Date of Award
Doctor of Philosophy
This dissetation is composed of one essay that utilizes the Shelby County Birth Certificate Data for the years 2004-2006 to propose three models that evaluate the effectiveness of prenatal care in preventing Potentially Avoidable Maternal Complications (PAMC) among different ethnicity groups while making a case for its relevance to economic theory and public policy. The complications can be reduced through effective prenatal care. Given the ethnical diversity of the U.S., and the obeserved disparities in maternal complications and access to prenatal care, it is critical that I analyze the relationship between prenatal care and maternal complications. To correct for the endogeneity of prenatal care-following an accepted econometric remedy to the problem of endogeneity- this study applies a simultaneous equation model that includes predicted rather than estimated values of prenatal care to correct for the inconsistency and biasedness. To further examine this relationship and to improve the model, I apply the Hurdle estimation approach combined with the Simultaneous Equation model. This approach confirmed the inverse relationship between prenatal care and PAMC with greater magnitude for estimates than the previous model. Blacks, women ages 30-35, and women with lower years of education were less likely to receive prenatal and hence, more likely to experience PAMC. However, for some variables such as white women, underweight, overweight and obese women, were significantly more likely to receive prenatal care and also significantly more likely to experience PAMC, opposing our original hypothesis. Therefore, I further apply the Blinder Oaxaca decomposition model to count for observed and unobserved factors causing the disparities between ethnicities in prenatal care access and experiencing PAMC. Results demonstrate that Education, Body Mass Index, and type of insurance, are significant contributors to widening the explained differences between Hispanic mothers and mothers of other ethnicity groups. In summary, this study helps to pave the way toward a role for health economics in emerging reasearch on prenatal care and pregnancy complications. As health care expenditures consume an even larger portion of U.S. national output, insights on the relationship between prenatal care and PAMCs through an economic lens underscore the significance of this study.
dissertation or thesis originally submitted to the local University of Memphis Electronic Theses & dissertation (ETD) Repository.
Ishak, Riham F., "The Effect of Prenatal Care in Preventing Potentially Avoidable Maternal Complications (PAMCs); An Empirical Investigation with Emphasis on Racial Disparities in Access and Outcome" (2013). Electronic Theses and Dissertations. 727.