Saving Lives at Birth: The Impact of Home Births on Infant Outcomes

Abstract

Many developed countries have recently experienced sharp increases in home birth rates. This paper investigates the impact of home births on the health of low-risk newborns using data from the Netherlands, the only developed country where home births are widespread. To account for endogeneity in location of birth, we exploit the exogenous variation in distance from a mother's residence to the closest hospital. We find that giving birth in a hospital leads to substantial reductions in newborn mortality. We provide suggestive evidence that proximity to medical technologies may be an important channel contributing to these health gains. (JEL I11, I12, J13, J16)

Discharge on the day of birth, parental response and health and schooling outcomes

“…This paper contributes to the growing literature on the importance of early life health and health interventions for long-run health and economic outcomes (Almond and Currie, 2011;Almond et al, 2017;Black et al, 2007;Chay et al, 2009;Bharadwaj et al, 2013;Daysal et al, 2015;Breining et al, 2015). 2 Our study contributes to the evidence on the impact of shortening postpartum hospital stay, a policy that is relevant in many developed countries.…”

“…Bharadwaj et al (2013) find that low birth-weight infants treated with intensive medical care at birth do better than their untreated counterparts in terms of educational achievement. Daysal et al (2015) show that giving birth at a hospital rather than at home reduced mortality among low-risk newborns. Breining et al (2015) show that both the focal children and their siblings experience long-run educational benefits of treatment assigned to very low birth weight infants.…”

Re: A recent study by economists on the impact of home births on infant outcomes confuses the debate on home birth

“…We respond to the letter by De Jonge et al . claiming that our study confuses the home birth debate . We argue the opposite.…”

Further Applications of Advanced Methods to Infer Causes in the Study of Physiologic Childbirth

“…A Dutch study conducted instrumental variable analysis using distance from maternal residence to the nearest hospital with a maternity care unit as an instrument. Outcomes were Apgar score and neonatal death . Valid causal inference in this instance requires the following assumptions: 1) distance to a maternity hospital affects the probability of home birth (an assumption the authors empirically verified), 2) distance does not affect outcomes except through birth setting, and 3) distance is not associated with any exposure‐outcome confounders.…”