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Exposure to Economic Distress during Pregnancy and Birth Outcomes

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Abstract

This paper uses the severe economic crisis in Turkey in 2008-2009 as a quasi-experiment to evaluate the impact of worsening economic conditions during pregnancy on birthweight. Using birth history data from the 2008 and 2013 waves of the Demographic Health Surveys, we find that the economic crisis resulted in decreased birthweight in Turkey, especially impacting infants born to mothers with lower educational levels. Furthermore, a procyclical relationship exists between provincial income levels and the birthweight of infants born to mothers with lower levels of education. However, this relationship is only statistically significant during the crisis period. These results highlights how economic constraints on mothers with lower socio-economic status during economic crises can negatively affect birth outcomes. Furthermore, we examine shifts in fertility behavior and find a decrease in childbirth rates during the crisis, particularly in economically disadvantaged provinces. In line with this decrease in fertility, we also observe a reduced propensity to seek an abortion during the crisis period. Overall, these findings underscore the importance of understanding how economic crises affect infant health and the need for targeted interventions to support vulnerable populations, as well as addressing underlying socio-economic disparities to mitigate their impact on infant well-being.

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Notes

  1. See also Paxson and Norbert (2005); Dehejia and Adriana (2004); Ferreira and Schady (2009); Baird et al. (2011) and Mary (2018) for further evidence on the effects of financial and macroeconomic crises on children outcomes.

  2. In fact, DHS provides a full birth history of all children the woman has ever given birth to including their date of birth, sex, survival status, age (if alive), and age at death (if died). However, information on birthweight is only available for the five years preceding the survey.

  3. Although Turkey has 81 provinces, there are only 26 regions. Conducting the analysis at the regional level would have significantly reduced the identifying variation.

  4. We further test the sensitivity of our results by using alternative definitions of crises taken from Cosar and Saygin (2018) and Aruoba and Cagri (2013). Our results remain robust to these alternative definitions.

  5. However, we note that our results remain similar when we include these groups in our analysis sample.

  6. The standard difference–in–differences estimator can produce biased results in the presence of staggered treatment (Goodman-Bacon 2021). However, this problem does not apply in our context since the treatment assignment does not vary over time.

  7. We also investigated the impact of the Turkish economic crisis on two related outcomes: a binary indicator for low birthweight (defined as birthweight \(\le \) 2,500 grams) and a binary indicator for premature birth (defined as gestational length \(\le \) 37 weeks). Our findings suggest that the economic crisis led to a 16 percent increase in the likelihood of low birthweight although this coefficient lacks statistical significance at conventional levels. Surprisingly, in the case of premature birth, the results indicate a slight reduction in the likelihood during the crisis, yet this effect is also imprecisely estimated. Additionally, the estimates for provincial GDP per capita and the interaction term between the crisis indicator and provincial GDP per capita are all small and statistically insignificant.

  8. Note that the provincial GDP per capita is included in the fertility analysis after being divided by 10,000.

  9. The abortion information is based on self-reports and there may be considerable reporting error in this variable. Therefore, we caution the reader to keep this in mind when interpreting the results in Table 6.

  10. This is calculated as -0.059-(0.053*0.7252). Note that provincial GDP per capita is entered into the regression after being divided by 10,000.

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Authors and Affiliations

  1. Dalhousie University, Halifax, Nova Scotia, Canada; Institute of Labor Economics (IZA); Households in Conflict Network (HICN), Halifax, Canada

    Mevlude Akbulut-Yuksel

  2. TED University, Department of Economics, Ankara, Turkey

    Seyit Mümin Cilasun

  3. School of Public Affairs, American University, Washington, DC, USA; Institute of Labor Economics (IZA); National Bureau of Economic Research (NBER), Washington, DC, USA

    Erdal Tekin

  4. TOBB-University of Economics and Technology, Department of Economics, Ankara, Turkey

    Belgi Turan

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  1. Mevlude Akbulut-Yuksel
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  2. Seyit Mümin Cilasun
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  3. Erdal Tekin
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  4. Belgi Turan
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Correspondence to Erdal Tekin.

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Appendix

Appendix

 

Table 8 Effect of financial crisis on prenatal care
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Akbulut-Yuksel, M., Cilasun, S.M., Tekin, E. et al. Exposure to Economic Distress during Pregnancy and Birth Outcomes. J Labor Res 45, 1–29 (2024). https://doi.org/10.1007/s12122-024-09354-z

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