The Impact of Adequate Prenatal Care on Urban Birth Outcomes: An Analysis in a Developing Country Context

Deficient birth outcomes entail greater mortality risks and higher probabilities of poor future health. This study examines the effect of the World Health Organization’s prenatal care recommendations for developing countries. It accounts for the endogenous nature of prenatal care decisions by using an instrumental variables approach based on the opportunity cost and accessibility of prenatal services. Using the urban sample of the Cebu Longitudinal Health and Nutrition Survey, I construct a measure of prenatal care based on the WHO recommendations. This measure involves both timing and intensity. The instrumental variable used is shown to be strong and valid. The results show that adequate care has a positive impact on birth weight and decreases the probability of poor birth outcomes. The results are robust to seasonality and time effects and are not driven by the potential influence of rainfall shocks on maternal health. I also test the effectiveness of the WHO methodology by modifying the definition of adequate care in terms of both its timing and frequency. The results suggest that the current recommendations are appropriately defined.