Effect of Neighborhood Characteristics on the Health of Pregnant Women and Their Newborns

Poor infant health outcomes, such as low birthweight and preterm birth, and certain pregnancy behaviors, like tobacco use, alcohol consumption, and excessive weight gain are public health concerns that have long been of interest to social scientists and policymakers alike. The traditional solution to these health problems is individual-based medication and treatment. However, the observation that individuals living in low socioeconomic status neighborhoods generally have worse health than individuals in wealthier neighborhoods raises the question: can the health of pregnant women and their infants be improved by changing the characteristics of the neighborhoods in which they live?

This paper estimates the impact of neighborhood characteristics, particularly crime prevalence and access to alcohol and tobacco, on a variety of prenatal and infant health outcomes. These physical and social aspects of neighborhoods can plausibly influence the health of pregnant women and their newborns in two ways: directly, by altering women’s demand for prenatal health inputs; and indirectly, through anxiety or stress, which are known risk factors for low birthweight and preterm birth. For example, the availability of substances may affect pregnant women’s demand for these goods, as they relate to the cost of quitting during pregnancy. Indirectly, crime prevalence may induce psychological stress or anxiety which may discourage women from engaging in physical activity or make it harder to quit substance use, thereby worsening maternal and infant health.

There is large cross-sectional literature investigating the relationship between various neighborhood characteristics and pregnancy outcomes. However, the results of these studies cannot be interpreted as causal as they do not account for the possibility that place of residence is a choice and that unobserved factors may be correlated with both neighborhood traits and health outcomes.

The primary data source is the 2000-2010 Natality Detail Files, which is a compilation of birth certificates of the universe of children born in the U.S. in those years. These data are merged with various measures of county characteristics for the study period; particularly, county-level crime statistics that are obtained from the FBI’s Uniform Crime Reports and the counts of establishments that sell alcohol and tobacco, which are drawn from the County Business Patterns. County fixed-effects method is used to account for unobserved factors, e.g. norms and attitudes towards violence and substance use that may be correlated with characteristics of the neighborhood and pregnancy outcomes. Although the econometric method does not account for all potential sources of bias, e.g. individual taste for violence, the paper adds to the small literature on the causal effect of neighborhood characteristics on maternal and infant health. The results of this analysis will also have policy consequences as it may suggest alternate avenues (e.g. zoning laws, law enforcement, etc.) for improving the health of pregnant women and their newborns.