Long-Term Health Benefits of Occupational Licensing: Evidence from Midwifery Laws

Abstract

During the late 19^th and early 20^th century, several states mandated midwifery licensing requirements to improve midwives' knowledge, education, and quality. Previous studies point to the health benefits of midwifery quality improvements for maternal and infant health outcomes. This paper exploits the staggered adoption of midwifery laws across states using event-study and difference-in-difference frameworks. We use the universe of death records in the US over the years 1979-2020 and find that exposure to a midwifery licensing law at birth is associated with a 2.5 percent reduction in cumulative mortality rates and an increase of 0.6 months in longevity during adulthood and old age. The effects are concentrated on deaths due to infectious diseases, neoplasm diseases, and suicide mortality. We also show that the impacts are confined among blacks and are slightly larger among males. Additional analyses using alternative data sources suggest small but significant increases in educational attainments, income, measures of socioeconomic status, employment, and measures of height as potential mechanism channels. We provide a discussion on the economic magnitude and policy implication of the results.

Keywords: Health; Historical Data; Longevity; Midwifery; Mortality; Occupational Licensing.

Fig. 1.

Midwifery Law Year across States.

Fig. 2.

Geographic Distribution of Mortality and Longevity by Birth States in the NCHS Mortality Data (Death Years 1979–2020).

Fig. 3.

Density Distribution of Mortality and Longevity in the NCHS Mortality Data (Death Years 1979–2020).

Fig. 4.

Event-Study to Explore the Effects of Midwifery Law Enactment on Mortality Rate. Notes. Point estimates and 95 percent confidence intervals are depicted. Standard errors are clustered at birth-state-year level. Regressions include birth-state fixed effects, birth-year by region-of-birth fixed effects, birth-state trend, individual controls, and birth-state covariates. Individual controls include dummies for gender and race. Birth-state controls include share of homeowners, share of children, share of immigrants, share of different occupations, literacy rate, share of married people, female labor force participation rate, and average socioeconomic index. Regressions are weighted using average birth-state population. The data comes from NCHS death records collapsed at birth-state-year and gender-race level for death years of 1979–2020. N=6,415

Fig. 5.

Event-Study to Explore the Effects of Midwifery Law Enactment on Longevity. Notes. Point estimates and 95 percent confidence intervals are depicted. Standard errors are clustered at birth-state-year level. Regressions include birth-state fixed effects, birth-year by region-of-birth fixed effects, birth-state trend, individual controls, and birth-state covariates. Individual controls include dummies for gender and race. Birth-state controls include share of homeowners, share of children, share of immigrants, share of different occupations, literacy rate, share of married people, female labor force participation rate, and average socioeconomic index. Regressions are weighted using average birth-state population. The data comes from NCHS death records at the individual level for death years of 1979–2020. N=48,251,867

Fig. 6.

Balancing Test Event-Study to Explore Changes in the Sample Demographic Composition before and after Midwifery Law Enactment. Notes. Point estimates and 95 percent confidence intervals are depicted. Regressions include state fixed effects, year-by-region fixed effects, and a state-specific trend. Regressions are weighted using state-level population. The data comes from NCHS death records collapsed at birth-state-year and gender-race level for death years of 1979–2020. N=6,415