Effects of antenatal testing laws on infant mortality

Even though syphilis can be prevented effectively and treated inexpensively, it has remained a global public health problem. Untreated congenital syphilis results in neonatal death, stillbirth, preterm birth, or congenital deformities. Many developing countries have recently instituted syphilis prevention programs in antenatal care, but there has not been a systematic study of the effects of such programs. This paper is the first to study antenatal testing laws initiated in the U.S. in 1938-1947 which mandated physicians and other persons permitted by law to attend to a pregnant woman to test her for syphilis. We use the variation in the timing of state antenatal testing laws to estimate the laws' effect on neonatal mortality rates and deaths due to preterm birth. Using 1931-1947 Vital Statistics data, we find that these laws decreased neonatal mortality rates of nonwhites by 3.15 per 1000 live births (a 8.6% reduction) while having no discernible impact on whites. The laws contributed to an 18% narrowing of the white-nonwhite neonatal mortality gap by 1947. Using 1950 U.S. Census data, we find that mandatory antenatal testing led to a 7% increase in the cohort size of nonwhite poor, which is consistent with the neonatal mortality results. We find universal antenatal testing to be very cost-effective, with an estimated $7600 cost (in 2013 dollars) per life-year saved.