Academic journal article Journal of Marriage and Family

Marriage Advantages in Perinatal Health: Evidence of Marriage Selection or Marriage Protection?

Academic journal article Journal of Marriage and Family

Marriage Advantages in Perinatal Health: Evidence of Marriage Selection or Marriage Protection?

Article excerpt

Marriage is a social tie associated with health advantages for adults and their children (Repetti, Taylor, & Seeman, 2002; Umberson & Montez, 2010; Waite, 1995), provided the union is generally supportive and not extremely stressful (Kiecolt-Glaser & Newton, 2001; Umberson, Williams, Powers, Liu, & Needham, 2006). Health advantages are also widely documented for infants of married mothers: Lower rates of problematic health outcomes such as low birth weight (weighing less than 51/2 pounds at birth) and preterm birth (delivery before 37 weeks of gestation) have been reported among married (vs. unmarried) mothers (Buckles & Price, 2013; Martin, Hamilton, Osterman, Curtin, & Mathews, 2013).

At debate is whether marriage advantages in health are confounded by selection factors-a marriage selection hypothesis-or whether marriage causes women to adopt heathier attitudes or behaviors that translate to better health-a marriage protection hypothesis. In the case of perinatal health, the answer is unclear, in part because nearly all studies to date have not considered both explanations.

We also know very little about advantages in perinatal health for infants born to married women relative to infants born to cohabiting and single women. Past studies have largely contrasted birth outcomes between married women and all unmarried women, despite clear differences between cohabitation and singlehood. Among the studies that have distinguished between cohabitation and singlehood (Bird, Chandra, Bennett, & Harvey, 2000; Fomby, 2011; Sullivan, Raley, Hummer, & Schiefelbein, 2012), most examined pre-1990 births and/or did not directly measure cohabitation. The widespread, dramatic increase in cohabitation and nonmarital childbearing, along with marked compositional change among subgroups of women married, cohabiting, and single at birth, since the 1990s (Cherlin, 2010; Seltzer, 2000; Smock & Greenland, 2010) establishes the importance of understanding population-level perinatal health disparities across all three groups and within recent years. This new knowledge will not only clarify how pervasive these marriage advantages are but will also enrich our understanding of the broader implications of cohabitation for child well-being, a topic of substantial interest among marriage and family scholars.

Furthermore, nearly all marriage and perinatal health studies have measured marital status at the time of birth. This is likely due to data limitations; however, I argue below that, in pursuit of capturing the true effect of marriage on perinatal health, it is preferable to measure marital status at conception, given that (a) at least some of marriage's protective effect, as it has been described in past work, is assumed to be exerted during pregnancy and (b) changes in union status between the time when couples learn of a pregnancy and the time of birth are not uncommon (Bachu, 1999; Rackin & Gibson-Davis, 2012). Establishing the ideal stage at which to capture union status has important implications for how researchers conceptualize and model exposure to marriage.

Last, research in this area has yet to identify a rich set of selection factors that confound the association between marriage and perinatal health. It is well known that the early life environment influences women's risk of marital childbearing (see, e.g., Amato et al., 2008), but whether and how the early life environment influences birth weight is not well established. Health scholars have recently articulated the importance of identifying pre-conception factors affecting perinatal health, yet most studies continue to focus on the prenatal period-or on the 12 months leading up to conception-to the exclusion of prior life events (Johnson et al., 2006; van Dyck, 2010). This is partly due to data limitations, given that birth certificate data are commonly used and do not contain this information. But this is also due to statistical limitations, as fixed effects (FE) models are commonly used to account for selection, and this method differences out, rather than reveals, early life selection factors. …

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