Research
Job Market Paper
"Provider Choice, Home Births, and Health Outcomes"
Abstract: Home births in the US have increased twofold since the early 2000s, yet little is known about the policies that have driven the increase. Moreover, this increase in births outside of hospitals prompts concerns for maternal and infant health. In this paper, I use natality data from 1989 to 2021 to estimate relative changes in the prevalence of home birth and subsequent health outcomes before and after a change in access to provider choice. Staggered difference-in-differences estimates indicate a 20--30 percent increase in home births when states increase provider choice through non-nursing midwifery licensing. I find the change in access is most salient for college-educated mothers, low-risk pregnancies, and mothers who pay out of pocket. I find little evidence of an effect on other measures of infant health or maternal health.
Peer Reviewed Publications
"How Much Can Hospital-Level Interventions Improve Maternal Health? Evidence from State Perinatal Quality Collaboratives" (2024). Economic Inquiry https://doi.org/10.1111/ecin.13226
Abstract: Over the last 20 years, nearly all states have adopted Perinatal Quality Collaboratives (PQCs), which set guidelines for hospitals to provide higher standards of prenatal care. In this paper, I use individual-level natality data from 1989 to 2019 and a stacked difference in differences design comparing maternal and infant health outcomes in US states that have recently established a PQC to those that have not yet established one. Estimates indicate that PQCs decrease eclampsia, with the effect driven by Black mothers. Evidence also shows that PQCs reduce intensive care unit admissions for mothers.
Working Papers
"Effects of Expanding Contraceptive Choice: New Evidence from Virginia’s Contraceptive Access Initiative" (joint with Analisa Packham)
Abstract: In 2018, the Virginia Department of Health implemented the Contraceptive Access Initiative (CAI) to increase access to long-acting reversible contraceptives (LARCs). We use encounter-level data on contraceptive choice in participating CAI clinics and county-level natality data from 2014-2021 to estimate relative changes in LARC take-up and childbearing rates before and after the CAI. Difference-in-differences estimates indicate that the CAI reduced birth rates in participating counties by 1.6-3.5 percent, or less than half of the effect size of other similar, state-level programs. We show that this smaller effect is likely due to existing high LARC take-up and contraceptive substitution.
Draft Available Soon
Works in Progress
"Access to Birthing Facilities and the Impact on Health"
"Evaluating the Effectiveness of State-Level Contraceptive Access Initiatives" (joint with Analisa Packham)