Infant Health during the COVID-19 Pandemic in Mexico

The COVID19 pandemic has brought about profound disruptions in health outcomes across national and subnational populations. Among such consequences, those pertaining to infant health are of particular concern given their known links to wellbeing later in life. We focus on the consequences of the pandemic on health at birth using the case of Mexico, a medium-income country with high levels of inequality and a hybrid healthcare system that includes both publicly funded and private medical settings. We will analyze data obtained from birth records in Mexico and will use time-series models to investigate whether different stages of the pandemic were associated with changes in birthweight, gestational age and intrauterine growth relative to historical trends, as well as the extent to which any changes in birthweight are driven by trends in preterm birth rather than in intrauterine growth. We will also examine the consequences of a dramatic shift in the proportion of Mexican women giving birth in private as opposed to public settings during the pandemic. Preliminary results suggest that the risk of a preterm birth decreased during 2020, and then increased in 2021. The initial improvement was confined to urban areas and was driven by more educated women who gave birth in private hospitals. Women giving birth in public hospitals bore the brunt of the preterm birth increase in 2021. An individual-level analysis of all registered births in the country will be used to assess the extent to which changes in the quality of medical services received in public and private settings during the pandemic explains the observed trends in birth outcomes. The individual-level analysis will also allow us to investigate the role of differences in the intensity of the epidemic at the local level as measured by the COVID-related death rate and stay-at-home orders. Our study will be the first to examine the effect of the COVID-19 pandemic on health at birth using population-level data for any low or middle-income country, and one of a handful of studies using population-level data for an entire country. By relying on rich and detailed data for an entire national population, our study will contribute to understand the nature and reasons behind heterogeneities in the health impacts of the pandemic, which can also help illuminate the processes leading to similar health disparities in other national contexts.