The anatomy of a public health crisis: Household responses over the course of the Zika epidemic in Brazil
中文摘要
2015年，巴西经历了由寨卡病毒引起的疫情。我们使用数亿条行政记录，记录家庭对首个将寨卡病毒与宫内胎儿先天性疾病风险联系起来的公共卫生警报的应对。我们研究两个行为边际：风险规避（避免怀孕）和孕期风险缓解（超声检查和堕胎）。在风险规避方面，我们发现警报后怀孕减少了7%，这一应对在警报后立即被触发。在风险缓解方面，我们发现妊娠早期使用超声检查增加了9%，堕胎增加了5%，且集中于晚期堕胎。我们记录到，警报后所有家庭——例如不论种族或教育程度——都能够在孕期降低风险，这与预防措施成本不高相一致。相比之下，规避应对主要由受教育程度更高的母亲驱动，可能是因为这类家庭围绕生育时间调整计划的成本更低。我们进一步讨论其对出生结果的影响、供给侧应对，以及我们的发现如何推广到家庭对其他病毒威胁相关健康警报的应对。
Abstract
In 2015, Brazil experienced an epidemic caused by the Zika virus. We use hundreds of millions of administrative records to document household responses to the first public health alert linking the Zika virus to the risk of congenital disease for those in utero. We study two margins of behavior: risk avoidance (avoiding pregnancy), and risk mitigation during pregnancy (ultrasounds and abortions). On risk avoidance, we find a 7% reduction in pregnancies post-alert, a response triggered immediately after the alert. On risk mitigation, we find a 9% increase in the use of ultrasounds in the first trimester of pregnancy, and a 5% rise in abortions, concentrated among late term abortions. We document that post-alert all households - irrespective of race or education for example - were able to reduce risks during pregnancy, in line with preventative measures not being costly. In contrast, the avoidance response is driven by more educated mothers perhaps because such households face lower costs of altering their plans around the timing of fertility. We further discuss consequent impacts on birth outcomes, supply side responses, and how our findings extend to household responses to health alerts related to other viral threats.