Black Infant Health After Desegregation of Health Care in South Africa

What are the impacts of medical segregation? In 1990, South Africa repealed legislation enacted during Apartheid to segregate medical care. This made it legal for Black Africans to use medi- cal clinics, hospitals and wards that were of higher quality and previously exclusively reserved for Whites. We use data from the South African census, USAID Demographic and Health Surveys, the Project for Statistics on Living Standards and Development and a database of hospital and clinic lo- cations in South Africa in 1990. Using a birth cohort differences-in-differences regression we compare outcomes between Black South African children and other more advantaged South African children (first difference) born just before and just after desegregation (second difference). As an alternate differences-in-differences we examine Black South African children born just before and just after this policy change (first difference) to evaluate effects on child mortality through access to local White medical facilities. We compare areas that had a segregated White or mixed race clinic to places that did not and where service access would not have changed (second difference).We find a 5% decrease in the number of “missing” Black South African children per household and a 20% reduction in the mortality of the last Black child born to a family after desegregation. Black children are 3% less likely to have a disability, 25% less likely to have a physical disability, and 10% less likely to have a seeing disability after access to better health care, but this difference dissipates by ten years after the policy change. We find no evidence of improvement in anthropometric outcomes, but we find increased contacts with the formal health care system and modestly improved vaccine uptake. Depending on the baseline infant mortality rate, we estimate that desegregation of the medical system prevented 1200 to 4800 deaths per year among Black children