The Benefits of Prenatal Care: Evidence from the SARS Epidemic in Taiwan

The positive association between prenatal care and better birth outcomes has been established by numerous studies. However, there is scarce literature identifying the causal effect of prenatal care on birth outcomes. On the one hand, women who anticipate a poor birth outcome may be more likely to have prenatal care. On the other hand, women with a propensity to engage in a variety of healthy behaviors may be more likely to have prenatal care. In the former case the effect of prenatal care is understated, and in the latter case it is overstated. We examine the impact of prenatal visits on birth outcomes using the 2003 SARS epidemic in Taiwan as an exogenous source of variation in propensity to have prenatal care. Our first-stage estimates demonstrate that women pregnant at the time of the epidemic showed a drastic decline in prenatal care visits. We also find that the decline is larger among women in rural areas. We will use the SARS epidemic as an instrument for prenatal care in birth outcome equations. Our birth outcomes include the incidence of cesarean section, preterm birth, preventable complications and obstetric trauma during delivery. Since pregnant women were affected by the SARS epidemic at different point in their pregnancy, we can isolate the impact of missing prenatal visits early or late in a pregnancy. Our data are obtained from the National Health Insurance Data, maintained by the National Health Research Institute. The longitudinal nature of medical claims data also allows us to further control mother fixed effect. Our IV results suggest that prenatal care visits significantly reduce the probability of having a preterm birth and the probability of having a birth complication, but increase the incidence of cesarean section.