Essays on the Economics of Reproductive Healthcare
Author(s)
Motolenich, Mary
Advisor(s)
Hughes, Danny
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Abstract
This dissertation delves into multiple elements of reproductive healthcare in the United
States. In my first essay, I utilize a novel, proprietary medical claims dataset to structure pregnancy
episodes of care and use these care episodes to estimate two previously entangled effects on
maternal care: healthcare provider type and healthcare provider access. I find that CNM
involvement in pregnancy episodes generally decreases the likelihood of experiencing C-Section
delivery and significantly affects testing utilization. In my second essay, I exploit the variability
of and changes to sex education mandates and curriculum requirements to estimate a causal effect
on adolescent birth rates at the county level. Accounting for the changes in legislation and
characteristics of state-level educational requirements, I find that academic standards and
requirements significantly impact birth rates. In my third and final essay, I exploit the seemingly
arbitrary cutoff for the definition of advanced maternal age (defined at 35) to be considered a high
risk pregnancy using regression discontinuity design. Since this medical guideline may affect the
care, a pregnant person may seek out and the amount of care a provider may recommend, I restrict
a subset of Medicaid MAX data to include only pregnancy episodes to women ages 33 to 37 years
old to determine whether this guideline affects care, testing procedures, and adverse pregnancy
outcomes. I find evidence that there are discontinuities in prenatal care and outcomes around this
threshold, and the magnitude of these differences varies by underlying pregnancy risk. Both high
and low-risk women are more likely to experience fetal monitoring and detailed ultrasounds
because of the AMA designation.
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Date
2024-07-25
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Text
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Dissertation