Your health at birth is actually an indicator of how the rest of your life will turn out: health status, school performance and economic situation. In her thesis, Simona Bejenariu has studied government reforms in Romania and finds that although not intended public policies affect the health status of newborn children.
"Convincing studies in economics show that children with low birth weight have lower employment rate and lower income if employed later on in life. In my study I show that some socioeconomic factors that are clearly influenced by public policy can affect the health capital at birth of children", says Simona Bejenariu.
In 2010 the Romanian government implemented an unexpected wage cut of 25 percent, as an austerity measure, that affected all employees in the public sector.
"Prior expectations of an extreme change where people lost a quarter of their income, especially women in the public sector who already had low incomes, were that it would negatively affect the health of the child. But we actually found improvements in the health at birth – of boys".
Another outcome of the reform was that fewer boys were born. This is in line with the selection in utero hypothesis prevailing in medicine saying that exposure to extreme stress in early pregnancy more often leads to miscarriages of male fetuses. For some medical reason, weak male fetuses are selected out.
"In this time of economic downturn austerity measures have been extensively used to reduce budget deficits. This study shows that austerity measures not only have direct effects, but also affect unborn children. Before the implementation of policies they should be analyzed beyond direct effects such as budget savings. Policy makers should take into account the effects on the unborn children and early life environment per se", says Simona Bejenariu.
Romania is one of the poorest countries in the European Union looking at GDP. Compared to other European countries, Romania has higher rates of maternal mortality, prematurity and infant deaths. Also, the Romania has one of the world’s highest rates of abortion.
"Contraceptives and abortions were prohibited during the communist era, as the regime wanted to increase the population. People had no reproductive freedom. After the fall of communism, there was liberalization and reproduction was up to the individuals. But there are still many reproductive problems in Romania today, for example that people use abortion as a contraceptive", explains Simona Bejenariu.
About ten years ago the Romanian government unexpectedly introduced higher and fixed levels of maternity leave benefits. Simona Bejenariu has looked at the effects:
"Mothers using the benefits were 20 per cent less likely to use an abortion. Also women were more likely to conceive and have healthier children."
By far, the most vulnerable and poor group is the Roma ethnic minority. Roma children, for example, face significantly worse health conditions than the rest of the population, which includes lower birth weight and lower schooling. In her thesis Simona Bejenariu studied a large national health programme aiming at improving the health status of pregnant Roma women and children, with the help of trained Roma mediators.
"We found that the mediation program was successful and that prenatal care increased significantly among Roma women in rural areas. But we didn’t see any major improvements in the health of their children, which was surprising."
Also, to Simona Bejenariu’s surprise, this large social programme which also has been spread to other countries with large Roma minorities, has never before been evaluated. Therefore this study is an important contribution that can help to improve the implementation of such programmes.
The choice to study health and social reforms in Romania was not difficult to make. Simona Bejenariu is Romanian and has always been interested in medicine, but never fulfilled that interest. So health economics was a good combination.
"Romania is an extremely suitable place for studying social policies and programmes, compared to other developed countries where policies are rarely changed or slowly; policies in Romania change more quickly without much prior debate."
In September Simona Bejenariu will start her new job in Stockholm. She has got a post-doctoral position at SOFI, Swedish Institute for Social Research.
"I will continue research on early life inequalities and how these affect life further on. And hopefully conduct meaningful research that can be applied to the real world", says Simona Bejenariu.
The doctoral thesis "Determinants of Health Capital at Birth: Evidence from Policy Interventions" was defended on June 2, 2015, at the Department of Economics, School of Business, Economics & Law at the University of Gothenburg.