Abstract: The public health effects of the COVID-19 pandemic have been extensively studied but little is known about how individuals’ adaptive behaviors, subject to heterogeneous structural constraints, drove disparities in health outcomes. We address this question by evaluating the consequences of the COVID-19 pandemic for preterm birth in Mexico, a medium income country with high inequality, fragmented health insurance mechanisms, and a hybrid healthcare system with public and private hospitals. Despite the high out-of-pocket costs associated with private medical care, the proportion of women giving birth in private settings increased dramatically after the onset of the pandemic in 2020. This was likely a strategy to reduce their risk of infection in public hospitals, many of which were overcrowded. Time-series models suggest that preterm births increased among women who gave birth in public hospitals but decreased among women who gave birth in private settings. Difference-in-differences models based on a conception-cohort design reveal that the reduction in preterm births in private hospitals was explained by a combination of changes in women’s demographic characteristics, the ability to afford high quality medical care within the private sector, and other unobserved protective behaviors. As a result, the health benefits from receiving private rather than public care were concentrated among women with upper secondary and college education, while the less educated who paid for private care experienced no health premiums. Our analysis goes beyond documenting changes in preterm birth to illuminate how protective behaviors subject to heterogeneous socioeconomic and structural constraints led to unequal health outcomes during the pandemic.
Date: Oct 20, 2023
Location: 3505 N Charles St.