England worsen the health newborn babies. According to the study by Elisabetta De Cao, Barry McCormick and Catia Nicodemo, to be presented at the Royal Economic Society's annual conference at the University of Sussex in Brighton in March 2018:

• A one percentage point increase in the unemployment rate leads to a 1.3% increase in the proportion of babies with low birth weight; an increase of 1.4% in premature babies; a decrease in foetal growth by 0.1%; and an increase of 2.7% in stillbirth.

• The damaging effects are stronger for babies born to mothers from the most deprived areas, indicating that the poor were hit hardest by the Great Recession.

• Recessions typically reduce the number of pregnancies, but the effect is uneven across different groups: pregnancies fall by 0.73% in affluent areas following a one percentage point increase in unemployment, compared with a fall of 0.15% in the poorest areas.

The study shows that health inequality begins before birth and policy needs to focus on the wellbeing of the most vulnerable mothers, and particularly in economic downturns.

The study makes first use of English administrative data on hospital deliveries (Hospital Episode Statistics) during the period 2003-2012, linked to local unemployment rate data measured at Middle Super Output Area level. Uniquely, this dataset makes it possible to observe every birth in NHS hospitals in England in the period.

By focusing on mothers who have had at least two births, the authors are able to control for the decision to have a baby during an economic downturn.

Fertility is in general pro-cyclical: more babies are born during prosperous times, and an economic recession reduces the number of pregnancies. But the authors find an uneven effect: pregnancies fall by 0.73% in affluent areas following a one percentage point increase in unemployment, compared with a decrease of 0.15% in the poorest areas. As babies born in poor areas tend to have worse health outcomes, this unequal decrease in fertility leads to a different composition of births that explain the results.

The authors consider two other explanations. The first is maternal stress. Foetal exposure to maternal stress is associated with low birth weight, premature births, stillbirth and miscarriages.

The study tests for maternal stress with two measures: the probability of having a stillborn; and, as a proxy for miscarriage, the probability of having a female baby, because evidence shows that male foetuses are more likely to die as a consequence of maternal stress.

They find that a one percentage point increase in the unemployment rate leads to an increase of 2.7% in stillbirth, and of 0.3% in the probability of having a female baby. If the weakest babies die, then the main results underestimate the true effect of the economic recession on newborns’ health.

Results also show that the increase in mothers who have female babies is greater in the richest areas (1.1% increase) than in the poorest areas (0.4% increase).

The conventional expectation is that income is lower in a recession and that this reduces investment in the pregnancy. The authors test this by exploring whether prenatal care is sought later. In general, the earlier prenatal care is sought, the better it is for the mother and the infant.

The authors find that a one percentage point increase in the unemployment rate leads to a half-day delay in the first antenatal health assessment. Unexpectedly, this effect is larger in the most affluent areas (2.2 days) than it is in the most deprived areas (0.9 days).

But even if the poorest mothers are less vulnerable to financial stress, and seek prenatal care earlier, their health behaviour could worsen in a recession. Even if with their data the authors cannot test for this channel, related research points toward a decrease in healthy nutrition, and an increase in unhealthy habits, such as smoking, among the most financially constrained in a recession.

ENDS


Is the health of English babies worse in recessions?
Elisabetta De Cao, Barry McCormick and Catia Nicodemo
University of Oxford

Elisabetta De Cao: 07477601431, elisabetta.decao@phc.ox.ac.uk
Barry McCormick: barry.mccormick@phc.ox.ac.uk
Catia Nicodemo: catia.nicodemo@economics.ox.ac.uk