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The effect of health facility births on newborn mortality in Malawi

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Abstract

We examine the effect of health facility delivery on newborn mortality in Malawi using data from a survey of mothers in the Chimutu district, Malawi. The study exploits labour contraction time as an instrumental variable to overcome endogeneity of health facility delivery. The results show that health facility delivery does not reduce 7-day and 28-day mortality rates. In a low-income country like Malawi where the healthcare quality is severely compromised, we conclude that encouraging health facility delivery may not guarantee positive health outcomes for newborn births.

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Notes

  1. Neonatal sepsis, one of the leading causes for newborn births in low income countries, which is less likely to be managed in low-resource settings like Malawi, only accounts for about 5% of the neonatal mortality (Perin et al, 2022).

  2. If labour start timing is exogenous, then we would get a uniform distribution. However, the number of observations in each category in our sample is not uniformly distributed after considering that the length of each labour timing category is different. If we categorize mothers into two groups, such as 5 pm–5am and 5am-5 pm, the proportion of responses are 53.9% and 46.1% respectively, where we still do not obtain a balanced distribution but the difference becomes smaller. It is possible that the measurement of labor timing may confront recall bias. Although we recognize some limits of the use of labor timing as an instrument variable, we validate our instrument variable in the empirical strategy section by examining the orthogonality condition.

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Acknowledgements

We received helpful suggestions from seminar participants at the Pacific Conference for Development Economics and Interdisciplinary Ph.D. Workshop in Sustainable Development in Columbia University, Yonsei University and KDI School of Public Policy and Management. We thank Africa Future Foundation (AFF) and Hyuncheol Bryant Kim for making the data available and AFF staff in Malawi for their fieldwork. This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2018S1A3A2075117). We are also grateful to KDI School of Public Policy and Management for financial support. The IRB for this research project was approved by Malawi National Health Science Research Committee (Malawi NHSRC-903) and Cornell University Office of Research Integrity and Assurance (Protocol ID#: 1310004204).

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  1. Korea Institute of Public Finance, Sejong, Republic of Korea

    Dawoon Jung

  2. Department of Environmental Planning, Graduate School of Environmental Studies, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea

    Booyuel Kim

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Jung, D., Kim, B. The effect of health facility births on newborn mortality in Malawi. Int J Health Econ Manag. (2023). https://doi.org/10.1007/s10754-023-09348-x

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