The role of policy in promoting women's health during pregnancy and postpartum

Abstract

This dissertation research, presented in three manuscripts, uses a variety of quantitative methods to inform the role that policy can play to promote healthy behaviors to improve women’s health during and after pregnancy.

The first manuscript assessed whether states’ adoption of an optional Medicaid enrollment policy known as the “Unborn Child” (UC) option was associated with an increase in prenatal insurance coverage or the receipt of adequate prenatal care. Adoption of the policy was associated with a 12 percentage-point increase in Medicaid enrollment during pregnancy, but was not significantly associated with an increased receipt of adequate prenatal care.

The second manuscript took advantage of a natural experiment based on state variation in the timing of adoption of optional Medicaid enrollment policies to study the policies’ effects on prenatal cigarette smoking cessation and adverse birth outcomes. Presumptive eligibility, an optional enrollment policy that permits states to presume a pregnant woman to be eligible while her application is pending, led to a 7.7 percentage-point increase in prenatal smoking cessation. However, optional enrollment policies did not significantly affect adverse birth outcomes.

The third manuscript employed propensity score matching methods to estimate the effect of breastfeeding on maternal weight loss in the 12 months postpartum. Exclusive breastfeeding for at least 3 months resulted in an increased weight loss of 3.2 pounds at 12 months postpartum; and led to a 6 percentage-point increase in the probability of returning to pre-pregnancy weight or body mass index category.