Economics of Children's Health and Development

Drivers of Racial Differences in C-Sections

Presenter

Molly Schnell

Northwestern University

Abstract

Black mothers with unscheduled deliveries are 25 percent more likely to deliver by C-section than non-Hispanic White mothers. The gap is highest for mothers with the lowest risk and is reduced by only four percentage points when controlling for observed medical risk factors, sociodemographic characteristics, hospital, and doctor or medical practice group. Remarkably, the gap disappears when the costs of ordering an unscheduled C-section are higher due to the unscheduled delivery occurring at the same time as a scheduled C-section. This finding is consistent with provider discretion—rather than differences in unobserved medical risk—accounting for persistent racial disparities in delivery method. The additional C-sections that take place for low-risk women when hospitals are unconstrained negatively impact maternal and infant health.

Favorite Janet Memory

When I was a graduate student at Princeton, I submitted my third-year paper on a Friday afternoon, expecting not to hear anything back from the department for a few weeks. In true Janet fashion, she read it within the hour and returned it with detailed comments. I was blown away then—and am even more so now—as I try to balance my own work and support for students. Moments like that remind me just how extraordinary Janet is: her intellectual generosity, responsiveness, and care for her students are nothing short of superhuman!

Drivers of Racial Differences in C-Sections

Discussant:

Diane Alexander

University of Pennsylvania

Favorite Janet Memory:

I was so lucky to have Janet as an adviser! We share a love of gardening, so I got tips on both plants and research. She was so generous with her time and invested so much in her students. When she became department chair and got even more busy, all that meant for us students was that she responded to our emails on Fridays, instead of during the week. I don't know how she did it!

Cycles of Infertility: Intergenerational Transmission and the Role of Assisted Reproduction

Presenter

Emilia Simeonova

Johns Hopkins University

Abstract

This paper examines intergenerational correlations in fertility problems (sub-fertility) and the utilization of assisted reproductive technologies (ART) using comprehensive Swedish registry data. We document a significant intergenerational transmission of sub-fertility for both daughters and sons, independent of parental socioeconomic status. Daughters whose mothers reported fertility difficulties are 2.6 percentage points (19.4 percent) more likely to experience fertility problems themselves, while sons whose mothers reported fertility difficulties show a 1.7 percentage point (13.5 percent) increase. Although parental socioeconomic status does not predict fertility problems once we condition on age, higher parental education, particularly maternal education, is positively associated with the second generation's use of ART, irrespective of the parents’ own fertility experiences. We further demonstrate that parental fertility issues, especially on the male side, significantly increase the probability of gender-specific fertility treatments, indicating distinct transmission mechanisms by gender. While we find no evidence of assortative mating by family sub-fertility experience, couples with fertility issues on both sides face significantly higher divorce risks. Our findings highlight substantial personal and social costs of fertility problems, emphasizing that these issues are not simply consequences of lifestyle choices or delayed childbearing but are shaped by hereditary and environmental factors that persist across generations.

Favorite Janet Memory

My meeting time with Janet was Wednesdays at 10 am in her office. Before I headed out for my first academic job, I asked her what was the optimal strategy for junior faculty during department seminars. She told me it was best to stop asking questions when I knew that my last comment was well received by my colleagues. Things could "only go down from there".  Best advice ever, I follow it to this day!

The Labor Market and Health Impacts of Reducing Cesarean Section Deliveries

Presenter:

Maya Rossin-Slater

Stanford University

Abstract:

One in three births in the United States is delivered by cesarean section (c-section). This paper studies the labor market and health effects of c-sections, using newly linked administrative data that combines the universe of California birth records with mothers' quarterly earnings. We analyze the impact of an intervention that reduced c-section rates among low-risk first-time births, and show that mothers exposed to the intervention are more likely to be employed in the quarter following birth, and more likely to return to their pre-birth employer. These impacts attenuate over time---suggesting that a c-section primarily delays return to the labor market following childbirth---but attachment to the pre-birth employer remains higher five quarters post-birth. Further, among mothers who have another child, we find that exposure to the intervention at the first birth leads to a lower likelihood of c-section and preterm delivery at the second one, implying that both the economic and health benefits of reduced c-sections may compound with birth order.

Favorite Janet Memory:

Many wonderful things come to mind from over the years of knowing Janet. One memory that stands out is from my PhD graduation at Columbia. I had the honor of being a speaker at the graduation, and even though Janet had already moved to Princeton by then, she nevertheless came to the graduation ceremony at Columbia. She sat on stage behind me when I spoke, and then she met my family at the reception afterwards. It meant so much for both my family and me to have Janet there on that day.

The Labor Market and Health Impacts of Reducing Cesarean Section Deliveries

Discussant:

Adriana Corredor-Waldron

North Carolina State University

Effects of WIC on Birth Outcomes: Evidence from Newly Digitized Data from the National Archives

Presenter:

Maria Rosales-Rueda

University of Delaware

Abstract:

This paper examines the effect of nutrition---delivered via the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)--on infant health. We contribute to the literature by adding new data on WIC roll-out from the National Archives, employing novel methods, examining previously unexplored infant outcomes, and investigating new mechanisms. We find robust evidence that access to WIC in a woman’s county of residence by the start of their second trimester led to higher birth weight and a reduction in the probability of an infant being of low birth weight, with larger in magnitude effects for infants with Black mothers than for those with White mothers. Our results suggest a lower bound for treatment-on-the-treated effects for birth weight of around 33 grams and for low birth weight of -0.9 percentage points for infants with Black mothers, which are both economically significant. For White mothers, the results for low birth weight are much smaller in magnitude and statistically insignificant. These findings show WIC reduced overall disparities between Blacks and Whites in low birth weight by 3.8 percent.

Favorite Janet memory:

Janet’s brilliance and academic rigor, coupled with her generosity in mentoring, have deeply influenced me since I first met her. I cold-emailed Janet as a graduate student to ask if we could meet at the Summer Institute. She replied right away and kindly agreed. During our meeting, she offered thoughtful feedback on my job market paper. Since then, whenever I’ve reached out for advice, she has been generous with her time and insights. I’m also grateful for the opportunity to visit CHW a few years ago, where I learned a great deal through interactions with her. Over the years, I’ve often looked to Janet’s work, leadership, and impact as a source of inspiration.

Effects of WIC on Birth Outcomes: Evidence from Newly Digitized Data from the National Archives

Discussant:

Katherine Meckel

UC San Diego

Favorite Janet Memory:

When she called me immediately after I sent an email requesting advice on tenure. It felt like I had barely pressed "send" on the email when the phone rang!

Heterogeneity in the Long-Run Effects of Childhood Exposure to Medicaid

Presenter:

Amanda Kowalski

University of Michigan

Abstract:

We examine heterogeneity in the long-run effects of childhood exposure to Medicaid using administrative tax data linked to other data sources through the US Census.

Favorite Janet Memory:

One of my favorite memories with Janet occurred during my year-long visit to Princeton, where I had the privilege of working in the office next to hers. Although I had the opportunity to see Janet regularly, one interaction stands out in my mind. Instead of meeting in our offices, she suggested that we take a walk to the Princeton University Art Museum.

As we walked across the beautiful campus and wandered through the exhibits, we brainstormed research ideas while taking in our surroundings.  Janet’s research is deeply inspired by the world around her.  She once told me that she has never concerned herself with which research topics are popular; instead, she follows her own path, focusing on what she deems important.  This self-driven approach is what has enabled her to be truly innovative.    

I recently looked back at the notes that I took after our walk, and I see how they shaped the paper that I am presenting today.  The paper brings together Janet’s pioneering work that uses a simulated instrument strategy to study the impact of childhood Medicaid with advice from her Ely lecture that is important to examine consequences over the life cycle.  I can see direct connections between Janet’s work and more than a dozen other papers on today’s program.  

My walk with Janet was not just intellectually stimulating, but also it was a testament to Janet's way of blending mentorship with a warm, personal touch. Her ability to create an environment that is high-powered but also supportive is something I deeply admire.  Janet has been an inspiration to me through her research, her mentorship, and her leadership of various organizations within our profession.  She has also supported my career growth directly.  I did not meet Janet until I was a junior faculty member, but I am honored to be included in this celebration alongside her students. I am very grateful to be back at Princeton, walking alongside Janet and the community that she has created.

Heterogeneity in the Long-Run Effects of Childhood Exposure to Medicaid

Discussant:

Marianne Page

University of California Davis

Favorite Janet Memory:

I had the good fortune of being matched with Janet as a co-mentor for the CSWEP CeMENT workshop. As you can imagine, I was pretty intimidated, when I found out I was going to be critiquing papers beside her! Over the course of the next few days, I was bowled over, time and again, by the way she was able to quickly identify papers' strengths and weaknesses, and the efficiency with which she guided authors through the process of restructuring. I learned so much! I was also moved by her willingness to be vulnerable in sharing personal stories for the benefit of the mentees.

Fostering a Gentler Flight from the Nest: Effects of Foster Care Reform on Labor Market Outcomes

Presenter

Kate Musen

Columbia University

Abstract

Prior to the introduction of extended foster care in 2012, four to five thousand children aged out of foster care every year in California at age 18. The California Fostering Connections to Success Act (AB 12), which first took effect on January 1, 2012, extended foster care eligibility from up to age 18 to up to age 21 gradually over the course of three years. Using a difference-in-differences design, I estimate the causal effects of AB 12 on college enrollment and earnings for the first youth eligible for extended foster care. I find that each additional year of extended foster care increases the likelihood that youth enroll in any college by three percentage points and increases the likelihood of formal employment at 24 through 26 by 4%. These effects are largely driven by improved outcomes for the most vulnerable youth in foster care. Within the context of foster care, non-Hispanic white men are more likely to have characteristics that indicate high vulnerability, with correspondingly larger treatment effects.

Favorite Janet Memory

Janet once aptly referred to herself as a “full-service advisor,” reflecting the care and wisdom she provides every one of her students on questions in all domains of economics and life. Her truly exceptional advising is well known within the economics community. One thing people may not know, however, is that Janet is also an expert in art museums and installations around the globe. I’ve been lucky as a graduate student to go to conferences in many fun places, and Janet has made sure that not only are my slides prepared for my talks, but also that I am prepared with art museum recommendations. Thanks to Janet’s guidance, I have seen incredible art everywhere from Los Angeles to Munich to Princeton, NJ.

Fostering a Gentler Flight from the Nest: Effects of Foster Care Reform on Labor Market Outcomes

Discussant:

Jane Waldfogel

Columbia University

Favorite Janet Memory:

One of my favorite memories is going to see the play "Who's Afraid of Virginia Woolf?" together in early March 2020. It's a great play and it was a good production, we had good seats, there were celebrities in the audience - all in all, close to a perfect night out on Broadway. Less than a week later, the world shut down because of COVID-19, and it was a long time before we were able to go to the theater again. We've seen many memorable plays together but that one definitely stands out.

Workforce Quality and Early Childhood Development at Scale

Presenter

Gabriella Conti

University College London

Abstract

Early years programs have the potential to significantly enhance children’s developmental outcomes, but large-scale implementations often fail to replicate the successes observed in smaller trials. Identifying the drivers of successful outcomes is therefore essential to designing effective and scalable interventions. This paper provides the first causal evidence on the role of a key input—workforce quality—in achieving developmental gains through large-scale early years interventions.
Leveraging the quasi-random assignment of family nurses to families within a large-scale home visiting program in England, we estimate each home visitor’s effectiveness in improving program retention and children’s physical, cognitive, and socio-emotional development. We find considerable variation in effectiveness: a one standard deviation increase in home visitor quality is associated with a 0.20 standard deviation improvement in cognitive outcomes and a 0.23 standard deviation improvement in socio-emotional development at age 2. A family nurse’s ability to retain mothers in the program is uncorrelated with their ability to improve child outcomes—suggesting that retention is not a reliable proxy for program effectiveness.
Despite access to detailed data on worker characteristics, supervisory assessments, and program implementation, we find that traditional structural indicators—such as formal qualifications—are poor predictors of workforce effectiveness. Instead, process quality—how the program is delivered—emerges as far more important. We also identify key mechanisms through which effective home visitors operate, including improvements in maternal mental health and reductions in risky behaviors during pregnancy.
These findings underscore that maintaining high workforce quality and strong implementation practices is essential for achieving success in large-scale early childhood interventions.

Favorite Janet Memory

I’ll never forget the first time I met Janet. We were at the NBER Summer Institute, and I found myself alone with her in an elevator. I panicked—here I was, face-to-face with one of my academic idols, and only seconds to say something. I blurted out, all in one breath: “Hi, I’m Gabriella Conti, a postdoc at the University of Chicago, I work on early childhood development and I love your work.” She paused, smiled, and with her usual calm replied, “Oh, Gabriella, it’s very nice to meet you.”
That quiet grace and generosity defines Janet. Over the years, she’s been there through some of my toughest personal and professional moments—always generous with her support and kindness, never showy, just deeply human. She’s the kind of person who makes you feel seen and heard, and that’s incredibly rare. Her encouragement has meant more than I can say. She has been a mentor, a role model, and a source of strength and inspiration.

Thank you, Janet.

The Impact of Children’s Disabilities on Families

Presenter:

Herdis Steingrimsdottir

Copenhagen Business School

Abstract:

The birth of a child with a severe disability is a major health shock that affects parents early in their working life. We estimate its impact on parents’ long-term career trajectories, their balance sheets, and major life decisions using detailed register data from Denmark. To identify the causal effect of childhood disability we use an event study approach, examining serious disabilities, that have no or weak associations with socioeconomic determinants, and those that can’t be predicted during pregnancy. We find that having a child with a disability has strong negative impact on mothers’ earnings. The effect is persistent and the wage penalty grows over time. Fathers’ earnings are also affected, but the impact is notably smaller. Employment is not significantly affected for either parent, but both mothers and fathers face a reduced likelihood of reaching top executive positions. Moreover, the long-term structure of the household is disrupted, with lower subsequent fertility rates and higher rates of partnership dissolution. Earnings losses are especially pronounced among younger, low-income, and less-educated mothers, highlighting important heterogeneity in families’ capacity to absorb caregiving burdens. Our findings highlight the significant and enduring economic and social costs of caring for children with disabilities.

Favorite Janet Memory:

Janet was my PhD supervisor at Columbia University, and her mentorship truly shaped who I became as a researcher. She was incredibly supportive throughout my graduate studies. She had a big influence on both the focus of my research, and the way I approach scholarly work more broadly.

The Impact of Children‘s Disabilities on Families

Discussant: 

Hilary Hoynes

UC Berkeley

Prenatal Conditions and Midlife Mental Health: Evidence from an Alcohol Policy Experiment
 

Presenter:

Peter Nilsson

IIES, Stockholm University

Abstract:

We estimate the long-term mental health impact of an alcohol policy experiment on individuals exposed to the policy in utero. The policy lasted for 8.5 months and significantly expanded access to alcohol, especially for those under age 21. Using administrative data on healthcare visits, drug prescriptions, and psychological assessments, we show that prenatal policy exposure had a substantial, early, and persistent impact on the mental health of the children of young mothers. The exposed cohorts conceived just before the policy started are 16% more likely to be diagnosed with any mental condition in midlife. We find effects on common midlife conditions such as depression and anxiety, on the ability to cope with psychologically stressful situations at age 18, and on neurodevelopmental disorders that manifest in early childhood. The impact of the policy on midlife earnings is significantly reduced for individuals with mental health care needs who reside in areas with lower barriers to accessing mental health care. Overall, our findings indicate that policies increasing access to mental health treatments could substantially improve labor market outcomes, even for conditions with early-life origins.

Favorite Janet Memory:

I vividly recall my first experience of an ice storm—February 5, 2014. The entire university shut down (perhaps all of New Jersey did). Yet, in the eerily silent CHW building, only two people showed up: a Swede and a Canadian. Quite possibly the only ones on campus. We exchanged a nod—no words needed. We both knew: it was going to be a productive day.
And it was—though, as it turns out, my last productive day for a while. My first child was born the next day.

Prenatal Conditions and Midlife Mental Health

Discussant:

Anna Chorniy

Icahn School of Medicine at Mount Sinai

Favorite Janet Memory:

It’s hard to choose just one favorite memory of Janet, mostly because what I appreciate about her isn’t tied to a single moment. It has been the constancy of her support and guidance that was always thoughtful and grounded. She is a mentor you can look up to and someone who is there when you need her.
What has always stood out to me, and I think many of her students and postdocs would agree, is her ability to communicate so much without saying very much at all. If your work wasn’t quite ready or clearly missed the mark, she often wouldn’t say anything outright, or might offer a short comment like “well, this doesn’t seem quite right.” She gave you space to reflect and figure it out on your own, never making you feel small in the process. So if I found myself staring at my work in silence, I knew I needed to think more deeply and revisit the issue we had just discussed.

Providers, Places, and Children’s Mental Health Care

Presenter:

Gabriel Swagel

Princeton University

Abstract:

Children's mental health is the defining public health crisis of our time. Using insurance claims for a national sample of 8 million privately insured children, I provide the first systematic quantification of the drivers of variation in children's mental health prescribing in the United States. I separate variation in pediatric ADHD medication and antidepressant prescribing due to differences in: 1) primary care provider (PCP) prescribing intensities, 2) regional practice environments, and 3) child health and demand. I find that eliminating differences in PCP prescribing intensities would reduce the variance of provider prescribing rates by 50 percent for ADHD medication and 65 percent for antidepressants. Geographic variation analyses understate the extent of treatment variation and the role of providers in driving overall treatment variation. I also find suggestive evidence that higher-quality PCPs tend to have higher ADHD prescribing intensities but lower antidepressant prescribing intensities.

Favorite Janet Memory:

After I was accepted to Princeton, the first piece of advice I received was to try to work with Janet because she is not only a superstar economist, but also an incredibly dedicated advisor. Countless times in the past 3 years since, I have reflected that this is one of the best pieces of advice anyone has ever given me.

Providers, Places, and Children’s Mental Health Care

Discussant:

Mark Stabile

INSEAD

Intergenerational Effects of Opioid Exposure and Child Health, Human Capital, and Well-being Using Linked Microdata

Presenter:

Jonathan Zhang

Duke University

Abstract:

Over the past few decades, the opioid crisis has been a leading public health and economic emergency in Canada and the United States. Little is known about the causal impacts of opioid exposure on the outcomes of children. We analyze administrative data from British Columbia linking children to parents, and across domains of health, education, child protection, and income assistance beginning in 1991. Using a within-mother, across-siblings design, we study the impacts of both prenatal in utero opioid exposure and postnatal opioid exposure on outcomes of siblings. Prenatal opioid exposure and postnatal maternal opioid abuse has significant and lasting impacts on children. Postnatal paternal opioid abuse impacts are contemporaneous, and postnatal opioid exposure coincides with periods of broader family disadvantage.

Favorite Janet Memory:

Visiting Princeton for the first time in the final week of my postdoc in June 2021 was a memorable experience especially getting to meet Janet and the other postdocs, Adriana, Esmée, and Mike, in person at last. It was a beautiful, joyful day at Janet and Bentley’s home. I even got to experience the cicadas—whose buzzing still echoes in my ears.

Intergenerational Effects of Opioid Exposure and Child Health, Human Capital, and Well-being Using Linked Microdata

Discussant: 

Marianne Bitler

UC Davis

Favorite Janet memory:

I remember how Janet was always so kind and patient, with time for everyone. She also taught me some great lessons about efficiency where I aspire to follow her lead. I was assisting her with a project that involved providing feedback, and while I was taking careful notes I would have to later transcribe. She simply wrote the (high quality) feedback in real time and thus the task was done.
 

Affordable Housing During Childhood and Women’s Health at First Birth

Presenter

Jessica Van Parys

Hunter College

Abstract

The Low Income Housing Tax Credit (LIHTC) Program is the largest federal affordable housing program in the U.S. Yet, very little is known about its impacts on children and families. This paper shows how LIHTC exposure during childhood affects women's health outcomes in early-adulthood. Our data includes geocoded addresses for LIHTC units and women's addresses at birth in Florida from 1979-2024. Our sample includes low socioeconomic status women born before LIHTC began (1979-89), whose families were most likely to qualify for LIHTC units. We use a matching model to compare women born into Census tracts that receive LIHTC during their childhoods (treated women) to women born into Census tracts without LIHTC during their childhoods (control women). We track the women into adulthood when they first give birth in Florida. Our results show that Black women with 1-standard deviation higher LIHTC exposure in childhood have 0.05-standard deviations better health outcomes at first-birth. Their infants have 0.03-standard deviations better birth outcomes. LIHTC exposure during childhood does not improve outcomes for non-Black women. The primary reason is that the Black women in our sample are more likely to live in LIHTC units than non-Black women.

Favorite Janet Memory

Janet started at Princeton when I was in my third year at Columbia. Thankfully she remained my advisor. From then on, we often had research meetings in her NYC apartment and I remember being greeted by Quid, the family cat. His effect on productivity was questionable, but his effect on morale was very positive.

Intergenerational Transmission of Lifespan in the US

Presenter:

Sandra Black

Columbia University

Abstract: 

We examine the transmission of lifespan across generations in the US using a unique dataset containing more than 26 million individuals born between 1880 and 1920. On average, 47 percent of men and 57 percent of women lived longer than their parents, though this varied across cohorts and socio-economic groups. The intergenerational persistence in lifespan is low across cohorts and socio-economic groups, and it is much smaller than persistence in socio-economic status. Moreover, persistence in lifespan and in socio-economic status are independent of each other. Lifetime well-being, which combines socioeconomic and lifespan measures, is less persistent than socio-economic measures suggest.

Favorite Janet Memory:

I can't pick just one--Janet has been an amazing mentor and role model throughout my career, and I continue to learn from her!

Intergenerational Transmission of Lifespan in the US

Discussant:

Hannes Schwandt

Northwestern University

Favorite Janet Memory:

Working with Janet on a project is what defines a happy research experience for me -- this state of focused exploration, curiosity, freedom of thought, and high productivity. That's what we love our academic jobs for and it's pretty much a guaranteed experience whenever you work with Janet.