Maternal and infant health inequality: New evidence from linked administrative data (NBER, November 2022)

Summary

This paper, published by the National Bureau of Economic Research (NBER) aimed to explore how parental wealth and race affect maternal and infant health outcomes in California.

The authors used administrative data that combines the California birth records, hospitalisations and death records with parental income from Internal Revenue Service tax records and the Longitudinal Employer-Household Dynamics file to provide new evidence on economic inequality in infant and maternal health. The paper also used birth outcomes and infant mortality rates in Sweden as a benchmark, finding that infant and maternal health is worse in California than in Sweden for most outcomes throughout the entire income distribution.

Content

Key findings

• Babies born to the richest 20% of families are the least healthy. They are more likely to be born premature and at a low birth weight, two key risk factors for medical complications early in life. This is because their mothers are more likely to be older and to have twins (which are more common with the use of fertility treatments). However, even with those early risk factors, these babies are the most likely to survive both their first month and first year of life.

• Rich and poor mothers were equally likely to have high-risk pregnancies, but the poor mothers were three times as likely to die—even within the same hospitals.

• Maternal mortality rates were just as high among the highest-income Black women as among low-income white women. Infant mortality rates between the two groups were also similar.

• Babies born to the richest Black women (the top tenth of earners) tended to have more risk factors, including being born premature or underweight, than those born to the richest white mothers—and more than those born to the poorest white mothers.

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