Can early prenatal care initiation reduce racial inequalities in birth outcomes? A causal decomposition approach

Abstract

There are large and persistent racial inequalities in adverse birth outcomes in the United States. While much research presents “causal” effects of race on birth outcomes, such analyses are not counterfactually formulated and fail to inform policy in a meaningful way. Recent methodological advances in causal decomposition have developed double machine-learning-based approaches for understanding how a causal intermediate variable can potentially mitigate a gap between groups. Drawing on population-level birth data from California in 2018 and 2019, I consider the causal role of prenatal care timing in contributing to racial disparities in birth outcomes as measured by APGAR score and intrauterine growth restriction. My results suggest that prenatal care timing plays little to no role in contributing to racial inequalities in birth outcomes, indicating that research should focus on other factors driving disparities in neonatal health.