BOZEMAN, Mont. — Research by a Montana State University economist was recently published in the prestigious Journal of Political Economy examining the impacts of licensing requirements for midwives on infant and maternal mortality rates.
Mark Anderson is an associate professor in the Department of Agricultural Economics and Economics in MSU’s College of Agriculture and College of Letters and Science. With colleagues at the University of Colorado Denver and Yale, Anderson published “Occupational Licensing and Maternal Health: Evidence from Early Midwifery Laws” last month. The research synthesizes decades worth of U.S. Census Bureau data relating to maternal and infant mortality rates from 1900-1940, a period in which nearly half of the U.S. adopted state-mandated licensing requirements for midwives.
“Unlike today, American women in the early 20th century…were attended by a single health care provider — a doctor or a midwife — who had sole responsibility for the health of the mother and infant,” write the authors. “Licensure has historically been justified on the grounds that requiring licensees to pass an exam or receive formal training should put low-quality providers out of the market and raise the quality of those who remain, both of which should improve the health and safety of consumers.”
The timeframe chosen for the study allowed the team to specifically examine mortality trends pre- and post-licensing as states adopted the requirements. Their data analysis revealed that while licensed practitioners are often more expensive for patients, which led to concerns that fewer women would use them, the adoption of licensing requirements led to a 7-8% decrease in maternal mortality during that period, as well as a reduction in infant mortality.
“This publication is an extremely prestigious one, placing Mark in a small group of researchers from MSU to be featured in the Journal of Political Economy,” said Greg Gilpin, head of the Department of Agricultural Economic and Economics. “This work is very important because it is the strongest evidence to date that licensing restrictions can improve individual health, and is directly relevant to ongoing policy debates on the merits of licensing midwives.”
While the topic is historical, the authors argue that the results have important applications today.
“Given the levels of health, medical technology and wealth that prevailed in the United States during the time period we study, our results are directly relevant to ongoing policy debates about the merits of licensing and training midwives in developing countries today,” write Anderson and his team. “In many developing nations, the majority of births are attended by traditional birth attendants, or TBAs. Experts have claimed that replacing TBAs with licensed midwives would substantially reduce infant and maternal mortality, yet there has been a paucity of causal evidence to support this claim.”
Their research, Anderson said, helped address that lack of evidence to prove the importance of licensing to patient health.
