Life expectancy and mother-baby interventions : evidence from a historical trial

This paper investigates the potential of maternal and infant health programs to improve the life expectancy of women and children. We study a program trialed 1931-33 in seven Swedish medical districts, assembling individual data from parish records and aggregate data from annual reports of medical districts. We estimate short run program effects on maternal and infant mortality. In addition, we track individuals exposed to the program together with unexposed individuals from neighbouring birth-cohorts so as to establish whether they survive to age 40, an age by which maternal mortality of the offspring is determined, and age 75, an age by which 35% of the sample cohorts had died. We find significant impacts of exposure to the infant program on infant survival and on the probability of surviving to ages 5, 40 and 75. The estimates suggest that the impact on life expectancy is largely driven by infant survival. The program narrowed health inequalities. Its impact was systematically larger among children born out of wedlock, who also exhibit higher baseline rates of infant mortality. There is no evidence of endogenous fertility responses or of selection into the program on a range of relevant observables. The evidence is consistent with parents reinforcing treatment by the public health intervention. We are unable to identify any impacts of program components delivered to mothers.