Heterogeneous returns to antenatal care: Evidence from childhood immunization in Senegal.

Antenatal care (ANC) serves both as a medical input and as a source of health information in the child health production function. We use seven waves of the Senegal Demographic and Health Surveys, matched to regional health-facility data, to estimate the effect of ANC adherence on childhood vaccination outcomes. We address endogeneity arising from unobserved heterogeneity in ANC utilization using a two-stage copula-based control-function approach. We find that ANC adherence has no effect on the composite measure of full immunization, but significantly increases uptake of two injectable vaccines, the three-dose diphtheria-pertussis-tetanus vaccine (DTP3) and measles, by 8.2 % and 6.3 % points, respectively. These effects are concentrated among mothers with no schooling or only primary education. We also find no robust evidence that the marginal returns to ANC adherence differ by child sex, fertility intention, or ethnicity.