It’s a long walk: Lasting effects of maternity ward openings on labour market performance

Studies showing that large-scale public health interventions in early life have lasting economic consequences are still scarce and rarely disclose the mechanisms. Being born in a hospital versus having a traditional birth attendant at home represents the most common early life policy change worldwide. Knowing the consequences of this policy is also important given the ongoing enlargement of maternity hospitals. In 1931–1946, the Swedish state subsidized the opening of new maternity wards, which led to the gradual decline of home deliveries assisted by midwives. Maternity wards offered improved conditions for mothers and newborns, including hygiene, surgical proficiency and medications, and health monitoring. By applying a difference-in-differences approach and geocoding techniques to register-based individuallevel data on the total population, observed from birth until the age of 65, this paper explores the long-term economic effects of access to better health services at birth using the opening of maternity wards throughout the country as an early life quasi-experiment. The paper first finds that the reform substantially reduced neonatal mortality in the short term by 19.0–26.5 deaths per 1000. Capturing survivors of the affected cohorts at the ages of 47–64, it then shows sizable long-term effects of the introduction of maternity wards on labour income (2.4–4.7 per cent) and disability pensions (4.4–11.9 per cent). The effects run directly through better health and indirectly through higher levels of schooling. Small-scale local maternity wards yield a larger social rate of return than large-scale hospitals, stemming from the treatment of normal births.