Abstract: The public health effects of the COVID-19 pandemic have been extensively studied but little is known about how individuals’ adaptive behaviors, subject to heterogeneous structural constraints, drove disparities in health outcomes. We address this question by evaluating the consequences of the COVID-19 pandemic for preterm birth in Mexico, a medium-income country with high inequality, fragmented health insurance mechanisms, and a hybrid healthcare system with public and private hospitals. Despite the high out-of-pocket costs associated with private medical care, the proportion of women giving birth in private settings increased dramatically after the onset of the pandemic in 2020. This was likely a strategy to reduce their risk of infection in public hospitals, many of which were overcrowded. Time-series models suggest that preterm births increased among women who gave birth in public hospitals but decreased among women who gave birth in private settings. Difference-in-differences models based on a conception-cohort design reveal that the reduction in preterm births in private hospitals was explained by a combination of changes in women’s demographic characteristics, the ability to afford high quality medical care within the private sector, and other unobserved protective behaviors. As a result, the health benefits from receiving private rather than public care were concentrated among women with upper secondary and college education, while the less educated who paid for private care experienced no health premiums. Our analysis goes beyond documenting changes in preterm birth to illuminate how protective behaviors subject to heterogeneous socioeconomic and structural constraints led to unequal health outcomes during the pandemic.

Bio: I am an Assistant Professor in the Sociology Department at the University of Maryland, College Park since 2019. I hold a PhD in Sociology from New York University and specialize in domestic and international research in family demography, reproductive health, and maternal and infant health. A large part of my work focuses on the demographic and health consequences of disruptions to social contexts in the United States and Mexico. One of my lines of research investigates the relationship between the opioid epidemic and fertility, family formation, and family structures in the United States. Another set of projects assesses the effect of community violence on reproductive health and family formation and stability in Mexico. A separate area of interest focuses on the consequences of the COVID-19 pandemic on infant and maternal health in that same country. In addition, I am conducting work on inequality in knowledge about contraception, pregnancy intentions, and reproductive autonomy in the United States.