Matern Child Health J
Another factor that could potentially confound the effects
of VLBW is maternal risky behavior during pregnancy. In
particular, consider a situation where a marriage was unsta-
ble even prior to the birth of the baby in 1988 but no formal
divorce or separation occurred prior to the birth in 1988.
The unstable marriage might have resulted in the mother in-
dulging in risky behaviors such as drinking or smoking dur-
ing pregnancy. The above scenario could potentially result
in both a VLBW baby and a marriage that ends in either a di-
vorce or separation. Thus, what we are attributing to VLBW
might infact be a result of unmeasured factors (risky behavior
during pregnancy as a result of an unhappy marriage) that are
correlated with both VLBW and marital dissolution. To alle-
viate some of these concerns, we included separate dummy
variables for whether or not the mother drank or smoke dur-
ing pregnancy as proxy variables for maternal risky behavior.
We observed that our VLBW estimates changed very little
as a result of this modiﬁcation in the model speciﬁcation.
Beyond alleviating some concern about bias from unknown
confounders, understanding the possible underpinnings of
these ﬁndings (e.g., are lower divorce risks related to lower
long-run psychological and monetary costs?) will require
further research, which may lead to improvements in our
ability to adequately counsel patents making decisions about
infants born at the limit of viability or with little chance of
survival. An important caveat in this study is that one third
of births in the U.S. take place outside of marriage and un-
married mothers have higher rates of VLBW than married
mothers. The burdens of VLBW may be particularly high
for unmarried mothers. However, we do not consider these
women in our analysis because the focus of this paper is on
the transition from marriage to divorce/separation.
Finally, this paper uses data from the 1988–1990 period
and is thus not using current data. These data are among
the few available data sets with the necessary structure and
variables required for this research. Moreover, we have not
identiﬁed persuasive reasons to expect that the costs or stress
associated with caring for a VLBW infant have declined over
the last decade. Nevertheless, this is a concern for further
investigation with national surveys that might emerge in the
These study results indicate that families with VLBW
infants exhibit a multi-fold risk of marital instability and di-
vorce, which may further increase in the presence of other
factors, including pregnancy wantedness. As divorce in these
circumstances likely has broad long-term consequences for
these infants and their siblings and parents, there is a need to
counsel and support families with VLBW children on mecha-
nisms to cope with the initial stressors that can be anticipated
to arise. We are cognizant of the fact that a signiﬁcant pro-
portion of the VLBW babies go on to lead perfectly normal
lives. Yet, our results suggest that parents are often mak-
ing divorce/separation decisions within the ﬁrst 2 years after
delivery of the VLBW infant. Thus, informed counseling
about the chances of the VLBW, premature child regaining
normal physical and mental functioning over the medium
to long-run may could prove extremely useful in reducing
divorce rates. For families employing artiﬁcial reproductive
technology, which may increase the risk of multiple and
VLBW births, disclosure of the potential risks of divorce
may well be indicated. Given the rising rate of VLBW births
and their increasing survival, family-oriented policies and
programs are indicated to assure that families with VLBW
infants have more reasonable prospects of staying intact and
Acknowledgement This work was supported in part by DHHS,
HRSA, MCHB grant 5T76MC00008.
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