Eduardo Fajnzylber

An Economic Model of Amniocentesis Choice

Medical practitioners typically utilize the following protocol when advising pregnant women about testing for the possibility of genetic disorders with their fetus: Pregnant women over the age of 35 should be tested for Down syndrome and other genetic disorders, while for younger women, such tests are discouraged (or not discussed) as the test can cause a pregnancy to miscarry. The logic appears compelling. The rate at which amniocentesis causes a pregnancy to miscarry is constant while the rate of genetic disorder rises substantially over a womans reproductive years. Hence the potential benefit from testing - being able to terminate a fetus that is known to have a genetic disorder - rises with maternal age. This article argues that this logic is incomplete. While the benefits to testing do rise with age, the costs rise as well. Undergoing an amniocentesis always entails the risk of inducing a miscarriage of a healthy fetus. However, these costs are lower at early ages, because there is a higher probability of being able to replace a miscarried fetus with a healthy birth at a later age. We develop and calibrate a dynamic model of amniocentesis choice to explore this tradeoff. For parameters that characterize realistic age patterns of chromosomal abnormalities, fertility rates and miscarriages following amniocentesis, our model implies a falling, rather than rising, rate of amniocentesis as women approach menopause.

Inequality in mortality decreases with age: evidence from developing countries using census data

With some exceptions, studies consistently find that mortality rate ratios between the highest and lowest socioeconomic status (SES) groups are substantially larger among the young-age population, rather than the old one. This pattern is relevant for policy and research, but it has seldom been explored in populations of developing countries. In this study, eight samples in the Integrated Public Use Microdata Series (IPUMS) that contain mortality data (El Salvador 1992, Rwanda 2002, Senegal 2002, Sierra Leone 2004, Uganda 2002, Malawi 2008, Brazil 2010, and Zambia 2010) and information about household assets are analyzed, and, using SES of equal relative size, results in seven out of eight cases are the same as those in developed societies: ratios are larger among the young age group and among men. Therefore, the ratio of mortality by relative-SES also decreases with age in several developing ones.