Do Medicaid family planning waivers reduce low birth weight prevalence?  A nationwide, state-level analysis
Creators: name: Howard, Cheryl B.
Publisher: name: Maryland Shared Open Access Repository
Year: 2013
Subjects: low birth weight
Medicaid
Section 1115 family planning waiver

description: Too many infants in the United States are delivered with unhealthy weights.  Low birth weight is a noteworthy public health problem because it is a major risk factor for infant mortality.  It consumes a disproportionately high level of health care resources and its prevalence continues to rise despite investment of public resources aimed toward improving birth outcomes.  One solution has been to ensure satisfactory maternal health by preventing unintended pregnancy and promoting optimal birth spacing.  Federal and state governments have responded to the need for managing the timing of conception using public policy to assure access to family planning services, particularly for low-income residents who might not otherwise be able to access or afford them.  Policy implementation at the state level has relied on the Medicaid program to finance and deliver contraceptive medical care to populations who would not ordinarily be eligible for basic program enrollment, using Section 1115 family planning waivers.   A policy question relevant to the problem of low birth weight is whether states with Section 1115 family planning waivers in effect exhibit significantly better infant birth weight rates as a result.  This study evaluated the extent to which these rates varied in response to implementation of waiver policies, while controlling for inter-state differences in population demographic composition, labor force factors, and other non-medical determinants of health.  Public use data from the U.S. Natality files and the Current Population Survey were used to construct a panel data set including observations for 50 states and the District of Columbia for each year from 1990 through 2010.  Multivariate linear regression models including state and year fixed-effects consistently produced ordinary least squares (OLS) coefficients on the policy intervention variable that were statistically insignificant and substantively small in all but non-Hispanic Black populations.  Estimated effects observed for this sub-group suggest that implementation of Section 1115 family planning waivers is associated with significantly higher low birth weight rates, an unanticipated outcome.   Results produced by this study failed to support the research hypothesis that Medicaid family planning waivers are effective in lowering the prevalence of infants that weigh 2,500 g or less at birth, when measured as a percent of total live births.  Waivers may nevertheless be functioning to reduce the number of infants at healthy and unhealthy weights alike, for all populations studied except non-Hispanic Black.  It is critical to note that although low birth weight rates were significantly higher for non-Hispanic Black populations following policy implementation, it seems unlikely that absolute prevalence increased.  These results are more likely a measurement artifact related to an overall decline in birth rates combined with possible changes in composition of the full birth weight distribution.  Nevertheless, ensuring access to contraceptive medical care appears to be an effective approach to mitigate low birth weight prevalence by reducing the number of these births, but policy alternatives other than subsidized contraceptive medical care ought to be considered for reducing the proportion of total births that are under 2,500 g.