Centralizing Swedish maternal and labor care: Consequences for women’s health

Sammanfattning

This thesis examines the consequences of the centralization of Swedish maternity care for women’s health. During the study period (1993-2024), the number of maternity wards decreased by almost one-third, despite continuous population growth. The effects of centralization on health outcomes are a priori ambiguous. On one hand, larger hospitals may be more cost-efficient and provide higher-quality care than smaller units. On the other hand, centralization increases travel time and is likely to increase crowding and workload for maternity ward staff. This has raised concerns regarding trade-offs between cost-effectiveness and maternal health outcomes. This thesis relies on three sources of data: regional-level data from the Medical Birth Registry, hospital-level data constructed from yearly Birth Reports, and data from a survey I designed and conducted. The analysis uses an event-study difference-in-difference design to determine the effects of maternity ward closures on maternal health outcomes and finds an increase in C-sections and severe vaginal tears. Associations between maternal health outcomes and travel time, as well as hospital size, were also examined. I find that increased travel time is associated with negative psychological outcomes, and that hospital size is correlated with indicators of quality and some adverse health outcomes.