Our objective was to identify determinants of prenatal care demand and evaluate the effects of this demand on low birth weight and preterm birth. Delay in initiating prenatal care was modeled as a function of pregnancy risk indicators, enabling factors, and regional characteristics. Conditional maximum likelihood (CML) estimation was used to model self-selection into prenatal care use when estimating its effectiveness. Birth registry data was collected post delivery on infants with and without common birth defects born in [1995][1996][1997][1998][1999][2000][2001][2002] in Argentina using a standard procedure. Several maternal health and fertility indicators had significant effects on prenatal care use. In the group without birth defects, prenatal care delay increased significantly LBW and preterm birth when accounting for selfselection using the CML model but not in the standard probit model. Prenatal care was found to be ineffective on average in the birth defect group. The self-selection of higher risk women into earlier initiation of prenatal care resulted in underestimation of prenatal care effectiveness when using a standard probit model with several covariates. Large improvements in birth outcomes are suggested with earlier initiation of prenatal care for pregnancies uncomplicated with birth defects in Argentina, implying large opportunity costs from the long waiting time observed in this sample (about 17 weeks on average). The suggested ineffectiveness for pregnancies complicated with common birth defects deserves further research. Improvement in health care over the past several decades has contributed to a substantial increase in the likelihood of survival of infants born prematurely and/or at low birth weight (LBW) as well as those born with birth defects and disabilities. Preterm birth and LBW have been widely associated with an increased risk for delayed development, physical disabilities and reduced life expectancy. Child disability imposes a substantial burden on the affected child, family and community. Further, LBW has recently been shown to be related to lower human capital accumulation including education and wealth and lower maternal birth weight has also Correspondence to: George L. Wehby.
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NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript been related to lower birth weight in the offspring in a sample of low and middle income countries (Victora et al, 2008).A 7% LBW rate has been reported in Argentina in 1998(Kramer et al. 2005. The rates of preterm birth and LBW have been increasing in the past two decades in several countries including by about 28% and 16% respectively in the US (Arias et al. 2003) 1 . The rates of LBW and preterm birth have been estimated to have increased over the past decade in Argentina. 2 The increasing prevalence of preterm and LBW births has generally been parallel to increases in multiple births and maternal age, yet the main causes of these outcomes remain unknown. LBW can occur due to shorter gestational age ...