China's one-child policy: the economic choices and consequences faced by pregnant women

This paper addresses the important issue of the effect of China's one-child policy on prenatal and obstetric care utilization. The paper provides the first detailed empirical approach to this question, exploiting a unique hig h quality household survey China officially codified a set of rules and reg ulations in 1979 governing the approved size of Chinese families. commonly known as the one-child policy. The policy imposed economic and social costs on families failing to adhere to the family size limits. In particular, th e policy raised the prier of obstetric medical services for unapproved preg nancies in comparison to approved pregnancies and imposed fines on families with unapproved births. Using data from an eight-province longitudinal hou sehold survey (The China Health and Nutrition Survey), we investigate wheth er or not the one-child policy's financial penalties were associated with t he avoidance of obstetric care by pregnant Chinese women with unapproved pr egnancies. The one-child policy variables of particular interest were a dic hotomous measure of the approval status of the pregnancy. a continuous meas ure of the fine imposed upon families with unapproved births, and a continu ous measure of the prices of prenatal care and delivery services net of any subsidy available for approved births. The results partially confirm the h ypotheses that the one-child policy's economic and social costs caused wome n to forego seeking modern obstetric care services. The fine was found to b e a significant deterrent to the utilization of prenatal care. Additionally . the unapproved-status of a pregnancy was strongly negatively associated w ith the use of obstetric care. However. higher prices were not consistently found to be a significant deterrent to the use of obstetric care. (C) 2001 Elsevier Science Ltd. All rights reserved.