Birth Order Effects in Maternal Health-Seeking Behavior: Evidence From India

Can maternal health-seeking behavior change with subsequent births? Using two rounds of India's National Family Health Survey and within-mother comparisons, we document a decline in institutional delivery, skilled attendance, and antenatal care after the first birth. We distinguish between learning about individual-specific risk, learning about average childbirth risk through experience and information, and efficient response to biomedical differences across children at different birth orders as potential reasons behind the birth order gradient. The gradient is attenuated among mothers with adverse early birth experiences and among those informed about complications during antenatal care, consistent with belief updating. However, it cannot be fully explained by differences in biomedical risk. Exploiting plausibly exogenous improvements in road connectivity and financial access, we show that credit and supply constraints can amplify the gradient, and improved infrastructure attenuates it.