Long-term causal effects of access to institutional delivery service on dementia risk

Despite its potential significance, we lack a comprehensive understanding regarding the enduring casual effects of access to maternity wards for childbirth. Building upon theoretical frameworks we anticipate effects on cognitive skills and the accumulation of human capital across various life stages. In this paper we examine dynamic impacts of access to institutional delivery on educational, labour and health outcomes across the life course. To study cognitive impacts, we track individuals from childhood through adulthood to elderhood, assessing effects on test scores, educational attainment, and dementia risk in later life. We further explore the role of selection by contextualizing the estimated effects through various lenses. We identify reduced risk for later-life dementia from being born in a hospital as compared to a midwife assisted home birth. Leveraging a historical policyintervention in Sweden during the 1920s–1940s that expanded access to hospital maternity wards, we link individual-level administrative data to assess impacts from childhood through old age. We find that being born in a hospital had considerable gains across the life-course. Improvements in cognitive abilities were visible already in childhood and manifests in task content of mid-life occupations, but we also identify subsequent gains in secondary schooling, employment, and earnings. Reduced child morbidity following better treatment of complications in hospitals compared available options in home settings is a likely mechanism. Studying selection indicates very strong selection into treatment, which implies that the estimated LATE seriously overstate the population-level treatment effect.