Demography, Vol. 27, No.1, February 1990 Pregnancy Wantedness and the Early Initiation of Prenatal Care Theodore J. Joyce Department of Health Care Administration, Baruch College, City University of New York, and National Bureau of Economic Research, 269 Mercer Street, New York, New York 10003 Michael Grossman Graduate Center, City University of New York, and National Bureau of Economic Research, 269 Mercer Street, New York, New York 10003 The study examines the impact of the wantedness of a pregnancy on the demand for early prenatal care. Using a cohort of pregnant women in New YorkCity, we estimate a prenatal care demand function in which we control for the probability of giving birth, given a woman is pregnant. We interpret this control as a measure of wantedness, The results indicate that if the black and Hispanic women who aborted had instead given birth, they would have delayed the initiation of prenatal care, on average, more than three-quarters of a month longer than the mean number of months of delay that were actually observed for the women who gave birth. Byallowing women to terminate an unwanted pregnancy, induced abortion increases the average use of prenatal care among black and Hispanic women relative to what would have been observed if the women who aborted had instead given birth. Two recent and comprehensive reports on infant health in the United States both recommended that efforts be directed at reducing the number of unintended or unwanted pregnancies (Institute of Medicine 1985; U. S. Dept. of Health and Human Services 1986). The recommendation was based on the proposed link between pregnancy planning, improved prenatal behavior, and favorable birth outcomes. Specifically, women who choose to become pregnant are apt to be better prepared emotionally and financially for the demands of pregnancy and childbearing. Thus they may be more likely to avoid smoking, to seek out prenatal care earlier, and in general to have a more heightened concern for the impact of their behavior on the health of the fetus than are women whose pregnancies are unwanted or unintended. As plausible as the recommendation appears, the evidence supporting it is scarce, A number of ecological analyses have documented a relationship between the use of family planning clinics and lower rates of neonatal mortality (Grossman & Jacobowitz 1981; Joyce 1987a). The availability and use of abortion services have also been associated with im- provements in area-wide birth outcomes (Corman & Grossman 1985; Joyce 1987b). These authors argue that the use of contraception and abortion should be inversely related to the incidence of unwanted pregnancies and births and positively related to the increased use of prenatal care and other healthy behaviors, At the individual level, there is some evidence that women who describe their births as wanted begin prenatal care earlier and smoke less during pregnancy (Marsiglio & Mott 1988; Weller, Eberstein, & Bailey 1987), The methodological problems of using self-as- Copyright © 1990 Population Association of America Downloaded from http://read.dukeupress.edu/demography/article-pdf/27/1/1/904368/1joyce.pdf by guest on 20 December 2021