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Bringing delivery forward for non-medical reasons to collect the “baby cheque” posed a risk to babies’ health

Bringing delivery forward for non-medical reasons to collect the “baby cheque” posed a risk to babies’ health

Such is the conclusion of a study involving Libertad González, professor with the Department of Economics and Business at UPF and the Barcelona GSE, focusing on deliveries at the turn of the year between 2010 and 2011, when the “baby cheque” was scrapped.

06.02.2019

 

 A study by Libertad González, professor with the Department of Economics and Business at UPF and the Barcelona GSE;  Cristina Borra (University of Seville) and  Almudena Sevilla (University College, London), found that children born prematurely due to the scrapping of the “baby cheque” weighed less at birth (between 130 and 300 grams) and had 20% more hospitalizations, especially due to respiratory problems, although the negative effects seem to dissipate after the second month of life.

Some 2,000 families scheduled an early delivery to receive a subsidy of 2,500 euros.

The research, which is framed in the increased number of early deliveries for non-medical reasons in Spain (induced delivery rate in Spain was 19.4% in 2010, almost double the WHO recommendation), shows that some 2,000 families scheduled an early birth to receive a subsidy of 2,500 euros (known as the “baby cheque”). This has enabled investigating the impact of this practice on the health of babies.

Research that evolves with the passage of time

The study, driven by the Social Observatory of "la Caixa" and published in Journal of the European Economic Association on 1 February, is part of the lines of research of the project “The Causal Effect of Early Interventions on Child Health and Human Capital”, with which Libertad González obtained a Consolidator Grant 2017 from the European Research Council.

Within this project, the UPF researcher continues to monitor these children, now aged nine (from the school tests currently being done by third-year primary school children, for example) to try to detect possible longer-term effects on health and cognitive development.

To perform this extensive data collection task, Libertad González received a Research Grant on Socio-Economic Wellbeing, which involves the collaboration of the “La Caixa” Foundation and the organization of the Barcelona GSE.

A study of babies born near the turn of the year 2010-2011

According to the research, at the turn of the year 2010 to 2011, coinciding with the scrapping of the “baby cheque”, a subsidy of 2,500 euros per child born introduced by the Spanish government to increase the birth rate, there were many more deliveries in late December than in early January.

The authors estimate that some 2,000 deliveries were brought forward for non-medical reasons, accounting for approximately 6% of all births in January. “Families who brought childbirth forward most were those with a university education, women of Spanish nationality and in provinces with a greater presence of the private hospitals network”, they say.

The change in regulations introduced by the Spanish government unexpectedly created an incentive to bring deliveries that were expected for around the end of the new year forward to December. “These conditions created an interesting natural experiment to evaluate the effects of lower gestational age (preterm delivery) on the health of new-borns”, the researchers suggest.

“During the last week of 2010 there was a rise in the number of births and a fall in early January 2011”.

The study is based on high quality administrative data on births and hospital admissions of all babies born in Spain between 2000 and 2013. Specifically, the authors analysed two data sources provided by the National Statistics Institute (INE): Birth statistics, which are completed in hospitals for every birth, and Survey of hospital morbidity, with information on 99% of hospitalizations of at least one night.

To estimate the number of advanced deliveries, the number of births that occurred around the turn of the year (late December 2010 and early January 2011) was compared using the previous and subsequent years as a reference. Under normal conditions, about 50% of the babies born around the turn of the year do so in December, and the remaining 50% in January. However, at the turn of 2010 to 2011, 56% were born in December (9,946 new-borns) and 44% in January (7,845). “During the last week of 2010 there was a rise in the number of births and a fall in early January 2011, which is when the baby cheque disappeared, and this is clearly an unusual case”, state the authors.

A study of babies born near the turn of the year 2010-2011

Risks posed to children’s health by planned early delivery

Babies born preterm due to the scrapping of the “baby cheque” weighed less at birth (between 130 and 300 grams less than the average, i.e., weighing up to 9% less) and suffered a considerable increase in hospitalization rates during their first two months of life (approximately 20% more), mainly due to respiratory conditions. However, no long-term effects were observed on the health of these children.

Babies born before the end of gestation due to the scrapping of the “baby cheque” weighed less at birth (between 130 and 300 grams less than the average).

However, the proportion of babies with low or extremely low weight (less than 2,500 grams or less than 1,500 grams, respectively) did not increase, suggesting that scheduled advances occurred primarily in very advanced pregnancies. “It doesn’t appear that such foolhardy acts were committed as causing delivery several weeks before the due date, but rather that the early deliveries were fundamentally related to births with an estimated due date close to the turn of the year”, say the authors of the study.

Average birth weight of babies born near the turn of the year 2010-2011 (last and first week of the year)

Political implications and the importance of available information

“Since individuals and families respond to economic incentives, it would have been advisable not to have scrapped the “baby cheque” so suddenly but to have progressively reduced the amount of the subsidy over the months”, the researchers advise.

The decision to bring deliveries forward for non-medical reasons is not neutral from the perspective of health.

They also warn that families and healthcare agents should be aware that the decision to bring the delivery forward for non-medical reasons is not neutral from the perspective of health, and it is desirable to have sufficient available information regarding the subject.

Finally, the authors stress the importance of administrative data for research purposes, in order to evaluate public policies and thus design better measures and programmes based on evidence and on their effectiveness.

Reference work: C. Borra, L. González, A. Sevilla (February 2019). “The Impact of Scheduling Birth Early on Infant Health“. Journal of the European Economic Association (pages 30 to 78). https://doi.org/10.1093/jeea/jvx060

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