Mothers and Others: Who Invests in Children's Health?

Children living with stepmothers are significantly less likely to have routine doctor and dentist visits or to receive regular medical care, are less likely to wear seatbelts.

Roughly half of all children in the United States grow up with at least one of their birth parents absent. Research has shown that these children tend to have more behavioral, academic, and social problems than other children. In Mothers and Others: Who Invests in Children's Health? (NBER Working Paper No. 7691), NBER Research Associates Anne Case and Christina Paxson investigate whether part of the reason these children face poorer outcomes is because parents invest less in them. They find that children living with stepmothers are significantly less likely to have routine doctor and dentist visits or to receive regular medical care, are less likely to wear seatbelts, and are significantly more likely to be living with a cigarette smoker in the household than other children.

The authors use data from the 1988 Child Health Supplement to the National Health Interview Survey to analyze family composition and investments in children's healthcare. Children living with foster or adoptive mothers generally have similar experiences in these areas to children living with birth mothers. Also, the nature of the relationship of the child to the father has little effect on the health care investments made in the children. As a rule, fathers appear to know very little about their children's health or health investments.

When the authors control for household income and parental and household characteristics, they find that children living with stepmothers and birth fathers appear to be disadvantaged in terms of health investments and behaviors relative to children living with their birth mothers. There appears to be no difference between the health investments in children living with stepmothers and birth fathers as compared with the health investments made by birth fathers raising their children alone.

The researchers identify two mechanisms that can mitigate these negative health investments: if the birth mother has regular contact with the child, the child is not less likely to visit the doctor and the dentist. Moreover, if the stepmother has children of her own living in the household, there is more likely to be a doctor's office or clinic that the stepmother can take her stepchild to, if the child is sick.

These step children are still less likely to have been to the doctor or the dentist in the past year, but at least a place for their medical care has been identified.

In general, health investments in children are made by the birth mother. Stepmothers do not appear to be substitutes for birth mothers in this area of child rearing.

-- Les Picker