Impact of Immigration on Prenatal Care Use and Birth Weight: Evidence from California in the 1990's.

Abstract

The mid-1990’s witnessed the passage of two legislative measures restricting noncitizens’ use of public services in response to the extensive and costly use of public assistance by immigrants reported by earlier studies (Jane L. Ross, 1996). First, the Immigration Control and Financial Responsibility Act restricted illegal immigrants’ access to medical services and to other forms of public assistance. In addition, the Personal Responsibility and Work Opportunity Reconciliation Act extended the restriction to legal immigrants entering the country after its enactment for at least five years after entry and effectively until they naturalize. However, some states with large immigrant populations, like California, chose to institute state-funded substitute benefits for immigrants losing federal assistance. In spite of these states’ assistance possibly working as an “immigrant magnet” (George J. Borjas, 2001), the literature emerging after welfare reform has often found a greater decline in the use of public assistance, particularly Medicaid, among noncitizen households relative to citizens. This finding has been attributed to the “chilling effects” of welfare reform (Wendy Zimmermann and Michael Fix, 1998). In light of these findings, should we now expect greater noncitizenship rates to ease access to public services or, rather, to impose a burden on access to public services? In this paper, we look into this question and examine the impact of noncitizenship rates on women’s use of prenatal care (PNC) over the period 1991–2000 in California. We focus on women’s PNC use given the health implications that PNC can have for both mother and infant, and yet the lack of studies examining the role of noncitizenship rates, even in high immigration areas, on women’s PNC use. We use 1991 and 2000 to assess significant changes in the effect of noncitizenship rates on women’s PNC use before and after the 1996 reform. Additionally, we focus on California due to its population size and its large immigrant population, of whom approximately 61 percent are noncitizens. Finally, given the implications of adequate PNC on newborns’ birth weight through the early detection and treatment of any existing health problems, we examine how PNC, in turn, has affected the birth weight of babies born in California over the examined time period. In sum, this study addresses the following questions: Has the effect of noncitizenship rates on women’s PNC use changed before and after the 1996 reform? In particular, do greater noncitizenship rates result in reduced PNC use due to increased competition for public services, or do they lead to increased PNC use due to welfare reform’s “chilling effect” and increased awareness of the importance of PNC? Furthermore, how does PNC use affect birth weight?