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We develop an equilibrium model of the labor market to investigate the joint evolution of gender gaps in labor force participation and wages. We do this overall and by task-based occupation and skill, which allows us to study distributional effects. We structurally estimate the model using data from Mexico over a period during which women’s participation increased by fifty percent. We provide new evidence that male and female labor are closer substitutes in high-paying analytical task-intensive occupations than in lower-paying manual and routine task-intensive occupations. We find that demand trends favored women, especially college-educated women. Consistent with these results, we see a widening of the gender wage gap at the lower end of the distribution, alongside a narrowing at the top. On the supply side, we find that increased appliance availability was the key driver of increases in the participation of unskilled women, and fertility decline a key driver for skilled women. The growth of appliances acted to widen the gender wage gap and the decline of fertility to narrow it. We also trace equilibrium impacts of growth in college attainment, which was more rapid among women, and of emigration, which was dominated by unskilled men. Our counterfactual estimates demonstrate that ignoring the countervailing effects of equilibrium wage adjustments on labor supplies, as is commonly done in the literature, can be misleading.

We estimate impacts of male job loss, female job loss, and male unemployment benefits on domestic violence in Brazil. We merge employer-employee and social welfare registers with administrative data on domestic violence cases brought to criminal courts, use of public shelters by victims and mandatory notifications of domestic violence by health providers. Leveraging mass layoffs for identification, we find that both male and female job loss, independently, lead to large and pervasive increases in domestic violence. Exploiting a discontinuity in unemployment insurance eligibility, we find that eligible men are not less likely to commit domestic violence while benefits are being paid, and more likely to commit it once benefits expire. Our findings are consistent with job loss increasing domestic violence on account of a negative income shock and an increase in exposure of victims to perpetrators, with unemployment benefits partially offsetting the income shock while reinforcing the exposure shock.

We examine the impact of establishing women police stations (WPS) on reporting of gender- based violence. Using administrative crime data and exploiting staggered implementation across Indian cities, we find that the opening of WPS is associated with an increase in police reports of crimes against women of 29 percent, a result driven by domestic violence. This appears to reflect reporting rather than incidence as we find no changes in femicide or in survey-reported domestic violence. We also find some evidence of an increase in women's labor supply following WPS opening, consistent with women feeling safer once the costs of reporting violence fall.

We leverage staggered implementation of lockdown across Chile's 346 municipalities, identifying dynamic impacts on domestic violence (DV). Using administrative data, we find lockdown imposition increases indicators of DV-related distress, while decreasing DV reports to the police. We identify male job loss as a mechanism driving distress, and female job loss as driving decreased reporting. Stimulus payments to poor households act on both margins, their impacts partially differentiated by lockdown status. Once lockdown is lifted, police reports surge but we see a ratchet effect in distress. Our findings accentuate the controversy around welfare impacts of lockdown mandates

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Millions of women continue to die during and soon after childbirth, even where the knowledge and resources to avoid this are available. We posit that raising the share of women in parliament can trigger action. Leveraging the timing of gender quota legislation across developing countries, we identify sharp sustained reductions of 8–10 percent in maternal mortality. Investigating mechanisms, we find that gender quotas lead to increases in percentage points of 5–8 in skilled birth attendance and 4–8 in prenatal care utilization, alongside a decline in fertility of 6–7 percent and an increase in the schooling of young women of about 0.5 years. The results are robust to numerous robustness checks. They suggest a new policy tool for tackling maternal mortality.

This study estimates the relative importance of alternative supply and demand mechanisms in explaining the rise of female labor-force participation (FLFP) over the last 55 years in Mexico. The growth of FLFP in Mexico between 1960 and 2015 followed an S-shaped, with a considerable acceleration during the 1990s. Using descriptive decomposition methods and a shift-share design, the study shows that, put together, supply and demand factors can account for most of the rise of FLFP over the entire period, led by increases in women’s education, declining fertility, and shifts in the occupational structure of the workforce. However, there is unexplained variation in the 1990s, when FLFP spiked

The chapter explores the literature on how women’s participation in politics affects policy making, in terms of redistribution, public health intervention, schooling, and policies outcomes of those directed at improving mothers and children health. Identification issues are then discussed, and designs based on the introduction of quotas, close elections in mixed-gender contexts, and textual analysis. The chapter moves on to the supply and demand side (discrimination) factors creating barriers to entering into politics. It concludes stressing the importance of gender-specific policy preferences (more redistribution and more spending for children and maternal health) in contexts where politicians’ selection matters

We analyze long-term impacts of the 1967–1970 Nigerian Civil War, providing the first evidence of intergenerational impacts. War exposure among women results in reduced adult stature, an increased likelihood of being overweight, earlier age at first birth, and lower educational attainment. War exposure of mothers has adverse impacts on next-generation child survival, growth, and education. Impacts vary with age of exposure. For the mother and child health outcomes, the largest impacts stem from adolescent exposure. Exposure to a primary education program mitigates impacts of war exposure. War exposure leads to men marrying later and having fewer children.

This paper discusses research on the relationship between fertility and women’s labour force participation. It surveys methods used to obtain causal identification, and provides an overview of the evidence of causal effects in both directions. We highlight a few themes that we regard as important in guiding research and in reading the evidence. These include the importance of distinguishing between extensive and intensive margin changes in both variables; consideration not only of women’s participation but also of occupational and sectoral choice and of relative earnings; the relevance of studying dynamic effects and of analysing changes across the lifecycle and across successive cohorts; and of recognizing that women’s choices over both fertility and labour force participation are subject to multiple constraints. We observe that, while technological innovations in reproductive health technologies have muted the family career trade off primarily by allowing women to time their fertility, policy has not achieved as much as it might.

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Disruptions in the hypothalamic-pituitary-adrenal (HPA) axis are thought to be key neuroendocrine mechanisms involved in psychopathology and may have intergenerational impacts. Hair-derived HPA hormones offer a measure of long-term HPA axis activity that may be useful in assessing maternal and infant health. Building on a community-based randomized control trial of a perinatal depression intervention in Pakistan, we examine intervention effects on HPA axis activity in a subsample of mothers and infants.

The occurrence of twin births has been widely used as a natural experiment. With a focus upon the use of twin births for identification of causal effects in economics, this chapter provides a critical review of methods and results.

Access to prenatal sex-detection technology in India has led to a phenomenal increase in abortion of girls. We find that it has also narrowed the gender gap in under-five mortality, consistent with surviving girls being more wanted than aborted girls. For every three aborted girls, one additional girl survived to age five. Mechanisms include moderation of son-biased fertility stopping and narrowing of gender gaps in parental investments. However, surviving girls are more likely to be born in lower-status families. Our findings have implications not only for counts of missing girls but also for the later life outcomes of girls.

IVF allows women to delay birth and pursue careers, but IVF massively increases the risk of twin birth. There is limited evidence of how having twins influences women’s post-birth careers. We investigate this, leveraging a single embryo transfer (SET) mandate implemented in Sweden in 2003, following which the share of twin births showed a precipitous drop of 70%. Linking birth registers to hospitalization and earnings registers, we identify substantial improvements in maternal and child health and women’s earnings following IVF birth, alongside an increase in subsequent fertility. We provide the first comprehensive evaluation of SET, relevant given the secular rise in IVF births and growing concerns over twin birth risk. We contribute new estimates of the child penalty imposed by twin as opposed to singleton birth, relevant to the secular rise in the global twin birth rate

The Global Gag Rule is a policy that has been historically toggled between enactment and revocation based on the political party of the U.S. President. It restricts U.S. aid to international non-governmental organizations that provide or even discuss abortion-related services. Since its inception by President Reagan in 1984, Republican presidents have consistently enforced it, while Democratic presidents have repealed it. The policy saw further restrictions under President Trump and was then rescinded by President Biden. Analyzing data spanning from 1985 to 2019, it's evident that family planning aid from the U.S. has been 48% higher during Democratic administrations. The study finds that when there is a political shift from a Democratic to a Republican presidency, a country that highly depends on U.S. aid for family planning experiences an increase in maternal mortality—0.6 additional deaths per 1,000 women, or an 8% rise. This uptick essentially negates one-fifth of the global reduction in maternal deaths since 1990.

We investigate the importance of subjective expectations of returns to and effort costs of the two main investments that mothers make in newborns: breastfeeding and stimulation. We find heterogeneity across mothers in expected effort costs and expected returns for outcomes in the cognitive, socio-emotional and health domains, and we show that this contributes to explaining heterogeneity in investments. We find no significant heterogeneity in preferences for child developmental outcomes. We simulate the impact of various policies on investments. Our findings highlight the relevance of interventions designed to reduce perinatal fatigue alongside interventions that increase perceived returns to investments.

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Debates around abortion typically invoke religion and politics but there is no causal evidence of the impact of politician religion on abortion. Leveraging quasi-random variation in politician religion generated by close elections in India and controlling for the party affiliation of politicians, we find lower rates of sex-selective abortion in districts won by Muslim state legislators, consistent with a higher reported aversion to abortion among Muslims compared to Hindus. The competing hypothesis that this reflects weaker son preference among Muslims is undermined by stated preference data and by demonstrating that fertility and girl-biased infant mortality increase in Muslim-won districts.

This paper examines the importance of gender differences in labour supply and demand for job flexibility to the growth of the gender wage gap over the life cycle and over time for graduates in the UK. We document that the graduate gender wage gap increases over the life cycle, especially between ages 25 and 40, to about 20% of real hourly male earnings by age 55. The share of women working in flexible occupations has grown over the life cycle, and especially substantially over time for successive cohorts, whereas men are less likely to work in flexible occupations at older ages. The wage penalty from working in flexible occupations increases both over the life cycle and over time. We estimate a model of labour supply and demand to quantify the importance of changes to preferences and relative demand for flexibility on the gender wage gap. Higher relative demand for male labour at older ages, and in in flexible occupations, explains almost all (96%) of the estimated life cycle increases in the gender wage gap, whereas women's higher preferences for working in flexible occupations drives the increases in sorting into flexible occupations over time, contributing to about 60% of the estimated increase in the gender wage gap over time.

This study examines the association of unemployment variation with intimate partner violence using representative data from thirty-one developing countries, from 2005 to 2016. It finds that a 1 percent increase in the male unemployment rate is associated with an increase in the incidence of physical violence against women by 0.50 percentage points, or 2.75 percent. This is consistent with financial and psychological stress generated by unemployment. Female unemployment rates have the opposite effect, a 1 percent decrease being associated with an increase in the probability of victimization of 0.52 percentage points, or 2.87 percent. That an improvement in women’s employment opportunities is associated with increased violence is consistent with male backlash. The study finds that this pattern of behaviours emerges entirely from countries in which women have more limited access to divorce than men

Depression in the perinatal period, during pregnancy or within 1 year of childbirth, imposes a high burden on women with rippling effects through her and her child's life course. Social support may be an important protective factor, but the complex bidirectional relationship with depression, alongside a paucity of longitudinal explorations, leaves much unknown about critical windows of social support exposure across the perinatal period and causal impacts on future depressive episodes.

Twin births are often used as an instrument to address selection of women into fertility. However, recent work shows selection of women into twin birth such that, while OLS estimates tend to be downward biased, twin-IV estimates will tend to be upward biased. This is pertinent given the emerging consensus that fertility has limited impacts on women’s labour supply, or on investments in children. Using data for developing countries and the United States to estimate the trade-off between fertility and children’s human capital, we demonstrate the nature and size of the bias in the twin-IV estimator and estimate bounds on the true parameter. (JEL: J12, J13, C13, D13, I12)

We investigate whether legislation of equal inheritance rights for women modifies the historic preference for sons in India, and find that it exacerbates it. Children born after the reform in families with a firstborn daughter are 3.8–4.3 percentage points less likely to be girls, indicating that the reform encouraged female foeticide. We also find that the reform increased excess female infant mortality and son-biased fertility stopping. This suggests that the inheritance reform raised the costs of having daughters, consistent with which we document an increase in stated son preference in fertility post reform. We conclude that this is a case where legal reform was frustrated by persistence of cultural norms. We provide some suggestive evidence of slowly changing patrilocality norms.

We evaluate the medium-term impacts of treating maternal depression on women’s mental health, financial empowerment, and parenting decisions. We leverage variation induced by a cluster-randomized controlled trial that provided psychotherapy to 903 prenatally depressed mothers in rural Pakistan. It was one of the world’s largest psych otherapy interventions, and it dramatically reduced postpartum depression. Seven years after psychotherapy concluded, we returned to the study site to find that impacts on women’s mental health had persisted, with a 17 percent reduction in depression rates. The intervention also improved women’s financial empowerment and increased both time- and money-intensive parental investments by between 0.2 and 0.3 standard deviations. (JEL G51, I12, J16, O15)

We provide evidence that dowry costs motivate son-preferring behaviors in India. Since gold is an integral part of dowry, we study parental responses to shocks in the world gold price. Exploiting monthly variation in gold prices across 35 years we find that monthly changes in gold prices lead to an increase in girl relative to boy neonatal mortality and that surviving girls are shorter. After the introduction of prenatal sex determination technology, we find that gold price shocks during pregnancy increase female foeticide.

Traditional postpartum practices are intended to provide care to mothers, but there is mixed evidence concerning their impact on postpartum depression (PPD). It remains unknown if there is a unique impact of postpartum practices on PPD separately from other types of social support, or if practices differentially affect those with existing prenatal depression. In Pakistan, chilla (چله) is a traditional postpartum practice in which women receive relief from household work, additional familial support, and supplemental food for up to 40 days postpartum. This study aims to understand if chilla protects against PPD independent of other support and whether this relationship varies by prenatal depression status.

Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal.

Function is an important marker of health throughout the life course, however, in low-and-middle-income-countries, little is known about the burden of functional impairment as women transition from pregnancy to the first year post-partum. Leveraging longitudinal data from 960 women participating in the Share Child Cohort in Pakistan, this study sought to (1) characterize functional trajectories over time among women in their perinatal period and (2) assess predictors of chronic poor functioning following childbirth. We used a group-based trajectory modeling approach to examine maternal patterns of function from the third trimester of pregnancy through 12 months post-partum. Three trajectory groups were found: persistently well-functioning (51% of women), poor functioning with recovery (39% of women), and chronically poor functioning (10% of women). When compared to mothers in the highest functioning group, psychosocial characteristics (e.g., depression, stress, and serious life events) were significantly associated with sustained poor functioning one-year following child-birth. Mothers living in nuclear households were more likely to experience chronic poor functioning. Higher education independently predicted maternal function recovery, even when controlling for psychosocial characteristics. Education, above and beyond socio-economic assets, appears to play an important protective role in maternal functional trajectories following childbirth. Public health implications related to maternal function and perinatal mental health are discussed.

We examine intra-household gender-differentiated effects of property rights securitisation following West Bengal’s tenancy registration program, using two independently gathered datasets. In both samples, higher program implementation increased male child survival rates in families without a firstborn son, but not in those that already have a firstborn male child. We argue this reflects intensified son preference as land rights improve, ostensibly to ensure a male heir to inherit land. Consistent with this, girls with firstborn brothers also experience increased survival, but not girls with firstborn sisters. The gender bias manifests both in infant mortality rates and the sex ratio at birth.

The contribution of fathers to child development and maternal mental health is increasingly acknowledged, although research on this topic outside of high income countries is limited. Using longitudinal data, we characterized father involvement in a rural setting in Pakistan and investigated the link between father involvement in the first year of life and child development and maternal depression. Data come from the Bachpan study, a birth cohort established in the context of a perinatal depression intervention. Father involvement was mother reported at 3 and 12 months postpartum and covered domains such as playing with or soothing the infant. Child outcomes included growth at 3, 6 and 12 months postpartum, socioemotional development at 6 months (Ages and Stages Questionnaire-socioemotional), and developmental milestones at 12 months (Bayley Scales of Infant and Toddler Development, BSID)). Maternal depression was assessed at 3, 6, and 12 months postpartum. Roughly 20% of the fathers were temporarily non-resident. Among the rest, most mothers reported that fathers were involved: for example, approximately 40% reported that the father plays with the baby on a typical day. We observed no clear pattern of association between 3-month father involvement and child growth at any time point; however, 12-month father involvement was cross-sectionally inversely associated with child growth. We observed a protective pattern of association between 3-month father involvement and 6-month child socioemotional development. For the BSID domains, while almost all effect estimates suggested a protective association with higher levels of father involvement/father being temporarily non-resident, the magnitude of the estimates was smaller and most 95% confidence intervals crossed the null. Finally, there was a trend toward greater father involvement/being temporary non-resident predicting lower levels of maternal depression. Using longitudinal data, these results provide new evidence about the association between father involvement, and both child development and maternal mental health.

Twin births are often construed as a natural experiment in the social and natural sciences on the premise that the occurrence of twins is quasi-random. We present new population-level evidence that challenges this premise. Using individual data for 17 million births in 72 countries, we demonstrate that indicators of mother's health and health-related behaviours are systematically positively associated with the probability of a twin birth. The estimated associations are sizeable, evident in richer and poorer countries, evident even among women who do not use IVF, and hold for numerous different measures of health. We discuss potential mechanisms, showing evidence that favours selective miscarriage. Positive selection of women into twinning implies that estimates of impacts of fertility on parental investments and on women's labour supply that use twin births to instrument fertility will tend to be downward biased. This is pertinent given the emerging consensus that these relationships are weak. Our findings also potentially challenge the external validity of studies that rely upon twin differences.

We investigate whether the event of women being competitively elected as state legislators encourages subsequent political participation among women. Using a regression discontinuity design on Indian constituency level data, we find that female incumbents are more likely than male incumbents to re‐contest and that there is a decline in the entry of new women candidates. This decline is most pronounced in states with entrenched gender bias and in male‐headed parties, suggesting an intensification of barriers against women in these areas. Similar results for (mostly male) Muslim candidates indicate the presence of institutionalised demand‐side barriers rather than gender‐specific preferences and constraints.

ABSTRACT

There is growing interest in the relationship between socioeconomic status (SES), poverty, and mental health in low and middle-income countries (LMIC). However, it is not clear whether a gradient approach focused on a wider SES distribution or a binary poverty approach is more salient for mental health in LMIC. Yet this distinction has implications for interventions aimed at improving population health. We contribute to the literature by examining how multiple indicators of socioeconomic status, including gradient SES and binary poverty indicators, contribute to prenatal depression symptoms in a LMIC context. Prenatal depression is an important public health concern with negative sequela for the mother and her children. We use data on assets, education, food insecurity, debt, and depression symptoms from a sample of 1154 pregnant women residing in rural Pakistan. Women who screened positive for depression participated in a cluster randomized controlled trial of a perinatal depression intervention; all women were interviewed October 2015-February 2016, prior to the start of the intervention. Cluster-specific sampling weights were used to approximate a random sample of pregnant women in the area. Findings indicate that fewer assets, experiencing food insecurity, and having household debt are independently associated with worse depression symptoms. The association with assets is linear with no evidence of a threshold effect, supporting the idea of a gradient in the association between levels of SES and depression symptoms. A gradient was also initially observed with woman’s educational attainment, but this association was attenuated once other SES variables were included in the model. Together, the asset, food insecurity, and debt indicators explain 14% of the variance in depression symptoms, more than has been reported in high income country studies. These findings support the use of multiple SES indicators to better elucidate the complex relationship between socioeconomic status and mental health in LMIC.

This paper investigates the consequences of sex imbalance in India’s population for violence against women. We match administrative crime data by category to age-specific sex ratios in census data by district across four decades and, to analyse mechanisms, we also use census data on marriage rates and household survey data on attitudes to violence against women and marriage quality measures. We find that a surplus of men at age 20-24 increases crimes committed against women, and that this explains about 21% of the rise in gender-based violence. Although less robust, there is some evidence that the youth sex ratio also raises non-gendered forms of violence, but we find no discernible impact upon property and economic crime. In probing mechanisms, we show that marriage rates, marriage quality, and attitudes to violence against women are all modified by population sex ratios.

This paper investigates the potential of an infant intervention to improve life expectancy, contributing to emerging interest in the early life origins of chronic disease. We track individuals from birth to death, and are able to identify age and cause of death. The intervention was pioneered in Sweden in 1931–1933, and appears to have been pivotal in the emergence of universal infant care programmes in the Scandinavian countries during the creation of the Welfare State. It provided information and support to mothers, with an emphasis on nutrition and sanitation, while monitoring infant care through home visits and clinics. We estimate that the average duration of programme exposure in infancy led to a 1.56% point decline in the risk of infant death (24% of baseline risk) and a 2.56% point decline in the risk of dying by age 75 (7.0% of baseline risk), and these impacts are much larger for children born out of wedlock. Intervention-led declines in the risk of dying after the age of 50 are dominated by reductions in cancer and cardiovascular mortality. We find no evidence of selective utilisation, and the estimates are similar when we exploit within-mother variation in outcomes.

This paper is part also of: Bundy AP, de Silva N, Horton S, Patton GC, Schultz L, Jamison DT, for the Disease Control Priorities-3 Child and Adolescent Health and Development Authors Group (includes Bhalotra, S). (2017). "Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition". The Lancet. Asserts that early-life health and nutritional interventions, including those that act to improve the health and nutritional status of potential mothers and pregnant women and those that directly treat children in early life, have significant impacts on schooling, earnings, and productivity over the lifecycle in low- and middle-income countries (LMICs). Estimates of benefit-cost ratios for such interventions, obtained under a range of plausible parameters, consistently exceed one, suggesting that the present discounted value of gains exceeds costs. These results motivate the case for placing early-life health and nutrition high on the policy agenda. Causal estimates of impacts of early-life nutritional interventions mostly stem from small-scale local interventions, however, and will likely prove sensitive to (1) population heterogeneity (social, economic, and cultural differences); (2) differences in program implementation (administrative capacity and trust); and (3) differences in the wider political economy of reform. Benefits may not scale up, however, and the benefit-cost ratio for nationwide implementation may prove lower.

We address the significant gaps in knowledge of prevalence and correlates of child mental health (CMH) problems outside of high income countries. We describe the prevalence of CMH problems and their correlates with a focus on the association with maternal depression in a sample of seven-year-old children in rural Pakistan.

Perinatal depression has been linked with deleterious child development outcomes, yet maternal depression interventions have not been shown to have lasting effects on child development, and evidence is not available from countries of low or middle income. In the Thinking Healthy Programme cluster-randomised controlled trial, a perinatal depression intervention was assessed in Pakistan in 2006–07. The intervention significantly reduced depression levels 12 months post partum compared with a control. We aimed to assess the effect of this same intervention on the cognitive, socioemotional, and physical development of children at around age 7 years.

We analyze the evolution of the gender wage gap in Mexico between 1989 and 2012, a period in which skill-biased technological change accelerated. We deviate from most prior work investigating the gap across the wage distribution. We find substantial gender wage convergence in the decade of the 2000s at the mean and, more markedly, at the upper and lower ends of the wage distribution, alongside little change in the median wage gap. The gender wage gap at the 90th percentile was largely eliminated by the year 2012 and, at the 10th percentile, it narrowed by a fourth of its 1990 level. This narrowing of gender inequality in wages occurred alongside a narrowing of inequality in wages within each gender group. The share of college-educated women relative to men in the work force grew substantially over the two decades, and they sorted disproportionately into brain-intensive occupations, where the gender wage gap fell sharply. The wage return to being in a brain-intensive occupation was, in both periods, greater for women; it declined for men while rising for women during the 2000s. Our findings demonstrate how structural economic change may interact with a biologically premised comparative advantage of women in brain-intensive occupations to raise their relative wages. Our results also underline the relevance of studying changes across the wage distribution.

We investigate whether women's political representation in state legislatures improves public provision of antenatal and childhood health services in the districts from which they are elected, arguing that the costs of poor services in this domain fall disproportionately upon women. Using large representative data samples from India and accounting for potential endogeneity of politician gender and the sample composition of births, we find that a 10 percentage point increase in women's representation results in a 2.1 percentage point reduction in neonatal mortality, and we elucidate mechanisms. Women's political representation may be an underutilized tool for addressing health in developing countries. (JEL D72, I12, I15, J16, O15, O17)

ABSTRACT

This paper investigates the sensitivity of the intergenerational transmission of health to changes in the socioeconomic and public health environment into which children are born using individual survey data on 2.24 million children born to 600,000 mothers during the period 1970 to 2000 in 38 developing countries merged by country and cohort with macroeconomic data. We find that children are more likely to bear the penalty exerted by poor maternal health if they are conceived or born in adverse socioeconomic conditions. Equivalently, shocks to the child's birth environment are more damaging of children born to women with weaker health at birth. [PUBLICATION ABSTRACT] International Bibliography of the Social Sciences (IBSS)

We exploit exogenous variation in the risk of waterborne disease created by implementation of a major water reform in Mexico in 1991 to investigate impacts of infant exposure on indicators of cognitive development and academic achievement in late childhood. We estimate that a one standard deviation reduction in childhood diarrhea mortality rates results in about a 0.1 standard deviation increase in test scores, but only for girls. We show that a reason for the gender differentiated impacts is that the water reform induces parents to make complementary investments in education that favor girls, consistent with their comparative advantage in skilled occupations. The results provide novel evidence of the potential for clean water provision to narrow test score gaps across countries and, within countries, across gender.

This paper is motivated to investigate the often neglected payoff to investments in the health of girls and women in terms of next generation outcomes. This paper investigates the intergenerational persistence of health across time and region as well as across the distribution of maternal health. It uses comparable microdata on as many as 2.24 million children born of about 0.6 million mothers in 38 developing countries in the 31 year period, 1970–2000. Mother's health is indicated by her height, BMI and anemia status. Child health is indicated by mortality risk and anthropometric failure. We find a positive relationship between maternal and child health across indicators and highlight non-linearities in these relationships. The results suggest that both contemporary and childhood health of the mother matter and that the benefits to the next generation are likely to be persistent. Averaging across the sample, persistence shows a considerable decline over time. Disaggregation shows that the decline is only significant in Latin America. Persistence has remained largely constant in Asia and has risen in Africa. The paper provides the first cross-country estimates of the intergenerational persistence in health and the first estimates of trends.

This chapter describes and analyses differences in primary educational enrolment by gender for 6-14 year old Indian children across three social groups, namely, upper and lower caste Hindus, and Muslims. It also studies the evolution of community and gender differences across the 1990s. This was a decade of unprecedented economic growth in India and overall enrolment rates rose rapidly but there is as yet limited evidence of how social inequalities evolved. We find initial community enrolment gaps of the order of 15-20 percentage points and within-community gender gaps of a similar magnitude. Every group progresses during the period considered and the initially disadvantaged groups progress a bit faster, with girls from low caste and Muslim households exhibiting the greatest progress. Nevertheless community and gender gaps of the order of 10 percentage points remain at the end of the decade. We decompose enrolment differences between communities in each year so as to gain an estimate of the contribution of observed characteristics. The striking result is that, while 70-80% of the enrolment gap between high and low caste Hindus is explained by the weaker socio-economic characteristics of the low caste group, characteristics can explain only about 35% of the enrolment differential between high caste Hindus and Muslims. This suggests that Muslims either have a lower “taste” for education or have been “discriminated” against in this sphere. We draw upon our research on health differentials between communities to argue that the evidence points more towards tastes, while recognising that tastes may evolve in response to institutions and past outcomes so that a role for discrimination cannot be ruled out. We observe that the contribution of observed characteristics to enrolment differentials has declined over time in both comparisons

This article investigates the hypothesis that child labour is compelled by poverty. It shows that a testable implication of this hypothesis is that the wage elasticity of child labour supply is negative. Using a large household survey for rural Pakistan, labour supply models for boys and girls in wage work are estimated. Conditioning on non‐labour income and a range of demographic variables, the article finds a negative wage elasticity for boys and an elasticity that is insignificantly different from zero for girls. Thus, while boys appear to work on account of poverty compulsions, the evidence for girls is ambiguous.

While South Asia has the largest number of working children, sub-Saharan Africa has the highest incidence of child labour. Child work participation rates are 41 per cent in Africa as compared with 21 per cent in Asia and 17 per cent in Latin America (Ashagrie, 1998). Comparative work is a first step in gaining an insight into the universality of the problem of child work. South Asia and sub-Saharan Africa are clearly very different environments, their common ground being that the average household, at least in rural areas, is poor. We compare the determinants of child labour in the two countries, including household living standards, household human capital and demographics, and community-level data on schools and infrastructure. The data describe prominent differences in the environment that children grow up in. We then present a summary of the determinants of the variation in child work across households within each country. Interesting contrasts across country and gender are highlighted.

We estimate semiparametric Engel curves for rural Pakistan using a large household survey. This allows us to obtain consistent estimates of the effects of household size and composition on consumption patterns even when these demographic variables are correlated with an unknown function of income. The coefficients on the household composition variables are used to infer patterns of intrahousehold allocation. While there is little evidence of gender differences among children, adult males appear to consume more than adult females. Amongst males, workers consume more than dependents. There is no evidence of differential treatment of the elderly or of higher birth-order children. We identify substantial economics of size in food consumption which implies that some commonly used demand models are inappropriate. 1998 John Wile & Sons. Ltd.

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Millions of women continue to die during and soon after childbirth, even where the knowledge and resources to avoid this are available. We posit that raising the share of women in parliament can trigger action. Leveraging the timing of gender quota legislation across developing countries, we identify sharp sustained reductions of 8–10 percent in maternal mortality. Investigating mechanisms, we find that gender quotas lead to increases in percentage points of 5–8 in skilled birth attendance and 4–8 in prenatal care utilization, alongside a decline in fertility of 6–7 percent and an increase in the schooling of young women of about 0.5 years. The results are robust to numerous robustness checks. They suggest a new policy tool for tackling maternal mortality.

The chapter explores the literature on how women’s participation in politics affects policy making, in terms of redistribution, public health intervention, schooling, and policies outcomes of those directed at improving mothers and children health. Identification issues are then discussed, and designs based on the introduction of quotas, close elections in mixed-gender contexts, and textual analysis. The chapter moves on to the supply and demand side (discrimination) factors creating barriers to entering into politics. It concludes stressing the importance of gender-specific policy preferences (more redistribution and more spending for children and maternal health) in contexts where politicians’ selection matters.

We analyze long-term impacts of the 1967–1970 Nigerian Civil War, providing the first evidence of intergenerational impacts. War exposure among women results in reduced adult stature, an increased likelihood of being overweight, earlier age at first birth, and lower educational attainment. War exposure of mothers has adverse impacts on next-generation child survival, growth, and education. Impacts vary with age of exposure. For the mother and child health outcomes, the largest impacts stem from adolescent exposure. Exposure to a primary education program mitigates impacts of war exposure. War exposure leads to men marrying later and having fewer children.

ABSTRACT

Disruptions in the hypothalamic-pituitary-adrenal (HPA) axis are thought to be key neuroendocrine mechanisms involved in psychopathology and may have intergenerational impacts. Hair-derived HPA hormones offer a measure of long-term HPA axis activity that may be useful in assessing maternal and infant health. Building on a community-based randomized control trial of a perinatal depression intervention in Pakistan, we examine intervention effects on HPA axis activity in a subsample of mothers and infants.

ABSTRACT

We identify earnings impacts of exposure to an infant health intervention in Sweden, using individual-linked administrative data to trace potential mechanisms. Leveraging quasi-random variation in eligibility, we estimate that exposure was associated with higher test scores in primary school for boys and girls. However, only girls were more likely to score in the top quintile. Subsequent gains, in secondary schooling, employment, and earnings, are restricted to girls. We show that the differential gains for women accrued from both skills and opportunities.

The occurrence of twin births has been widely used as a natural experiment. With a focus upon the use of twin births for identification of causal effects in economics, this chapter provides a critical review of methods and results.

In this article we undertake a legal and policy analysis of Brazil’s Family Health Program which confirms that the right to health extended beyond Brazil’s constitution, and into the laws, policies, and documents associated with that program in 1996–2004. We then use Big Data to show that the right to health contributed to the large and sustained health gains, including in maternal and infant mortality, especially among less educated women. For example, the data shows progressive realization, enhanced access in poor and underserved areas, and reduced health inequalities, all of which are features of the right to health

Access to prenatal sex-detection technology in India has led to a phenomenal increase in abortion of girls. We find that it has also narrowed the gender gap in under-five mortality, consistent with surviving girls being more wanted than aborted girls. For every three aborted girls, one additional girl survived to age five. Mechanisms include moderation of son-biased fertility stopping and narrowing of gender gaps in parental investments. However, surviving girls are more likely to be born in lower-status families. Our findings have implications not only for counts of missing girls but also for the later life outcomes of girls.

IVF allows women to delay birth and pursue careers, but IVF massively increases the risk of twin birth. There is limited evidence of how having twins influences women’s post-birth careers. We investigate this, leveraging a single embryo transfer (SET) mandate implemented in Sweden in 2003, following which the share of twin births showed a precipitous drop of 70%. Linking birth registers to hospitalization and earnings registers, we identify substantial improvements in maternal and child health and women’s earnings following IVF birth, alongside an increase in subsequent fertility. We provide the first comprehensive evaluation of SET, relevant given the secular rise in IVF births and growing concerns over twin birth risk. We contribute new estimates of the child penalty imposed by twin as opposed to singleton birth, relevant to the secular rise in the global twin birth rate.

ABSTRACT

Historically, improvements in municipal water quality led to substantial mortality decline in today’s wealthy countries. However, water disinfection has not consistently produced large benefits in lower-income countries. We study this issue by analyzing a large-scale municipal water disinfection program in Mexico that increased water chlorination coverage in urban areas from 58 percent to over 90 percent within 18 months. We estimate that the program reduced childhood diarrheal disease mortality rates by 45 to 67 percent. However, inadequate sanitation infrastructure and age (degradation) of water pipes may have attenuated these benefits substantially. (JEL I12, I18, L95, O13, O18, Q25, Q53)

Depression in the perinatal period, during pregnancy or within 1 year of childbirth, imposes a high burden on women with rippling effects through her and her child's life course. Social support may be an important protective factor, but the complex bidirectional relationship with depression, alongside a paucity of longitudinal explorations, leaves much unknown about critical windows of social support exposure across the perinatal period and causal impacts on future depressive episodes.

We estimate the health costs of supply-side barriers to accessing medical care. The setting is Colombia, where citizens have a constitutional right to health care, but insurance companies that manage delivery impose restrictions on access. We use administrative data on judicial claims for health as a proxy for unmet demand. We validate this using the register recording all health service utilization, estimating that a one standard deviation increase in judicial claims is associated with pervasive decreases in utilization rates of between 0.25 and 0.71 standard deviations, including in medical consultations, procedures, hospitalizations and emergency care. These restrictions on access manifest in population health outcomes. We estimate that a one standard deviation increase in judicial claims increases the all-cause mortality rate by between 0.10 and 0.23 standard deviations. Increases in mortality are pervasive across causes, with the largest increase in deaths from certain cancers. They are also pervasive across the age and sex distribution but larger among individuals over the age of fifty and (weakly) among women and the low-income population.

Hospitals are under increasing pressure as they bear a growing burden of chronic disease while also dealing with emergency cases that do not all require hospital care. Many countries have responded by introducing alternative facilities that provide 24/7 care for basic and medium-complexity cases. Using administrative data, we investigate impacts of the opening of these intermediate facilities (UPA) in the state of Rio de Janeiro in Brazil. We find that an UPA opening in the catchment area of a hospital reduces hospital outpatient procedures and admissions and that this is associated with improved hospital performance, indicated by a decline in inpatient mortality. This does not appear to derive from a change in the risk profile of cases going to hospital but rather from hospital resources being re-focused. In a significant departure from related research, we identify displacement by investigating population-level outcomes. Our most striking result is that a large share of the decline in hospital mortality is offset by deaths in UPAs, though there remains a net decline in deaths from cardiovascular conditions that are typically amenable to primary care.

Twin births are often used as an instrument to address selection of women into fertility. However, recent work shows selection of women into twin birth such that, while OLS estimates tend to be downward biased, twin-IV estimates will tend to be upward biased. This is pertinent given the emerging consensus that fertility has limited impacts on women’s labour supply, or on investments in children. Using data for developing countries and the United States to estimate the trade-off between fertility and children’s human capital, we demonstrate the nature and size of the bias in the twin-IV estimator and estimate bounds on the true parameter. (JEL: J12, J13, C13, D13, I12)

Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal.

We investigate whether legislation of equal inheritance rights for women modifies the historic preference for sons in India, and find that it exacerbates it. Children born after the reform in families with a firstborn daughter are 3.8–4.3 percentage points less likely to be girls, indicating that the reform encouraged female foeticide. We also find that the reform increased excess female infant mortality and son-biased fertility stopping. This suggests that the inheritance reform raised the costs of having daughters, consistent with which we document an increase in stated son preference in fertility post reform. We conclude that this is a case where legal reform was frustrated by persistence of cultural norms. We provide some suggestive evidence of slowly changing patrilocality norms.

We evaluate the medium-term impacts of treating maternal depression on women’s mental health, financial empowerment, and parenting decisions. We leverage variation induced by a cluster-randomized controlled trial that provided psychotherapy to 903 prenatally depressed mothers in rural Pakistan. It was one of the world’s largest psych otherapy interventions, and it dramatically reduced postpartum depression. Seven years after psychotherapy concluded, we returned to the study site to find that impacts on women’s mental health had persisted, with a 17 percent reduction in depression rates. The intervention also improved women’s financial empowerment and increased both time- and money-intensive parental investments by between 0.2 and 0.3 standard deviations. (JEL G51, I12, J16, O15)

We provide evidence that dowry costs motivate son-preferring behaviors in India. Since gold is an integral part of dowry, we study parental responses to shocks in the world gold price. Exploiting monthly variation in gold prices across 35 years we find that monthly changes in gold prices lead to an increase in girl relative to boy neonatal mortality and that surviving girls are shorter. After the introduction of prenatal sex determination technology, we find that gold price shocks during pregnancy increase female foeticide.

Under Revision

We investigate universalization of access to health in Brazil. We find large reductions in maternal, foetal, neonatal and post-neonatal mortality, a reduction in fertility and, possibly on account of selection, no change in the quality of births. Using rich administrative data, we investigate changes in organization, access and outcomes, thereby illuminating the driving mechanisms. We find sharp increases in coverage of primary health facilities with GPs and outreach workers and, in line with this, increases in outpatient procedures, prenatal care visits, health-education activities and home visits by medical professionals. Consistent with an attempt to rationalize use of hospital resources, we find a decline in specialists and hospital beds per capita. Despite this, we see increases in hospital births, C-sections, and maternal hospitalization for complications, with no change in rates of infant hospitalization.

The contribution of fathers to child development and maternal mental health is increasingly acknowledged, although research on this topic outside of high income countries is limited. Using longitudinal data, we characterized father involvement in a rural setting in Pakistan and investigated the link between father involvement in the first year of life and child development and maternal depression. Data come from the Bachpan study, a birth cohort established in the context of a perinatal depression intervention. Father involvement was mother reported at 3 and 12 months postpartum and covered domains such as playing with or soothing the infant. Child outcomes included growth at 3, 6 and 12 months postpartum, socioemotional development at 6 months (Ages and Stages Questionnaire-socioemotional), and developmental milestones at 12 months (Bayley Scales of Infant and Toddler Development, BSID)). Maternal depression was assessed at 3, 6, and 12 months postpartum. Roughly 20% of the fathers were temporarily non-resident. Among the rest, most mothers reported that fathers were involved: for example, approximately 40% reported that the father plays with the baby on a typical day. We observed no clear pattern of association between 3-month father involvement and child growth at any time point; however, 12-month father involvement was cross-sectionally inversely associated with child growth. We observed a protective pattern of association between 3-month father involvement and 6-month child socioemotional development. For the BSID domains, while almost all effect estimates suggested a protective association with higher levels of father involvement/father being temporarily non-resident, the magnitude of the estimates was smaller and most 95% confidence intervals crossed the null. Finally, there was a trend toward greater father involvement/being temporary non-resident predicting lower levels of maternal depression. Using longitudinal data, these results provide new evidence about the association between father involvement, and both child development and maternal mental health.

Function is an important marker of health throughout the life course, however, in low-and-middle-income-countries, little is known about the burden of functional impairment as women transition from pregnancy to the first year post-partum. Leveraging longitudinal data from 960 women participating in the Share Child Cohort in Pakistan, this study sought to (1) characterize functional trajectories over time among women in their perinatal period and (2) assess predictors of chronic poor functioning following childbirth. We used a group-based trajectory modeling approach to examine maternal patterns of function from the third trimester of pregnancy through 12 months post-partum. Three trajectory groups were found: persistently well-functioning (51% of women), poor functioning with recovery (39% of women), and chronically poor functioning (10% of women). When compared to mothers in the highest functioning group, psychosocial characteristics (e.g., depression, stress, and serious life events) were significantly associated with sustained poor functioning one-year following child-birth. Mothers living in nuclear households were more likely to experience chronic poor functioning. Higher education independently predicted maternal function recovery, even when controlling for psychosocial characteristics. Education, above and beyond socio-economic assets, appears to play an important protective role in maternal functional trajectories following childbirth. Public health implications related to maternal function and perinatal mental health are discussed.

We examine intra-household gender-differentiated effects of property rights securitisation following West Bengal’s tenancy registration program, using two independently gathered datasets. In both samples, higher program implementation increased male child survival rates in families without a firstborn son, but not in those that already have a firstborn male child. We argue this reflects intensified son preference as land rights improve, ostensibly to ensure a male heir to inherit land. Consistent with this, girls with firstborn brothers also experience increased survival, but not girls with firstborn sisters. The gender bias manifests both in infant mortality rates and the sex ratio at birth.

Abstract Twin births are often construed as a natural experiment in the social and natural sciences on the premise that the occurrence of twins is quasi-random. We present population-level evidence that challenges this premise. Using individual data for 17 million births in 72 countries, we demonstrate that indicators of mother's health, health-related behaviors, and the prenatal environment are systematically positively associated with twin birth. The associations are sizable, evident in richer and poorer countries—evident even among women who do not use in vitro fertilization—and hold for numerous different measures of health. We discuss potential mechanisms, showing evidence that favours selective miscarriage.

The contribution of fathers to child development and maternal mental health is increasingly acknowledged, although research on this topic outside of high income countries is limited. Using longitudinal data, we characterized father involvement in a rural setting in Pakistan and investigated the link between father involvement in the first year of life and child development and maternal depression. Data come from the Bachpan study, a birth cohort established in the context of a perinatal depression intervention. Father involvement was mother reported at 3 and 12 months postpartum and covered domains such as playing with or soothing the infant. Child outcomes included growth at 3, 6 and 12 months postpartum, socioemotional development at 6 months (Ages and Stages Questionnaire-socioemotional), and developmental milestones at 12 months (Bayley Scales of Infant and Toddler Development, BSID)). Maternal depression was assessed at 3, 6, and 12 months postpartum. Roughly 20% of the fathers were temporarily non-resident. Among the rest, most mothers reported that fathers were involved: for example, approximately 40% reported that the father plays with the baby on a typical day. We observed no clear pattern of association between 3-month father involvement and child growth at any time point; however, 12-month father involvement was cross-sectionally inversely associated with child growth. We observed a protective pattern of association between 3-month father involvement and 6-month child socioemotional development. For the BSID domains, while almost all effect estimates suggested a protective association with higher levels of father involvement/father being temporarily non-resident, the magnitude of the estimates was smaller and most 95% confidence intervals crossed the null. Finally, there was a trend toward greater father involvement/being temporary non-resident predicting lower levels of maternal depression. Using longitudinal data, these results provide new evidence about the association between father involvement, and both child development and maternal mental health.

Although understanding the role of health in driving labor market outcomes is a matter of great importance, it has proven difficult to isolate this effect due to empirical challenges and a lack of compelling sources of identification. We obtain causal estimates of the effect of health on income and welfare dependency through two different channels: a negative health shock (dengue outbreak) and a positive health shock (opening of a health-care facility). To do this, we rely on instrumental variables and difference-in-difference methods, as well as on novel datasets. We find that dengue outbreaks lower the average working hours and income. This effect is particularly high for low-income individuals, but conditional cash transfer programs can insulate them from this shock. On the other hand, the opening of a new health-care facility in a families catchment area rises family per capita income and employment. All together, this evidence suggest that health shocks are an important part of income, poverty and welfare dependency.

This paper investigates the consequences of sex imbalance in India’s population for violence against women. We match administrative crime data by category to age-specific sex ratios in census data by district across four decades and, to analyse mechanisms, we also use census data on marriage rates and household survey data on attitudes to violence against women and marriage quality measures. We find that a surplus of men at age 20-24 increases crimes committed against women, and that this explains about 21% of the rise in gender-based violence. Although less robust, there is some evidence that the youth sex ratio also raises non-gendered forms of violence, but we find no discernible impact upon property and economic crime. In probing mechanisms, we show that marriage rates, marriage quality, and attitudes to violence against women are all modified by population sex ratios.

There is growing interest in the relationship between socioeconomic status (SES), poverty, and mental health in low and middle-income countries (LMIC). However, it is not clear whether a gradient approach focused on a wider SES distribution or a binary poverty approach is more salient for mental health in LMIC. Yet this distinction has implications for interventions aimed at improving population health. We contribute to the literature by examining how multiple indicators of socioeconomic status, including gradient SES and binary poverty indicators, contribute to prenatal depression symptoms in a LMIC context. Prenatal depression is an important public health concern with negative sequela for the mother and her children. We use data on assets, education, food insecurity, debt, and depression symptoms from a sample of 1154 pregnant women residing in rural Pakistan. Women who screened positive for depression participated in a cluster randomized controlled trial of a perinatal depression intervention; all women were interviewed October 2015-February 2016, prior to the start of the intervention. Cluster-specific sampling weights were used to approximate a random sample of pregnant women in the area. Findings indicate that fewer assets, experiencing food insecurity, and having household debt are independently associated with worse depression symptoms. The association with assets is linear with no evidence of a threshold effect, supporting the idea of a gradient in the association between levels of SES and depression symptoms. A gradient was also initially observed with woman’s educational attainment, but this association was attenuated once other SES variables were included in the model. Together, the asset, food insecurity, and debt indicators explain 14% of the variance in depression symptoms, more than has been reported in high income country studies. These findings support the use of multiple SES indicators to better elucidate the complex relationship between socioeconomic status and mental health in LMIC. •We compare the association between poverty, gradient measures of SES, and depression.•Above the poverty level, SES predict depression in a low income country.•Relying on simple, dichotomous, poverty measures in studies of mental health is not recommended.

This paper investigates the potential of an infant intervention to improve life expectancy, contributing to emerging interest in the early life origins of chronic disease. We track individuals from birth to death, and are able to identify age and cause of death. The intervention was pioneered in Sweden in 1931–1933, and appears to have been pivotal in the emergence of universal infant care programmes in the Scandinavian countries during the creation of the Welfare State. It provided information and support to mothers, with an emphasis on nutrition and sanitation, while monitoring infant care through home visits and clinics. We estimate that the average duration of programme exposure in infancy led to a 1.56% point decline in the risk of infant death (24% of baseline risk) and a 2.56% point decline in the risk of dying by age 75 (7.0% of baseline risk), and these impacts are much larger for children born out of wedlock. Intervention-led declines in the risk of dying after the age of 50 are dominated by reductions in cancer and cardiovascular mortality. We find no evidence of selective utilisation, and the estimates are similar when we exploit within-mother variation in outcomes.

This paper is part also of: Bundy AP, de Silva N, Horton S, Patton GC, Schultz L, Jamison DT, for the Disease Control Priorities-3 Child and Adolescent Health and Development Authors Group (includes Bhalotra, S). (2017). "Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition". The Lancet. Asserts that early-life health and nutritional interventions, including those that act to improve the health and nutritional status of potential mothers and pregnant women and those that directly treat children in early life, have significant impacts on schooling, earnings, and productivity over the lifecycle in low- and middle-income countries (LMICs). Estimates of benefit-cost ratios for such interventions, obtained under a range of plausible parameters, consistently exceed one, suggesting that the present discounted value of gains exceeds costs. These results motivate the case for placing early-life health and nutrition high on the policy agenda. Causal estimates of impacts of early-life nutritional interventions mostly stem from small-scale local interventions, however, and will likely prove sensitive to (1) population heterogeneity (social, economic, and cultural differences); (2) differences in program implementation (administrative capacity and trust); and (3) differences in the wider political economy of reform. Benefits may not scale up, however, and the benefit-cost ratio for nationwide implementation may prove lower.

We address the significant gaps in knowledge of prevalence and correlates of child mental health (CMH) problems outside of high income countries. We describe the prevalence of CMH problems and their correlates with a focus on the association with maternal depression in a sample of seven-year-old children in rural Pakistan.

Perinatal depression has been linked with deleterious child development outcomes, yet maternal depression interventions have not been shown to have lasting effects on child development, and evidence is not available from countries of low or middle income. In the Thinking Healthy Programme cluster-randomised controlled trial, a perinatal depression intervention was assessed in Pakistan in 2006–07. The intervention significantly reduced depression levels 12 months post partum compared with a control. We aimed to assess the effect of this same intervention on the cognitive, socioemotional, and physical development of children at around age 7 years.

This paper investigates whether the religious identity of state legislators in India influences development outcomes, both for citizens of their religious group and for the population as a whole. To allow for politician identity to be correlated with constituency level voter preferences or characteristics that make religion salient, we use quasi-random variation in legislator identity generated by close elections between Muslim and non-Muslim candidates. We find that increasing the political representation of Muslims improves health and education outcomes in the district from which the legislator is elected. We find no evidence of religious favoritism: Muslim children do not benefit more from Muslim political representation than children from other religious groups.

We investigate whether women's political representation in state legislatures improves public provision of antenatal and childhood health services in the districts from which they are elected, arguing that the costs of poor services in this domain fall disproportionately upon women. Using large representative data samples from India and accounting for potential endogeneity of politician gender and the sample composition of births, we find that a 10 percentage point increase in women's representation results in a 2.1 percentage point reduction in neonatal mortality, and we elucidate mechanisms. Women's political representation may be an underutilized tool for addressing health in developing countries. (JEL D72, I12, I15, J16, O15, O17)

Interventions that improve childhood health directly improve the quality of life and, in addition, have multiplier effects, producing sustained population and economic gains in poor countries. We suggest how contemporary global institutions shaping the development, pricing and distribution of vaccines and drugs may be modified to deliver large improvements in health. To support a justice argument for such modification, we show how the current global economic order may contribute to perpetuating poverty and poor health in less-developed countries.

Gradients of the intergenerational transmission of health in developing countries. With S. Rawlings. Review of Economics and Statistics, May 2013.

The Nigerian civil war of 1967-70 was precipitated by secession of the Igbo-dominated south-eastern region to create the state of Biafra. It was the first civil war in Africa, the predecessor of many. We investigate the legacies of this war four decades later. Using variation across ethnicity and cohort, we identify significant long-run impacts on human health capital. Individuals exposed to the war at all ages between birth and adolescence exhibit reduced adult stature and these impacts are largest in adolescence. Adult stature is portentous of reduced life expectancy and lower earnings.

A recent literature highlights the uncertainty concerning whether economic growth has any causal protective effect on health and survival. But equal rates of growth often deliver unequal rates of poverty reduction and absolute deprivation is more clearly relevant. Using state-level panel data for India, we contribute the first estimates of the impact of changes in poverty on infant survival. We identify a significant within-state relationship which persists conditional upon state income, indicating the size of survival gains from redistribution in favour of households below the poverty line. The poverty elasticity declines over time after 1981. It is invariant to controlling for income inequality but diminished upon controlling for education, fertility and state health expenditure, and eliminated once we introduce controls for omitted trends. [PUBLICATION ABSTRACT]

This paper is motivated to investigate the often neglected payoff to investments in the health of girls and women in terms of next generation outcomes. This paper investigates the intergenerational persistence of health across time and region as well as across the distribution of maternal health. It uses comparable microdata on as many as 2.24 million children born of about 0.6 million mothers in 38 developing countries in the 31 year period, 1970–2000. Mother's health is indicated by her height, BMI and anemia status. Child health is indicated by mortality risk and anthropometric failure. We find a positive relationship between maternal and child health across indicators and highlight non-linearities in these relationships. The results suggest that both contemporary and childhood health of the mother matter and that the benefits to the next generation are likely to be persistent. Averaging across the sample, persistence shows a considerable decline over time. Disaggregation shows that the decline is only significant in Latin America. Persistence has remained largely constant in Asia and has risen in Africa. The paper provides the first cross-country estimates of the intergenerational persistence in health and the first estimates of trends.

The socioeconomic status of Indian Muslims is, on average, considerably lower than that of upper-caste Hindus. Muslims nevertheless exhibit substantially higher child survival rates, and have done for decades. This paper analyses this seeming puzzle. A decomposition of the survival differential confirms that some compositional effects favour Muslims but that, overall, differences in characteristics and especially the Muslim deficit in parental education predict a Muslim disadvantage. The results of this study contribute to a recent literature that debates the importance of socioeconomic status (SES) in determining health and survival. They augment a growing literature on the role of religion or culture as encapsulating important unobservable behaviours or endowments that influence health, indeed, enough to reverse the SES gradient that is commonly observed.

This paper investigates the impact of aggregate income shocks on infant mortality in India and investigates likely mechanisms. A recent OECD-dominated literature reports the provocative finding that mortality at most ages is pro-cyclical. Similar analyses for poorer countries are scarce, and both income risk and mortality risk are greater in poor countries. This paper uses data and methods designed to avoid some of the specification problems in previous studies and it explores mechanisms and extensions that have not been previously considered. It uses individual data on infant mortality for about 150,000 children born in 1970-1997, merged by cohort and state of birth with a state panel containing information on aggregate income. Identification rests upon comparing the effects of annual deviations in income from trend on the mortality risks of children born at different times to the same mother, conditional upon a number of state-time varying covariates including rainshocks and state social expenditure. Rural infant mortality is counter-cyclical, the elasticity being about -0.33.

Using microdata on 30,000 childbirths in India and dynamic panel data models, we analyse causal effects of birth-spacing on subsequent neonatal mortality and of mortality on subsequent birth intervals, controlling for unobserved heterogeneity. Right censoring is accounted for by jointly estimating a fertility equation, identified by using data on sterilization. We find evidence of frailty, fecundity, and causal effects in both directions. Birth intervals explain only a limited share of the correlation between neonatal mortality of successive children in a family. We predict that for every neonatal death, 0.37 additional children are born, of whom 0.30 survive.

A set of time-bound targets for human development were agreed by 189 countries at the Millennium Summit held in New York in September 2000, and these are referred to as the Millennium Development Goals (henceforth MDGs). They represent an unprecedented commitment on the part of both rich and poor countries. One of the eight targets is to reduce under-5 mortality by two-thirds by the year 2015, relative to its level in 1990. This requires an annual rate of decline of about 4.3 per cent per annum.

This paper reports an analysis of micro-data for India that shows a high correlation in infant mortality among siblings. In 13 of 15 states, we identify a causal effect of infant death on the risk of infant death of the subsequent sibling (a scarring effect), after controlling for mother-level heterogeneity. The scarring effects are large, the only other covariate with a similarly large effect being mother's (secondary or higher) education. The two states in which evidence of scarring is weak are Punjab, the richest, and Kerala, the socially most progressive. The size of the scarring effect depends upon the sex of the previous child in three states, in a direction consistent with son-preference. Evidence of scarring implies that policies targeted at reducing infant mortality will have social multiplier effects by helping avoid the death of subsequent siblings. Comparison of other covariate effects across the states offers some interesting new insights.

Abstract There are severe inequalities in health in the world, poor health being concentrated amongst poor people in poor countries. Poor countries spend a much smaller share of national income on health expenditure than do richer countries. What potential lies in political or growth processes that raise this share? This depends upon how effective government health spending in developing countries is. Existing research presents little evidence of an impact on childhood mortality. Using specifications similar to those in the existing literature, this paper finds a similar result for India, which is that state health spending saves no lives. However, upon allowing lagged effects, controlling in a flexible way for trended unobservables and restricting the sample to rural households, a significant effect of health expenditure on infant mortality emerges, the long run elasticity being about −0.24. There are striking differences in the impact by social group. Slicing the data by gender, birth order, religion, maternal and paternal education and maternal age at birth, I find the weakest effects in the most vulnerable groups (with the exception of a large effect for scheduled tribes). Copyright © 2007 John Wiley & Sons, Ltd. T

Data from a range of environments indicate that the incidence of death is not randomly distributed across families but, rather, that there is a clustering of death among siblings. A natural explanation of this would be that there are (observed or unobserved) differences across families, e.g. in genetic frailty, education or living standards. Another hypothesis that is of considerable interest for both theory and policy is that there is a causal process whereby the death of a child influences the risk of death of the succeeding child in the family. Drawing language from the literature on the economics of unemployment, the causal effect is referred to here as state dependence (or scarring). The paper investigates the extent of state dependence in India. distinguishing this from family level risk factors that are common to siblings. It offers some methodological innovations on previous research. Estimates are obtained for each of three Indian states, which exhibit dramatic differences in socio-economic and demographic variables. The results suggest a significant degree of state dependence in each of the three regions. Eliminating scarring, it is estimated, would reduce the incidence of infant mortality (among children who are born after the first child) by 9.8% in the state of Uttar Pradesh, 6.0% in West Bengal and 5.9% in Kerala.

Work in Progress

Work in Progress

We leverage introduction of the first antibiotic therapies in 1937 to examine impacts of pneumonia in infancy on adult education, employment, disability, income and income mobility, and identify large impacts on each. We then examine how racial segregation in the pre-Civil Rights Era moderated the long-run benefits of antibiotics among blacks. We find that blacks born in more segregated states reaped smaller and less pervasive long run benefits despite sharp drops in pneumonia exposure. Our findings demonstrate causal effects of early life health on economic mobility and the importance of an investment-rewarding institutional environment in realization of the full potential of a healthy start.

Forthcoming

Millions of women continue to die during and soon after childbirth, even where the knowledge and resources to avoid this are available. We posit that raising the share of women in parliament can trigger action. Leveraging the timing of gender quota legislation across developing countries, we identify sharp sustained reductions of 8–10 percent in maternal mortality. Investigating mechanisms, we find that gender quotas lead to increases in percentage points of 5–8 in skilled birth attendance and 4–8 in prenatal care utilization, alongside a decline in fertility of 6–7 percent and an increase in the schooling of young women of about 0.5 years. The results are robust to numerous robustness checks. They suggest a new policy tool for tackling maternal mortality.

The chapter explores the literature on how women’s participation in politics affects policy making, in terms of redistribution, public health intervention, schooling, and policies outcomes of those directed at improving mothers and children health. Identification issues are then discussed, and designs based on the introduction of quotas, close elections in mixed-gender contexts, and textual analysis. The chapter moves on to the supply and demand side (discrimination) factors creating barriers to entering into politics. It concludes stressing the importance of gender-specific policy preferences (more redistribution and more spending for children and maternal health) in contexts where politicians’ selection matters.

ABSTRACT

This paper examines policy effectiveness as a function of leader identity. We experimentally vary leader religious identity in a coordination game implemented in India and focus on citizen reactions to leader identity, controlling for leader actions. We find that minority leaders improve coordination, and majority leaders do not. Alternative treatment arms reveal that affirmative action for minorities reverses this result, while intergroup contact improves the effectiveness of leaders of both identities. We also find that minority leaders are less effective in towns with a history of intergroup conflict. Our results demonstrate that leader and policy effectiveness depend on citizen reactions, conditioned by social identity and past conflict.

In this article we undertake a legal and policy analysis of Brazil’s Family Health Program which confirms that the right to health extended beyond Brazil’s constitution, and into the laws, policies, and documents associated with that program in 1996–2004. We then use Big Data to show that the right to health contributed to the large and sustained health gains, including in maternal and infant mortality, especially among less educated women. For example, the data shows progressive realization, enhanced access in poor and underserved areas, and reduced health inequalities, all of which are features of the right to health

The Global Gag Rule is a policy that has been historically toggled between enactment and revocation based on the political party of the U.S. President. It restricts U.S. aid to international non-governmental organizations that provide or even discuss abortion-related services. Since its inception by President Reagan in 1984, Republican presidents have consistently enforced it, while Democratic presidents have repealed it. The policy saw further restrictions under President Trump and was then rescinded by President Biden. Analyzing data spanning from 1985 to 2019, it's evident that family planning aid from the U.S. has been 48% higher during Democratic administrations. The study finds that when there is a political shift from a Democratic to a Republican presidency, a country that highly depends on U.S. aid for family planning experiences an increase in maternal mortality—0.6 additional deaths per 1,000 women, or an 8% rise. This uptick essentially negates one-fifth of the global reduction in maternal deaths since 1990.

Forthcoming

Debates around abortion typically invoke religion and politics but there is no causal evidence of the impact of politician religion on abortion. Leveraging quasi-random variation in politician religion generated by close elections in India and controlling for the party affiliation of politicians, we find lower rates of sex-selective abortion in districts won by Muslim state legislators, consistent with a higher reported aversion to abortion among Muslims compared to Hindus. The competing hypothesis that this reflects weaker son preference among Muslims is undermined by stated preference data and by demonstrating that fertility and girl-biased infant mortality inc

Updated version in progress with F Wang

We estimate the health costs of supply-side barriers to accessing medical care. The setting is Colombia, where citizens have a constitutional right to health care, but insurance companies that manage delivery impose restrictions on access. We use administrative data on judicial claims for health as a proxy for unmet demand. We validate this using the register recording all health service utilization, estimating that a one standard deviation increase in judicial claims is associated with pervasive decreases in utilization rates of between 0.25 and 0.71 standard deviations, including in medical consultations, procedures, hospitalizations and emergency care. These restrictions on access manifest in population health outcomes. We estimate that a one standard deviation increase in judicial claims increases the all-cause mortality rate by between 0.10 and 0.23 standard deviations. Increases in mortality are pervasive across causes, with the largest increase in deaths from certain cancers. They are also pervasive across the age and sex distribution but larger among individuals over the age of fifty and (weakly) among women and the low-income population.

We investigate whether legislation of equal inheritance rights for women modifies the historic preference for sons in India, and find that it exacerbates it. Children born after the reform in families with a firstborn daughter are 3.8–4.3 percentage points less likely to be girls, indicating that the reform encouraged female foeticide. We also find that the reform increased excess female infant mortality and son-biased fertility stopping. This suggests that the inheritance reform raised the costs of having daughters, consistent with which we document an increase in stated son preference in fertility post reform. We conclude that this is a case where legal reform was frustrated by persistence of cultural norms. We provide some suggestive evidence of slowly changing patrilocality norms.

We examine intra-household gender-differentiated effects of property rights securitisation following West Bengal’s tenancy registration program, using two independently gathered datasets. In both samples, higher program implementation increased male child survival rates in families without a firstborn son, but not in those that already have a firstborn male child. We argue this reflects intensified son preference as land rights improve, ostensibly to ensure a male heir to inherit land. Consistent with this, girls with firstborn brothers also experience increased survival, but not girls with firstborn sisters. The gender bias manifests both in infant mortality rates and the sex ratio at birth.

We investigate universalization of access to health in Brazil. We find large reductions in maternal, foetal, neonatal and post-neonatal mortality, a reduction in fertility and, possibly on account of selection, no change in the quality of births. Using rich administrative data, we investigate changes in organization, access and outcomes, thereby illuminating the driving mechanisms. We find sharp increases in coverage of primary health facilities with GPs and outreach workers and, in line with this, increases in outpatient procedures, prenatal care visits, health-education activities and home visits by medical professionals. Consistent with an attempt to rationalize use of hospital resources, we find a decline in specialists and hospital beds per capita. Despite this, we see increases in hospital births, C-sections, and maternal hospitalization for complications, with no change in rates of infant hospitalization.

This paper investigates the consequences of sex imbalance in India’s population for violence against women. We match administrative crime data by category to age-specific sex ratios in census data by district across four decades and, to analyse mechanisms, we also use census data on marriage rates and household survey data on attitudes to violence against women and marriage quality measures. We find that a surplus of men at age 20-24 increases crimes committed against women, and that this explains about 21% of the rise in gender-based violence. Although less robust, there is some evidence that the youth sex ratio also raises non-gendered forms of violence, but we find no discernible impact upon property and economic crime. In probing mechanisms, we show that marriage rates, marriage quality, and attitudes to violence against women are all modified by population sex ratios.

We investigate whether the event of women being competitively elected as state legislators encourages subsequent political participation among women. Using a regression discontinuity design on Indian constituency level data, we find that female incumbents are more likely than male incumbents to re‐contest and that there is a decline in the entry of new women candidates. This decline is most pronounced in states with entrenched gender bias and in male‐headed parties, suggesting an intensification of barriers against women in these areas. Similar results for (mostly male) Muslim candidates indicate the presence of institutionalised demand‐side barriers rather than gender‐specific preferences and constraints.

This paper investigates whether the religious identity of state legislators in India influences development outcomes, both for citizens of their religious group and for the population as a whole. To allow for politician identity to be correlated with constituency level voter preferences or characteristics that make religion salient, we use quasi-random variation in legislator identity generated by close elections between Muslim and non-Muslim candidates. We find that increasing the political representation of Muslims improves health and education outcomes in the district from which the legislator is elected. We find no evidence of religious favoritism: Muslim children do not benefit more from Muslim political representation than children from other religious groups.

Revision ongoing

We investigate whether women's political representation in state legislatures improves public provision of antenatal and childhood health services in the districts from which they are elected, arguing that the costs of poor services in this domain fall disproportionately upon women. Using large representative data samples from India and accounting for potential endogeneity of politician gender and the sample composition of births, we find that a 10 percentage point increase in women's representation results in a 2.1 percentage point reduction in neonatal mortality, and we elucidate mechanisms. Women's political representation may be an underutilized tool for addressing health in developing countries. (JEL D72, I12, I15, J16, O15, O17)

Interventions that improve childhood health directly improve the quality of life and, in addition, have multiplier effects, producing sustained population and economic gains in poor countries. We suggest how contemporary global institutions shaping the development, pricing and distribution of vaccines and drugs may be modified to deliver large improvements in health. To support a justice argument for such modification, we show how the current global economic order may contribute to perpetuating poverty and poor health in less-developed countries.

The responsibility for child labour is often cast as resting with (exploitative) employers. This creates a demand for legislation that bars employers from employing children. However, a careful look at household survey data suggests that the majority of employers are parents and, when not, parents have volunteered the child for work. This chapter focuses on the majority case of children working to help the family survive. It briefly discusses the role of legislation in curbing child labour, while arguing that it is not a substitute for efforts directed at creating income-generating opportunities amongst the poor and improving their access to education. Even when legislation is effective in lowering the incidence of child labour, it remains relevant to consider where children removed from the labour market go, which is why so much of the emphasis in the contemporary development literature is on education.

ABSTRACT

A set of time-bound targets for human development were agreed by 189 countries at the Millennium Summit held in New York in September 2000, and these are referred to as the Millennium Development Goals (henceforth MDGs). They represent an unprecedented commitment on the part of both rich and poor countries. One of the eight targets is to reduce under-5 mortality by two-thirds by the year 2015, relative to its level in 1990. This requires an annual rate of decline of about 4.3 per cent per annum.

This paper uses two large repeated cross-sections, one for the early 1990's, and one for the late 1990's, to describe growth in school enrolment and completion rates for boys and girls in India, and to explore the extent to which enrolment and completion rates have grown over time. It decomposes this growth into components due to change in the characteristics that determine schooling, and another associated with changes in the responsiveness of schooling to given characteristics. Our results caution against the common practice of using current data to make future projections on the assumption that the model parameters are stable. The analysis nevertheless performs illustrative simulations relevant to the question of whether India will be able to achieve the Millennium Development Goal of realising universal primary education by the year 2015. The simulations suggest that India will achieve universal attendance, but that primary school completion rates will not exhibit much progress.

ABSTRACT

ABSTRACT

This article is motivated by the remarkable observation that children of land-rich households are often more likely to be in work than the children of land-poor households. The vast majority of working children in developing economies are in agricultural work, predominantly on farms operated by their families. Land is the most important store of wealth in agrarian societies, and it is typically distributed very unequally. These facts challenge the common presumption that child labor emerges from the poorest households. This article suggests that this apparent paradox can be explained by failures of the markets for labor and land. Credit market failure will tend to weaken the force of this paradox. These effects are modeled and estimates obtained using survey data from rural Pakistan and Ghana. The main result is that the wealth paradox persists for girls in both countries, whereas for boys it disappears after conditioning on other covariates.

While South Asia has the largest number of working children, sub-Saharan Africa has the highest incidence of child labour. Child work participation rates are 41 per cent in Africa as compared with 21 per cent in Asia and 17 per cent in Latin America (Ashagrie, 1998). Comparative work is a first step in gaining an insight into the universality of the problem of child work. South Asia and sub-Saharan Africa are clearly very different environments, their common ground being that the average household, at least in rural areas, is poor. We compare the determinants of child labour in the two countries, including household living standards, household human capital and demographics, and community-level data on schools and infrastructure. The data describe prominent differences in the environment that children grow up in. We then present a summary of the determinants of the variation in child work across households within each country. Interesting contrasts across country and gender are highlighted.

A majority of individuals in poor countries have volatile incomes and are often unable to maintain adequate levels of consumption. There has nevertheless been limited interest in academic and government circles in state-guided provision of social security in these countries. Historians and historical demographers have created an exciting literature on the manner in which the poor laws operated and, independently, on changes in fertility and mortality rates in pre-industrial England. However, the two have not been brought together, partly because of data constraints. This paper argues that there is a research agenda there with considerable unexploited potential.

abstract

This paper provides an estimate of the production cost of losses in official working hours and of utilization-adjusted productivity growth using robust methods on a panel of industry-region data for Indian manufacturing in the 1980s. Time losses such as arise on account of power cuts and materials shortages appear to have cost the economy a sixth of its potential manufacturing output in 1979. Concomitant with deregulation and increased public investment in infrastructure in the 1980s, there was a significant recuperation of lost time. Although this contributed 25% of the observed acceleration in output, it has escaped notice so far. Recognizing the increase in factor utilization produces more modest estimates of productivity growth and casts doubt on its sustainability.

In the 1980s, India experimented with deregulation in industry and trade. Manufacturing output accelerated but employment declined, raising doubts about the desirability of the policy reforms. An explanation of employment behavior is proposed in terms of increased in total factor productivity, in actual hours worked, and in the product wage. Using robust methods, it is shown that neglect of hours worked results in a substantial upward bias in estimated of the wage elasticity. Growth in productivity and hours appears to be associated with the reform process, with the increase in hours worked reflecting recovery of lost time. To the extent that hours must hit a ceiling, the drop in employment on this count is expected to be temporary. Other things being equal, employment prospects appear to depend considerably on the course of productivity growth.

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Millions of women continue to die during and soon after childbirth, even where the knowledge and resources to avoid this are available. We posit that raising the share of women in parliament can trigger action. Leveraging the timing of gender quota legislation across developing countries, we identify sharp sustained reductions of 8–10 percent in maternal mortality. Investigating mechanisms, we find that gender quotas lead to increases in percentage points of 5–8 in skilled birth attendance and 4–8 in prenatal care utilization, alongside a decline in fertility of 6–7 percent and an increase in the schooling of young women of about 0.5 years. The results are robust to numerous robustness checks. They suggest a new policy tool for tackling maternal mortality.

This study estimates the relative importance of alternative supply and demand mechanisms in explaining the rise of female labor-force participation (FLFP) over the last 55 years in Mexico. The growth of FLFP in Mexico between 1960 and 2015 followed an S-shaped, with a considerable acceleration during the 1990s. Using descriptive decomposition methods and a shift-share design, the study shows that, put together, supply and demand factors can account for most of the rise of FLFP over the entire period, led by increases in women’s education, declining fertility, and shifts in the occupational structure of the workforce. However, there is unexplained variation in the 1990s, when FLFP spiked.

The chapter explores the literature on how women’s participation in politics affects policy making, in terms of redistribution, public health intervention, schooling, and policies outcomes of those directed at improving mothers and children health. Identification issues are then discussed, and designs based on the introduction of quotas, close elections in mixed-gender contexts, and textual analysis. The chapter moves on to the supply and demand side (discrimination) factors creating barriers to entering into politics. It concludes stressing the importance of gender-specific policy preferences (more redistribution and more spending for children and maternal health) in contexts where politicians’ selection matters.

ABSTRACT

This paper discusses research on the relationship between fertility and women’s labour force participation. It surveys methods used to obtain causal identification, and provides an overview of the evidence of causal effects in both directions. We highlight a few themes that we regard as important in guiding research and in reading the evidence. These include the importance of distinguishing between extensive and intensive margin changes in both variables; consideration not only of women’s participation but also of occupational and sectoral choice and of relative earnings; the relevance of studying dynamic effects and of analysing changes across the lifecycle and across successive cohorts; and of recognizing that women’s choices over both fertility and labour force participation are subject to multiple constraints. We observe that, while technological innovations in reproductive health technologies have muted the familycareer tradeoff primarily by allowing women to time their fertility, policy has not achieved as much as it might.

The occurrence of twin births has been widely used as a natural experiment. With a focus upon the use of twin births for identification of causal effects in economics, this chapter provides a critical review of methods and results.

Access to prenatal sex-detection technology in India has led to a phenomenal increase in abortion of girls. We find that it has also narrowed the gender gap in under-five mortality, consistent with surviving girls being more wanted than aborted girls. For every three aborted girls, one additional girl survived to age five. Mechanisms include moderation of son-biased fertility stopping and narrowing of gender gaps in parental investments. However, surviving girls are more likely to be born in lower-status families. Our findings have implications not only for counts of missing girls but also for the later life outcomes of girls.

The Global Gag Rule is a policy that has been historically toggled between enactment and revocation based on the political party of the U.S. President. It restricts U.S. aid to international non-governmental organizations that provide or even discuss abortion-related services. Since its inception by President Reagan in 1984, Republican presidents have consistently enforced it, while Democratic presidents have repealed it. The policy saw further restrictions under President Trump and was then rescinded by President Biden. Analyzing data spanning from 1985 to 2019, it's evident that family planning aid from the U.S. has been 48% higher during Democratic administrations. The study finds that when there is a political shift from a Democratic to a Republican presidency, a country that highly depends on U.S. aid for family planning experiences an increase in maternal mortality—0.6 additional deaths per 1,000 women, or an 8% rise. This uptick essentially negates one-fifth of the global reduction in maternal deaths since 1990.

IVF allows women to delay birth and pursue careers, but IVF massively increases the risk of twin birth. There is limited evidence of how having twins influences women’s post-birth careers. We investigate this, leveraging a single embryo transfer (SET) mandate implemented in Sweden in 2003, following which the share of twin births showed a precipitous drop of 70%. Linking birth registers to hospitalization and earnings registers, we identify substantial improvements in maternal and child health and women’s earnings following IVF birth, alongside an increase in subsequent fertility. We provide the first comprehensive evaluation of SET, relevant given the secular rise in IVF births and growing concerns over twin birth risk. We contribute new estimates of the child penalty imposed by twin as opposed to singleton birth, relevant to the secular rise in the global twin birth rate.

Debates around abortion typically invoke religion and politics but there is no causal evidence of the impact of politician religion on abortion. Leveraging quasi-random variation in politician religion generated by close elections in India and controlling for the party affiliation of politicians, we find lower rates of sex-selective abortion in districts won by Muslim state legislators, consistent with a higher reported aversion to abortion among Muslims compared to Hindus. The competing hypothesis that this reflects weaker son preference among Muslims is undermined by stated preference data and by demonstrating that fertility and girl-biased infant mortality increase in Muslim-won districts.

Updated version in progress with F Wang.

Forthcoming

Twin births are often used as an instrument to address selection of women into fertility. However, recent work shows selection of women into twin birth such that, while OLS estimates tend to be downward biased, twin-IV estimates will tend to be upward biased. This is pertinent given the emerging consensus that fertility has limited impacts on women’s labour supply, or on investments in children. Using data for developing countries and the United States to estimate the trade-off between fertility and children’s human capital, we demonstrate the nature and size of the bias in the twin-IV estimator and estimate bounds on the true parameter.

We investigate whether legislation of equal inheritance rights for women modifies the historic preference for sons in India, and find that it exacerbates it. Children born after the reform in families with a firstborn daughter are 3.8–4.3 percentage points less likely to be girls, indicating that the reform encouraged female foeticide. We also find that the reform increased excess female infant mortality and son-biased fertility stopping. This suggests that the inheritance reform raised the costs of having daughters, consistent with which we document an increase in stated son preference in fertility post reform. We conclude that this is a case where legal reform was frustrated by persistence of cultural norms. We provide some suggestive evidence of slowly changing patrilocality norms.

We provide evidence that dowry costs motivate son-preferring behaviors in India. Since gold is an integral part of dowry, we study parental responses to shocks in the world gold price. Exploiting monthly variation in gold prices across 35 years we find that monthly changes in gold prices lead to an increase in girl relative to boy neonatal mortality and that surviving girls are shorter. After the introduction of prenatal sex determination technology, we find that gold price shocks during pregnancy increase female foeticide.

We investigate universalization of access to health in Brazil. We find large reductions in maternal, foetal, neonatal and post-neonatal mortality, a reduction in fertility and, possibly on account of selection, no change in the quality of births. Using rich administrative data, we investigate changes in organization, access and outcomes, thereby illuminating the driving mechanisms. We find sharp increases in coverage of primary health facilities with GPs and outreach workers and, in line with this, increases in outpatient procedures, prenatal care visits, health-education activities and home visits by medical professionals. Consistent with an attempt to rationalize use of hospital resources, we find a decline in specialists and hospital beds per capita. Despite this, we see increases in hospital births, C-sections, and maternal hospitalization for complications, with no change in rates of infant hospitalization.

We examine intra-household gender-differentiated effects of property rights securitisation following West Bengal’s tenancy registration program, using two independently gathered datasets. In both samples, higher program implementation increased male child survival rates in families without a firstborn son, but not in those that already have a firstborn male child. We argue this reflects intensified son preference as land rights improve, ostensibly to ensure a male heir to inherit land. Consistent with this, girls with firstborn brothers also experience increased survival, but not girls with firstborn sisters. The gender bias manifests both in infant mortality rates and the sex ratio at birth.

Twin births are often construed as a natural experiment in the social and natural sciences on the premise that the occurrence of twins is quasi-random. We present population-level evidence that challenges this premise. Using individual data for 17 million births in 72 countries, we demonstrate that indicators of mother's health, health-related behaviors, and the prenatal environment are systematically positively associated with twin birth. The associations are sizable, evident in richer and poorer countries—evident even among women who do not use in vitro fertilization—and hold for numerous different measures of health. We discuss potential mechanisms, showing evidence that favors selective miscarriage.

This paper investigates the consequences of sex imbalance in India’s population for violence against women. We match administrative crime data by category to age-specific sex ratios in census data by district across four decades and, to analyse mechanisms, we also use census data on marriage rates and household survey data on attitudes to violence against women and marriage quality measures. We find that a surplus of men at age 20-24 increases crimes committed against women, and that this explains about 21% of the rise in gender-based violence. Although less robust, there is some evidence that the youth sex ratio also raises non-gendered forms of violence, but we find no discernible impact upon property and economic crime. In probing mechanisms, we show that marriage rates, marriage quality, and attitudes to violence against women are all modified by population sex ratios.

A recent literature highlights the uncertainty concerning whether economic growth has any causal protective effect on health and survival. But equal rates of growth often deliver unequal rates of poverty reduction and absolute deprivation is more clearly relevant. Using state-level panel data for India, we contribute the first estimates of the impact of changes in poverty on infant survival. We identify a significant within-state relationship which persists conditional upon state income, indicating the size of survival gains from redistribution in favour of households below the poverty line. The poverty elasticity declines over time after 1981. It is invariant to controlling for income inequality but diminished upon controlling for education, fertility and state health expenditure, and eliminated once we introduce controls for omitted trends. [PUBLICATION ABSTRACT]

The socioeconomic status of Indian Muslims is, on average, considerably lower than that of upper-caste Hindus. Muslims nevertheless exhibit substantially higher child survival rates, and have done for decades. This paper analyses this seeming puzzle. A decomposition of the survival differential confirms that some compositional effects favour Muslims but that, overall, differences in characteristics and especially the Muslim deficit in parental education predict a Muslim disadvantage. The results of this study contribute to a recent literature that debates the importance of socioeconomic status (SES) in determining health and survival. They augment a growing literature on the role of religion or culture as encapsulating important unobservable behaviours or endowments that influence health, indeed, enough to reverse the SES gradient that is commonly observed.

This paper investigates the impact of aggregate income shocks on infant mortality in India and investigates likely mechanisms. A recent OECD-dominated literature reports the provocative finding that mortality at most ages is pro-cyclical. Similar analyses for poorer countries are scarce, and both income risk and mortality risk are greater in poor countries. This paper uses data and methods designed to avoid some of the specification problems in previous studies and it explores mechanisms and extensions that have not been previously considered. It uses individual data on infant mortality for about 150,000 children born in 1970-1997, merged by cohort and state of birth with a state panel containing information on aggregate income. Identification rests upon comparing the effects of annual deviations in income from trend on the mortality risks of children born at different times to the same mother, conditional upon a number of state-time varying covariates including rainshocks and state social expenditure. Rural infant mortality is counter-cyclical, the elasticity being about -0.33.

Muslim children in India face substantially lower mortality risks than Hindu children. This is surprising because one would have expected just the opposite: Muslims have, on average, lower socio-economic status, higher fertility, shorter birth-spacing, and are a minority group in India that may be expected to live in areas that have relatively poor public provision. Although higher fertility amongst Muslims as compared with Hindus has excited considerable political and academic attention in India, higher mortality amongst Hindus has gone largely unnoticed. This paper considers this seeming puzzle in depth.

This paper highlights an aspect of the enormous and little-exploited potential of the Demographic and Health Surveys, namely the use of data on siblings. Such data can be used to control for family-level unobserved heterogeneity that might confound the relationship of interest and to study correlations in sibling outcomes. These uses are illustrated with examples. The paper ends with a discussion of potential problems associated with the sibling data being derived from retrospective fertility histories of mothers.

This paper reports an analysis of micro-data for India that shows a high correlation in infant mortality among siblings. In 13 of 15 states, we identify a causal effect of infant death on the risk of infant death of the subsequent sibling (a scarring effect), after controlling for mother-level heterogeneity. The scarring effects are large, the only other covariate with a similarly large effect being mother's (secondary or higher) education. The two states in which evidence of scarring is weak are Punjab, the richest, and Kerala, the socially most progressive. The size of the scarring effect depends upon the sex of the previous child in three states, in a direction consistent with son-preference. Evidence of scarring implies that policies targeted at reducing infant mortality will have social multiplier effects by helping avoid the death of subsequent siblings. Comparison of other covariate effects across the states offers some interesting new insights.

Using microdata on 30,000 childbirths in India and dynamic panel data models, we analyse causal effects of birth-spacing on subsequent neonatal mortality and of mortality on subsequent birth intervals, controlling for unobserved heterogeneity. Right censoring is accounted for by jointly estimating a fertility equation, identified by using data on sterilization. We find evidence of frailty, fecundity, and causal effects in both directions. Birth intervals explain only a limited share of the correlation between neonatal mortality of successive children in a family. We predict that for every neonatal death, 0.37 additional children are born, of whom 0.30 survive.

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We estimate impacts of male job loss, female job loss, and male unemployment benefits on domestic violence in Brazil. We merge employer-employee and social welfare registers with administrative data on domestic violence cases brought to criminal courts, use of public shelters by victims and mandatory notifications of domestic violence by health providers. Leveraging mass layoffs for identification, we find that both male and female job loss, independently, lead to large and pervasive increases in domestic violence. Exploiting a discontinuity in unemployment insurance eligibility, we find that eligible men are not less likely to commit domestic violence while benefits are being paid, and more likely to commit it once benefits expire. Our findings are consistent with job loss increasing domestic violence on account of a negative income shock and an increase in exposure of victims to perpetrators, with unemployment benefits partially offsetting the income shock while reinforcing the exposure shock.

We leverage staggered implementation of lockdown across Chile's 346 municipalities, identifying dynamic impacts on domestic violence (DV). Using administrative data, we find lockdown imposition increases indicators of DV-related distress, while decreasing DV reports to the police. We identify male job loss as a mechanism driving distress, and female job loss as driving decreased reporting. Stimulus payments to poor households act on both margins, their impacts partially differentiated by lockdown status. Once lockdown is lifted, police reports surge but we see a ratchet effect in distress. Our findings accentuate the controversy around welfare impacts of lockdown mandates.

We examine the impact of establishing women police stations (WPS) on reporting of gender-based violence. Using administrative crime data and exploiting staggered implementation across Indian cities, we find that the opening of WPS is associated with an increase in police reports of crimes against women of 29 percent, a result driven by domestic violence. This appears to reflect reporting rather than incidence as we find no changes in femicide or in survey-reported domestic violence. We also find some evidence of an increase in women's labor supply following WPS opening, consistent with women feeling safer once the costs of reporting violence fall.

Forthcoming

This study examines the association of unemployment variation with intimate partner violence using representative data from thirty-one developing countries, from 2005 to 2016. It finds that a 1 percent increase in the male unemployment rate is associated with an increase in the incidence of physical violence against women by 0.50 percentage points, or 2.75 percent. This is consistent with financial and psychological stress generated by unemployment. Female unemployment rates have the opposite effect, a 1 percent decrease being associated with an increase in the probability of victimization of 0.52 percentage points, or 2.87 percent. That an improvement in women’s employment opportunities is associated with increased violence is consistent with male backlash. The study finds that this pattern of behaviors emerges entirely from countries in which women have more limited access to divorce than men.

We investigate whether legislation of equal inheritance rights for women modifies the historic preference for sons in India, and find that it exacerbates it. Children born after the reform in families with a firstborn daughter are 3.8–4.3 percentage points less likely to be girls, indicating that the reform encouraged female foeticide. We also find that the reform increased excess female infant mortality and son-biased fertility stopping. This suggests that the inheritance reform raised the costs of having daughters, consistent with which we document an increase in stated son preference in fertility post reform. We conclude that this is a case where legal reform was frustrated by persistence of cultural norms. We provide some suggestive evidence of slowly changing patrilocality norms.

We provide evidence that dowry costs motivate son-preferring behaviors in India. Since gold is an integral part of dowry, we study parental responses to shocks in the world gold price. Exploiting monthly variation in gold prices across 35 years we find that monthly changes in gold prices lead to an increase in girl relative to boy neonatal mortality and that surviving girls are shorter. After the introduction of prenatal sex determination technology, we find that gold price shocks during pregnancy increase female foeticide.

This paper investigates the consequences of sex imbalance in India’s population for violence against women. We match administrative crime data by category to age-specific sex ratios in census data by district across four decades and, to analyse mechanisms, we also use census data on marriage rates and household survey data on attitudes to violence against women and marriage quality measures. We find that a surplus of men at age 20-24 increases crimes committed against women, and that this explains about 21% of the rise in gender-based violence. Although less robust, there is some evidence that the youth sex ratio also raises non-gendered forms of violence, but we find no discernible impact upon property and economic crime. In probing mechanisms, we show that marriage rates, marriage quality, and attitudes to violence against women are all modified by population sex ratios.

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Forthcoming

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Disruptions in the hypothalamic-pituitary-adrenal (HPA) axis are thought to be key neuroendocrine mechanisms involved in psychopathology and may have intergenerational impacts. Hair-derived HPA hormones offer a measure of long-term HPA axis activity that may be useful in assessing maternal and infant health. Building on a community-based randomized control trial of a perinatal depression intervention in Pakistan, we examine intervention effects on HPA axis activity in a subsample of mothers and infants.

We investigate the importance of subjective expectations of returns to and effort costs of the two main investments that mothers make in newborns: breastfeeding and stimulation. We find heterogeneity across mothers in expected effort costs and expected returns for outcomes in the cognitive, socio-emotional and health domains, and we show that this contributes to explaining heterogeneity in investments. We find no significant heterogeneity in preferences for child developmental outcomes. We simulate the impact of various policies on investments. Our findings highlight the relevance of interventions designed to reduce perinatal fatigue alongside interventions that increase perceived returns to investments.

Background: Depression in the perinatal period, during pregnancy or within 1 year of childbirth, imposes a high burden on women with rippling effects through her and her child's life course. Social support may be an important protective factor, but the complex bidirectional relationship with depression, alongside a paucity of longitudinal explorations, leaves much unknown about critical windows of social support exposure across the perinatal period and causal impacts on future depressive episodes. Methods: This study leverages marginal structural models to evaluate associations between longitudinal patterns of perinatal social support and subsequent maternal depression at 6 and 12 months postpartum. In a cohort of women in rural Pakistan (n=780), recruited in the third trimester of pregnancy and followed up at 3, 6 and 12 months postpartum, we assessed social support using two well-validated measures: the Multidimensional Scale of Perceived Social Support (MSPSS) and the Maternal Social Support Index (MSSI). Major depressive disorder was assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Results: High and sustained scores on the MSPSS through the perinatal period were associated with a decreased risk of depression at 12 months postpartum (0.35, 95% CI: 0.19 to 0.63). Evidence suggests the recency of support also matters, but estimates are imprecise. We did not find evidence of a protective effect for support based on the MSSI. Conclusions: This study highlights the protective effect of sustained social support, particularly emotional support, on perinatal depression. Interventions targeting, leveraging and maintaining this type of support may be particularly important for reducing postpartum depression.

We evaluate the medium-term impacts of treating maternal depression on women’s mental health, financial empowerment, and parenting decisions. We leverage variation induced by a cluster-randomized controlled trial that provided psychotherapy to 903 prenatally depressed mothers in rural Pakistan. It was one of the world’s largest psychotherapy interventions, and it dramatically reduced postpartum depression. Seven years after psychotherapy concluded, we returned to the study site to find that impacts on women’s mental health had persisted, with a 17 percent reduction in depression rates. The intervention also improved women’s financial empowerment and increased both time- and money-intensive parental investments by between 0.2 and 0.3 standard deviations.

Traditional postpartum practices are intended to provide care to mothers, but there is mixed evidence concerning their impact on postpartum depression (PPD). It remains unknown if there is a unique impact of postpartum practices on PPD separately from other types of social support, or if practices differentially affect those with existing prenatal depression. In Pakistan, chilla (چله) is a traditional postpartum practice in which women receive relief from household work, additional familial support, and supplemental food for up to 40 days postpartum. This study aims to understand if chilla protects against PPD independent of other support and whether this relationship varies by prenatal depression status.

Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal.

Function is an important marker of health throughout the life course, however, in low-and-middle-income-countries, little is known about the burden of functional impairment as women transition from pregnancy to the first year post-partum. Leveraging longitudinal data from 960 women participating in the Share Child Cohort in Pakistan, this study sought to (1) characterize functional trajectories over time among women in their perinatal period and (2) assess predictors of chronic poor functioning following childbirth. We used a group-based trajectory modeling approach to examine maternal patterns of function from the third trimester of pregnancy through 12 months post-partum. Three trajectory groups were found: persistently well-functioning (51% of women), poor functioning with recovery (39% of women), and chronically poor functioning (10% of women). When compared to mothers in the highest functioning group, psychosocial characteristics (e.g., depression, stress, and serious life events) were significantly associated with sustained poor functioning one-year following child-birth. Mothers living in nuclear households were more likely to experience chronic poor functioning. Higher education independently predicted maternal function recovery, even when controlling for psychosocial characteristics. Education, above and beyond socio-economic assets, appears to play an important protective role in maternal functional trajectories following childbirth. Public health implications related to maternal function and perinatal mental health are discussed.

The contribution of fathers to child development and maternal mental health is increasingly acknowledged, although research on this topic outside of high income countries is limited. Using longitudinal data, we characterized father involvement in a rural setting in Pakistan and investigated the link between father involvement in the first year of life and child development and maternal depression. Data come from the Bachpan study, a birth cohort established in the context of a perinatal depression intervention. Father involvement was mother reported at 3 and 12 months postpartum and covered domains such as playing with or soothing the infant. Child outcomes included growth at 3, 6 and 12 months postpartum, socioemotional development at 6 months (Ages and Stages Questionnaire-socioemotional), and developmental milestones at 12 months (Bayley Scales of Infant and Toddler Development, BSID)). Maternal depression was assessed at 3, 6, and 12 months postpartum. Roughly 20% of the fathers were temporarily non-resident. Among the rest, most mothers reported that fathers were involved: for example, approximately 40% reported that the father plays with the baby on a typical day. We observed no clear pattern of association between 3-month father involvement and child growth at any time point; however, 12-month father involvement was cross-sectionally inversely associated with child growth. We observed a protective pattern of association between 3-month father involvement and 6-month child socioemotional development. For the BSID domains, while almost all effect estimates suggested a protective association with higher levels of father involvement/father being temporarily non-resident, the magnitude of the estimates was smaller and most 95% confidence intervals crossed the null. Finally, there was a trend toward greater father involvement/being temporary non-resident predicting lower levels of maternal depression. Using longitudinal data, these results provide new evidence about the association between father involvement, and both child development and maternal mental health.

There is growing interest in the relationship between socioeconomic status (SES), poverty, and mental health in low and middle-income countries (LMIC). However, it is not clear whether a gradient approach focused on a wider SES distribution or a binary poverty approach is more salient for mental health in LMIC. Yet this distinction has implications for interventions aimed at improving population health. We contribute to the literature by examining how multiple indicators of socioeconomic status, including gradient SES and binary poverty indicators, contribute to prenatal depression symptoms in a LMIC context. Prenatal depression is an important public health concern with negative sequela for the mother and her children. We use data on assets, education, food insecurity, debt, and depression symptoms from a sample of 1154 pregnant women residing in rural Pakistan. Women who screened positive for depression participated in a cluster randomized controlled trial of a perinatal depression intervention; all women were interviewed October 2015-February 2016, prior to the start of the intervention. Cluster-specific sampling weights were used to approximate a random sample of pregnant women in the area. Findings indicate that fewer assets, experiencing food insecurity, and having household debt are independently associated with worse depression symptoms. The association with assets is linear with no evidence of a threshold effect, supporting the idea of a gradient in the association between levels of SES and depression symptoms. A gradient was also initially observed with woman’s educational attainment, but this association was attenuated once other SES variables were included in the model. Together, the asset, food insecurity, and debt indicators explain 14% of the variance in depression symptoms, more than has been reported in high income country studies. These findings support the use of multiple SES indicators to better elucidate the complex relationship between socioeconomic status and mental health in LMIC.

This paper is part also of: Bundy AP, de Silva N, Horton S, Patton GC, Schultz L, Jamison DT, for the Disease Control Priorities-3 Child and Adolescent Health and Development Authors Group (includes Bhalotra, S). (2017). "Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition". The Lancet. Asserts that early-life health and nutritional interventions, including those that act to improve the health and nutritional status of potential mothers and pregnant women and those that directly treat children in early life, have significant impacts on schooling, earnings, and productivity over the lifecycle in low- and middle-income countries (LMICs). Estimates of benefit-cost ratios for such interventions, obtained under a range of plausible parameters, consistently exceed one, suggesting that the present discounted value of gains exceeds costs. These results motivate the case for placing early-life health and nutrition high on the policy agenda. Causal estimates of impacts of early-life nutritional interventions mostly stem from small-scale local interventions, however, and will likely prove sensitive to (1) population heterogeneity (social, economic, and cultural differences); (2) differences in program implementation (administrative capacity and trust); and (3) differences in the wider political economy of reform. Benefits may not scale up, however, and the benefit-cost ratio for nationwide implementation may prove lower.

We address the significant gaps in knowledge of prevalence and correlates of child mental health (CMH) problems outside of high income countries. We describe the prevalence of CMH problems and their correlates with a focus on the association with maternal depression in a sample of seven-year-old children in rural Pakistan.

Perinatal depression has been linked with deleterious child development outcomes, yet maternal depression interventions have not been shown to have lasting effects on child development, and evidence is not available from countries of low or middle income. In the Thinking Healthy Programme cluster-randomised controlled trial, a perinatal depression intervention was assessed in Pakistan in 2006–07. The intervention significantly reduced depression levels 12 months post partum compared with a control. We aimed to assess the effect of this same intervention on the cognitive, socioemotional, and physical development of children at around age 7 years.

Interventions that improve childhood health directly improve the quality of life and, in addition, have multiplier effects, producing sustained population and economic gains in poor countries. We suggest how contemporary global institutions shaping the development, pricing and distribution of vaccines and drugs may be modified to deliver large improvements in health. To support a justice argument for such modification, we show how the current global economic order may contribute to perpetuating poverty and poor health in less-developed countries.

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ABSTRACT

This paper examines policy effectiveness as a function of leader identity. We experimentally vary leader religious identity in a coordination game implemented in India and focus on citizen reactions to leader identity, controlling for leader actions. We find that minority leaders improve coordination, and majority leaders do not. Alternative treatment arms reveal that affirmative action for minorities reverses this result, while intergroup contact improves the effectiveness of leaders of both identities. We also find that minority leaders are less effective in towns with a history of intergroup conflict. Our results demonstrate that leader and policy effectiveness depend on citizen reactions, conditioned by social identity and past conflict.

Debates around abortion typically invoke religion and politics but there is no causal evidence of the impact of politician religion on abortion. Leveraging quasi-random variation in politician religion generated by close elections in India and controlling for the party affiliation of politicians, we find lower rates of sex-selective abortion in districts won by Muslim state legislators, consistent with a higher reported aversion to abortion among Muslims compared to Hindus. The competing hypothesis that this reflects weaker son preference among Muslims is undermined by stated preference data and by demonstrating that fertility and girl-biased infant mortality increase in Muslim-won districts.

We investigate whether legislation of equal inheritance rights for women modifies the historic preference for sons in India, and find that it exacerbates it. Children born after the reform in families with a firstborn daughter are 3.8–4.3 percentage points less likely to be girls, indicating that the reform encouraged female foeticide. We also find that the reform increased excess female infant mortality and son-biased fertility stopping. This suggests that the inheritance reform raised the costs of having daughters, consistent with which we document an increase in stated son preference in fertility post reform. We conclude that this is a case where legal reform was frustrated by persistence of cultural norms. We provide some suggestive evidence of slowly changing patrilocality norms.

This paper investigates the consequences of sex imbalance in India’s population for violence against women. We match administrative crime data by category to age-specific sex ratios in census data by district across four decades and, to analyse mechanisms, we also use census data on marriage rates and household survey data on attitudes to violence against women and marriage quality measures. We find that a surplus of men at age 20-24 increases crimes committed against women, and that this explains about 21% of the rise in gender-based violence. Although less robust, there is some evidence that the youth sex ratio also raises non-gendered forms of violence, but we find no discernible impact upon property and economic crime. In probing mechanisms, we show that marriage rates, marriage quality, and attitudes to violence against women are all modified by population sex ratios.

This paper investigates whether the religious identity of state legislators in India influences development outcomes, both for citizens of their religious group and for the population as a whole. To allow for politician identity to be correlated with constituency level voter preferences or characteristics that make religion salient, we use quasi-random variation in legislator identity generated by close elections between Muslim and non-Muslim candidates. We find that increasing the political representation of Muslims improves health and education outcomes in the district from which the legislator is elected. We find no evidence of religious favoritism: Muslim children do not benefit more from Muslim political representation than children from other religious groups.

This data collection provides comprehensive data on all Hindu-Muslim riots reported in the major Indian newspaper of record (THE TIMES of India, Bombay edition), from January 1950 through December 1995. The dataset includes information on location (town, village, state, district, country), casualties, duration, reported causes, official involvement, policing arrangements, and other characteristics.

The socioeconomic status of Indian Muslims is, on average, considerably lower than that of upper-caste Hindus. Muslims nevertheless exhibit substantially higher child survival rates, and have done for decades. This paper analyses this seeming puzzle. A decomposition of the survival differential confirms that some compositional effects favour Muslims but that, overall, differences in characteristics and especially the Muslim deficit in parental education predict a Muslim disadvantage. The results of this study contribute to a recent literature that debates the importance of socioeconomic status (SES) in determining health and survival. They augment a growing literature on the role of religion or culture as encapsulating important unobservable behaviours or endowments that influence health, indeed, enough to reverse the SES gradient that is commonly observed.

Muslim children in India face substantially lower mortality risks than Hindu children. This is surprising because one would have expected just the opposite: Muslims have, on average, lower socio-economic status, higher fertility, shorter birth-spacing, and are a minority group in India that may be expected to live in areas that have relatively poor public provision. Although higher fertility amongst Muslims as compared with Hindus has excited considerable political and academic attention in India, higher mortality amongst Hindus has gone largely unnoticed. This paper considers this seeming puzzle in depth.

This chapter describes and analyses differences in primary educational enrolment by gender for 6-14 year old Indian children across three social groups, namely, upper and lower caste Hindus, and Muslims. It also studies the evolution of community and gender differences across the 1990s. This was a decade of unprecedented economic growth in India and overall enrolment rates rose rapidly but there is as yet limited evidence of how social inequalities evolved. We find initial community enrolment gaps of the order of 15-20 percentage points and within-community gender gaps of a similar magnitude. Every group progresses during the period considered and the initially disadvantaged groups progress a bit faster, with girls from low caste and Muslim households exhibiting the greatest progress. Nevertheless community and gender gaps of the order of 10 percentage points remain at the end of the decade. We decompose enrolment differences between communities in each year so as to gain an estimate of the contribution of observed characteristics. The striking result is that, while 70-80% of the enrolment gap between high and low caste Hindus is explained by the weaker socio-economic characteristics of the low caste group, characteristics can explain only about 35% of the enrolment differential between high caste Hindus and Muslims. This suggests that Muslims either have a lower “taste” for education or have been “discriminated” against in this sphere. We draw upon our research on health differentials between communities to argue that the evidence points more towards tastes, while recognising that tastes may evolve in response to institutions and past outcomes so that a role for discrimination cannot be ruled out. We observe that the contribution of observed characteristics to enrolment differentials has declined over time in both comparisons

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We exploit the introduction of sulfa drugs in 1937 to identify the causal impact of exposure to pneumonia in infancy on later life well-being and productivity in the United States. Using census data from 1980-2000, we find that cohorts born after the introduction of sulfa experienced increases in schooling, income, and the probability of employment, and reductions in disability rates. These improvements were larger for those born in states with higher pre-intervention levels of pneumonia as these were the areas that benefited most from the availability of sulfa drugs. These estimates are, in general, larger and more robust to specification for men than for women. With the exception of cognitive disability and poverty for men, the estimates for African Americans are smaller and less precisely estimated than those for whites. This is despite our finding that African Americans experienced larger absolute reductions in pneumonia mortality after the arrival of sulfa. We suggest that pre-Civil Rights barriers may have inhibited their translating improved endowments into gains in education and employment.

We estimate impacts of male job loss, female job loss, and male unemployment benefits on domestic violence in Brazil. We merge employer-employee and social welfare registers with administrative data on domestic violence cases brought to criminal courts, use of public shelters by victims and mandatory notifications of domestic violence by health providers. Leveraging mass layoffs for identification, we find that both male and female job loss, independently, lead to large and pervasive increases in domestic violence. Exploiting a discontinuity in unemployment insurance eligibility, we find that eligible men are not less likely to commit domestic violence while benefits are being paid, and more likely to commit it once benefits expire. Our findings are consistent with job loss increasing domestic violence on account of a negative income shock and an increase in exposure of victims to perpetrators, with unemployment benefits partially offsetting the income shock while reinforcing the exposure shock.

We investigate the importance of subjective expectations of returns to and effort costs of the two main investments that mothers make in newborns: breastfeeding and stimulation. We find heterogeneity across mothers in expected effort costs and expected returns for outcomes in the cognitive, socio-emotional and health domains, and we show that this contributes to explaining heterogeneity in investments. We find no significant heterogeneity in preferences for child developmental outcomes. We simulate the impact of various policies on investments. Our findings highlight the relevance of interventions designed to reduce perinatal fatigue alongside interventions that increase perceived returns to investments.

We leverage staggered implementation of lockdown across Chile's 346 municipalities, identifying dynamic impacts on domestic violence (DV). Using administrative data, we find lockdown imposition increases indicators of DV-related distress, while decreasing DV reports to the police. We identify male job loss as a mechanism driving distress, and female job loss as driving decreased reporting. Stimulus payments to poor households act on both margins, their impacts partially differentiated by lockdown status. Once lockdown is lifted, police reports surge but we see a ratchet effect in distress. Our findings accentuate the controversy around welfare impacts of lockdown mandates.

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Millions of women continue to die during and soon after childbirth, even where the knowledge and resources to avoid this are available. We posit that raising the share of women in parliament can trigger action. Leveraging the timing of gender quota legislation across developing countries, we identify sharp sustained reductions of 8–10 percent in maternal mortality. Investigating mechanisms, we find that gender quotas lead to increases in percentage points of 5–8 in skilled birth attendance and 4–8 in prenatal care utilization, alongside a decline in fertility of 6–7 percent and an increase in the schooling of young women of about 0.5 years. The results are robust to numerous robustness checks. They suggest a new policy tool for tackling maternal mortality.

The chapter explores the literature on how women’s participation in politics affects policy making, in terms of redistribution, public health intervention, schooling, and policies outcomes of those directed at improving mothers and children health. Identification issues are then discussed, and designs based on the introduction of quotas, close elections in mixed-gender contexts, and textual analysis. The chapter moves on to the supply and demand side (discrimination) factors creating barriers to entering into politics. It concludes stressing the importance of gender-specific policy preferences (more redistribution and more spending for children and maternal health) in contexts where politicians’ selection matters.

We analyze long-term impacts of the 1967–1970 Nigerian Civil War, providing the first evidence of intergenerational impacts. War exposure among women results in reduced adult stature, an increased likelihood of being overweight, earlier age at first birth, and lower educational attainment. War exposure of mothers has adverse impacts on next-generation child survival, growth, and education. Impacts vary with age of exposure. For the mother and child health outcomes, the largest impacts stem from adolescent exposure. Exposure to a primary education program mitigates impacts of war exposure. War exposure leads to men marrying later and having fewer children.

ABSTRACT

This paper discusses research on the relationship between fertility and women’s labour force participation. It surveys methods used to obtain causal identification, and provides an overview of the evidence of causal effects in both directions. We highlight a few themes that we regard as important in guiding research and in reading the evidence. These include the importance of distinguishing between extensive and intensive margin changes in both variables; consideration not only of women’s participation but also of occupational and sectoral choice and of relative earnings; the relevance of studying dynamic effects and of analysing changes across the lifecycle and across successive cohorts; and of recognizing that women’s choices over both fertility and labour force participation are subject to multiple constraints. We observe that, while technological innovations in reproductive health technologies have muted the familycareer tradeoff primarily by allowing women to time their fertility, policy has not achieved as much as it might.

IVF allows women to delay birth and pursue careers, but IVF massively increases the risk of twin birth. There is limited evidence of how having twins influences women’s post-birth careers. We investigate this, leveraging a single embryo transfer (SET) mandate implemented in Sweden in 2003, following which the share of twin births showed a precipitous drop of 70%. Linking birth registers to hospitalization and earnings registers, we identify substantial improvements in maternal and child health and women’s earnings following IVF birth, alongside an increase in subsequent fertility. We provide the first comprehensive evaluation of SET, relevant given the secular rise in IVF births and growing concerns over twin birth risk. We contribute new estimates of the child penalty imposed by twin as opposed to singleton birth, relevant to the secular rise in the global twin birth rate.

Disruptions in the hypothalamic-pituitary-adrenal (HPA) axis are thought to be key neuroendocrine mechanisms involved in psychopathology and may have intergenerational impacts. Hair-derived HPA hormones offer a measure of long-term HPA axis activity that may be useful in assessing maternal and infant health. Building on a community-based randomized control trial of a perinatal depression intervention in Pakistan, we examine intervention effects on HPA axis activity in a subsample of mothers and infants.

ABSTRACT

We identify earnings impacts of exposure to an infant health intervention in Sweden, using individual-linked administrative data to trace potential mechanisms. Leveraging quasi-random variation in eligibility, we estimate that exposure was associated with higher test scores in primary school for boys and girls. However, only girls were more likely to score in the top quintile. Subsequent gains, in secondary schooling, employment, and earnings, are restricted to girls. We show that the differential gains for women accrued from both skills and opportunities.

The occurrence of twin births has been widely used as a natural experiment. With a focus upon the use of twin births for identification of causal effects in economics, this chapter provides a critical review of methods and results.

In this article we undertake a legal and policy analysis of Brazil’s Family Health Program which confirms that the right to health extended beyond Brazil’s constitution, and into the laws, policies, and documents associated with that program in 1996–2004. We then use Big Data to show that the right to health contributed to the large and sustained health gains, including in maternal and infant mortality, especially among less educated women. For example, the data shows progressive realization, enhanced access in poor and underserved areas, and reduced health inequalities, all of which are features of the right to health.

Abstract Access to prenatal sex-detection technology in India has led to a phenomenal increase in abortion of girls. We find that it has also narrowed the gender gap in under-five mortality, consistent with surviving girls being more wanted than aborted girls. For every three aborted girls, one additional girl survived to age five. Mechanisms include moderation of son-biased fertility stopping and narrowing of gender gaps in parental investments. However, surviving girls are more likely to be born in lower-status families. Our findings have implications not only for counts of missing girls but also for the later life outcomes of girls.

The Global Gag Rule is a policy that has been historically toggled between enactment and revocation based on the political party of the U.S. President. It restricts U.S. aid to international non-governmental organizations that provide or even discuss abortion-related services. Since its inception by President Reagan in 1984, Republican presidents have consistently enforced it, while Democratic presidents have repealed it. The policy saw further restrictions under President Trump and was then rescinded by President Biden. Analyzing data spanning from 1985 to 2019, it's evident that family planning aid from the U.S. has been 48% higher during Democratic administrations. The study finds that when there is a political shift from a Democratic to a Republican presidency, a country that highly depends on U.S. aid for family planning experiences an increase in maternal mortality—0.6 additional deaths per 1,000 women, or an 8% rise. This uptick essentially negates one-fifth of the global reduction in maternal deaths since 1990.

Debates around abortion typically invoke religion and politics but there is no causal evidence of the impact of politician religion on abortion. Leveraging quasi-random variation in politician religion generated by close elections in India and controlling for the party affiliation of politicians, we find lower rates of sex-selective abortion in districts won by Muslim state legislators, consistent with a higher reported aversion to abortion among Muslims compared to Hindus. The competing hypothesis that this reflects weaker son preference among Muslims is undermined by stated preference data and by demonstrating that fertility and girl-biased infant mortality inc

Historically, improvements in municipal water quality led to substantial mortality decline in today’s wealthy countries. However, water disinfection has not consistently produced large benefits in lower-income countries. We study this issue by analyzing a large-scale municipal water disinfection program in Mexico that increased water chlorination coverage in urban areas from 58 percent to over 90 percent within 18 months. We estimate that the program reduced childhood diarrheal disease mortality rates by 45 to 67 percent. However, inadequate sanitation infrastructure and age (degradation) of water pipes may have attenuated these benefits substantially. (JEL I12, I18, L95, O13, O18, Q25, Q53)

Background: Depression in the perinatal period, during pregnancy or within 1 year of childbirth, imposes a high burden on women with rippling effects through her and her child's life course. Social support may be an important protective factor, but the complex bidirectional relationship with depression, alongside a paucity of longitudinal explorations, leaves much unknown about critical windows of social support exposure across the perinatal period and causal impacts on future depressive episodes. Methods: This study leverages marginal structural models to evaluate associations between longitudinal patterns of perinatal social support and subsequent maternal depression at 6 and 12 months postpartum. In a cohort of women in rural Pakistan (n=780), recruited in the third trimester of pregnancy and followed up at 3, 6 and 12 months postpartum, we assessed social support using two well-validated measures: the Multidimensional Scale of Perceived Social Support (MSPSS) and the Maternal Social Support Index (MSSI). Major depressive disorder was assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Results: High and sustained scores on the MSPSS through the perinatal period were associated with a decreased risk of depression at 12 months postpartum (0.35, 95% CI: 0.19 to 0.63). Evidence suggests the recency of support also matters, but estimates are imprecise. We did not find evidence of a protective effect for support based on the MSSI. Conclusions: This study highlights the protective effect of sustained social support, particularly emotional support, on perinatal depression. Interventions targeting, leveraging and maintaining this type of support may be particularly important for reducing postpartum depression.

We estimate the health costs of supply-side barriers to accessing medical care. The setting is Colombia, where citizens have a constitutional right to health care, but insurance companies that manage delivery impose restrictions on access. We use administrative data on judicial claims for health as a proxy for unmet demand. We validate this using the register recording all health service utilization, estimating that a one standard deviation increase in judicial claims is associated with pervasive decreases in utilization rates of between 0.25 and 0.71 standard deviations, including in medical consultations, procedures, hospitalizations and emergency care. These restrictions on access manifest in population health outcomes. We estimate that a one standard deviation increase in judicial claims increases the all-cause mortality rate by between 0.10 and 0.23 standard deviations. Increases in mortality are pervasive across causes, with the largest increase in deaths from certain cancers. They are also pervasive across the age and sex distribution but larger among individuals over the age of fifty and (weakly) among women and the low-income population.

This study examines the association of unemployment variation with intimate partner violence using representative data from thirty-one developing countries, from 2005 to 2016. It finds that a 1 percent increase in the male unemployment rate is associated with an increase in the incidence of physical violence against women by 0.50 percentage points, or 2.75 percent. This is consistent with financial and psychological stress generated by unemployment. Female unemployment rates have the opposite effect, a 1 percent decrease being associated with an increase in the probability of victimization of 0.52 percentage points, or 2.87 percent. That an improvement in women’s employment opportunities is associated with increased violence is consistent with male backlash. The study finds that this pattern of behaviors emerges entirely from countries in which women have more limited access to divorce than men.

Hospitals are under increasing pressure as they bear a growing burden of chronic disease while also dealing with emergency cases that do not all require hospital care. Many countries have responded by introducing alternative facilities that provide 24/7 care for basic and medium-complexity cases. Using administrative data, we investigate impacts of the opening of these intermediate facilities (UPA) in the state of Rio de Janeiro in Brazil. We find that an UPA opening in the catchment area of a hospital reduces hospital outpatient procedures and admissions and that this is associated with improved hospital performance, indicated by a decline in inpatient mortality. This does not appear to derive from a change in the risk profile of cases going to hospital but rather from hospital resources being re-focused. In a significant departure from related research, we identify displacement by investigating population-level outcomes. Our most striking result is that a large share of the decline in hospital mortality is offset by deaths in UPAs, though there remains a net decline in deaths from cardiovascular conditions that are typically amenable to primary care.

Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal.

Twin births are often used as an instrument to address selection of women into fertility. However, recent work shows selection of women into twin birth such that, while OLS estimates tend to be downward biased, twin-IV estimates will tend to be upward biased. This is pertinent given the emerging consensus that fertility has limited impacts on women’s labour supply, or on investments in children. Using data for developing countries and the United States to estimate the trade-off between fertility and children’s human capital, we demonstrate the nature and size of the bias in the twin-IV estimator and estimate bounds on the true parameter. (JEL: J12, J13, C13, D13, I12)

We investigate whether legislation of equal inheritance rights for women modifies the historic preference for sons in India, and find that it exacerbates it. Children born after the reform in families with a firstborn daughter are 3.8–4.3 percentage points less likely to be girls, indicating that the reform encouraged female foeticide. We also find that the reform increased excess female infant mortality and son-biased fertility stopping. This suggests that the inheritance reform raised the costs of having daughters, consistent with which we document an increase in stated son preference in fertility post reform. We conclude that this is a case where legal reform was frustrated by persistence of cultural norms. We provide some suggestive evidence of slowly changing patrilocality norms.

We provide evidence that dowry costs motivate son-preferring behaviors in India. Since gold is an integral part of dowry, we study parental responses to shocks in the world gold price. Exploiting monthly variation in gold prices across 35 years we find that monthly changes in gold prices lead to an increase in girl relative to boy neonatal mortality and that surviving girls are shorter. After the introduction of prenatal sex determination technology, we find that gold price shocks during pregnancy increase female foeticide.

We evaluate the medium-term impacts of treating maternal depression on women’s mental health, financial empowerment, and parenting decisions. We leverage variation induced by a cluster-randomized controlled trial that provided psychotherapy to 903 prenatally depressed mothers in rural Pakistan. It was one of the world’s largest psychotherapy interventions, and it dramatically reduced postpartum depression. Seven years after psychotherapy concluded, we returned to the study site to find that impacts on women’s mental health had persisted, with a 17 percent reduction in depression rates. The intervention also improved women’s financial empowerment and increased both time- and money-intensive parental investments by between 0.2 and 0.3 standard deviations. (JEL G51, I12, J16, O15)

Traditional postpartum practices are intended to provide care to mothers, but there is mixed evidence concerning their impact on postpartum depression (PPD). It remains unknown if there is a unique impact of postpartum practices on PPD separately from other types of social support, or if practices differentially affect those with existing prenatal depression. In Pakistan, chilla (چله) is a traditional postpartum practice in which women receive relief from household work, additional familial support, and supplemental food for up to 40 days postpartum. This study aims to understand if chilla protects against PPD independent of other support and whether this relationship varies by prenatal depression status. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6964000/

We investigate universalization of access to health in Brazil. We find large reductions in maternal, foetal, neonatal and post-neonatal mortality, a reduction in fertility and, possibly on account of selection, no change in the quality of births. Using rich administrative data, we investigate changes in organization, access and outcomes, thereby illuminating the driving mechanisms. We find sharp increases in coverage of primary health facilities with GPs and outreach workers and, in line with this, increases in outpatient procedures, prenatal care visits, health-education activities and home visits by medical professionals. Consistent with an attempt to rationalize use of hospital resources, we find a decline in specialists and hospital beds per capita. Despite this, we see increases in hospital births, C-sections, and maternal hospitalization for complications, with no change in rates of infant hospitalization.

Twin births are often construed as a natural experiment in the social and natural sciences on the premise that the occurrence of twins is quasi-random. We present population-level evidence that challenges this premise. Using individual data for 17 million births in 72 countries, we demonstrate that indicators of mother's health, health-related behaviors, and the prenatal environment are systematically positively associated with twin birth. The associations are sizable, evident in richer and poorer countries—evident even among women who do not use in vitro fertilization—and hold for numerous different measures of health. We discuss potential mechanisms, showing evidence that favors selective miscarriage.

Function is an important marker of health throughout the life course, however, in low-and-middle-income-countries, little is known about the burden of functional impairment as women transition from pregnancy to the first year post-partum. Leveraging longitudinal data from 960 women participating in the Share Child Cohort in Pakistan, this study sought to (1) characterize functional trajectories over time among women in their perinatal period and (2) assess predictors of chronic poor functioning following childbirth. We used a group-based trajectory modeling approach to examine maternal patterns of function from the third trimester of pregnancy through 12 months post-partum. Three trajectory groups were found: persistently well-functioning (51% of women), poor functioning with recovery (39% of women), and chronically poor functioning (10% of women). When compared to mothers in the highest functioning group, psychosocial characteristics (e.g., depression, stress, and serious life events) were significantly associated with sustained poor functioning one-year following child-birth. Mothers living in nuclear households were more likely to experience chronic poor functioning. Higher education independently predicted maternal function recovery, even when controlling for psychosocial characteristics. Education, above and beyond socio-economic assets, appears to play an important protective role in maternal functional trajectories following childbirth. Public health implications related to maternal function and perinatal mental health are discussed.

We examine intra-household gender-differentiated effects of property rights securitisation following West Bengal’s tenancy registration program, using two independently gathered datasets. In both samples, higher program implementation increased male child survival rates in families without a firstborn son, but not in those that already have a firstborn male child. We argue this reflects intensified son preference as land rights improve, ostensibly to ensure a male heir to inherit land. Consistent with this, girls with firstborn brothers also experience increased survival, but not girls with firstborn sisters. The gender bias manifests both in infant mortality rates and the sex ratio at birth.

Although understanding the role of health in driving labor market outcomes is a matter of great importance, it has proven difficult to isolate this effect due to empirical challenges and a lack of compelling sources of identification. We obtain causal estimates of the effect of health on income and welfare dependency through two different channels: a negative health shock (dengue outbreak) and a positive health shock (opening of a health-care facility). To do this, we rely on instrumental variables and difference-in-difference methods, as well as on novel datasets. We find that dengue outbreaks lower the average working hours and income. This effect is particularly high for low-income individuals, but conditional cash transfer programs can insulate them from this shock. On the other hand, the opening of a new health-care facility in a families catchment area rises family per capita income and employment. All together, this evidence suggest that health shocks are an important part of income, poverty and welfare dependency

The contribution of fathers to child development and maternal mental health is increasingly acknowledged, although research on this topic outside of high income countries is limited. Using longitudinal data, we characterized father involvement in a rural setting in Pakistan and investigated the link between father involvement in the first year of life and child development and maternal depression. Data come from the Bachpan study, a birth cohort established in the context of a perinatal depression intervention. Father involvement was mother reported at 3 and 12 months postpartum and covered domains such as playing with or soothing the infant. Child outcomes included growth at 3, 6 and 12 months postpartum, socioemotional development at 6 months (Ages and Stages Questionnaire-socioemotional), and developmental milestones at 12 months (Bayley Scales of Infant and Toddler Development, BSID)). Maternal depression was assessed at 3, 6, and 12 months postpartum. Roughly 20% of the fathers were temporarily non-resident. Among the rest, most mothers reported that fathers were involved: for example, approximately 40% reported that the father plays with the baby on a typical day. We observed no clear pattern of association between 3-month father involvement and child growth at any time point; however, 12-month father involvement was cross-sectionally inversely associated with child growth. We observed a protective pattern of association between 3-month father involvement and 6-month child socioemotional development. For the BSID domains, while almost all effect estimates suggested a protective association with higher levels of father involvement/father being temporarily non-resident, the magnitude of the estimates was smaller and most 95% confidence intervals crossed the null. Finally, there was a trend toward greater father involvement/being temporary non-resident predicting lower levels of maternal depression. Using longitudinal data, these results provide new evidence about the association between father involvement, and both child development and maternal mental health.

This paper investigates the consequences of sex imbalance in India’s population for violence against women. We match administrative crime data by category to age-specific sex ratios in census data by district across four decades and, to analyse mechanisms, we also use census data on marriage rates and household survey data on attitudes to violence against women and marriage quality measures. We find that a surplus of men at age 20-24 increases crimes committed against women, and that this explains about 21% of the rise in gender-based violence. Although less robust, there is some evidence that the youth sex ratio also raises non-gendered forms of violence, but we find no discernible impact upon property and economic crime. In probing mechanisms, we show that marriage rates, marriage quality, and attitudes to violence against women are all modified by population sex ratios.

There is growing interest in the relationship between socioeconomic status (SES), poverty, and mental health in low and middle-income countries (LMIC). However, it is not clear whether a gradient approach focused on a wider SES distribution or a binary poverty approach is more salient for mental health in LMIC. Yet this distinction has implications for interventions aimed at improving population health. We contribute to the literature by examining how multiple indicators of socioeconomic status, including gradient SES and binary poverty indicators, contribute to prenatal depression symptoms in a LMIC context. Prenatal depression is an important public health concern with negative sequela for the mother and her children. We use data on assets, education, food insecurity, debt, and depression symptoms from a sample of 1154 pregnant women residing in rural Pakistan. Women who screened positive for depression participated in a cluster randomized controlled trial of a perinatal depression intervention; all women were interviewed October 2015-February 2016, prior to the start of the intervention. Cluster-specific sampling weights were used to approximate a random sample of pregnant women in the area. Findings indicate that fewer assets, experiencing food insecurity, and having household debt are independently associated with worse depression symptoms. The association with assets is linear with no evidence of a threshold effect, supporting the idea of a gradient in the association between levels of SES and depression symptoms. A gradient was also initially observed with woman’s educational attainment, but this association was attenuated once other SES variables were included in the model. Together, the asset, food insecurity, and debt indicators explain 14% of the variance in depression symptoms, more than has been reported in high income country studies. These findings support the use of multiple SES indicators to better elucidate the complex relationship between socioeconomic status and mental health in LMIC. •We compare the association between poverty, gradient measures of SES, and depression.•Above the poverty level, SES predict depression in a low income country.•Relying on simple, dichotomous, poverty measures in studies of mental health is not recommended.

This paper investigates the potential of an infant intervention to improve life expectancy, contributing to emerging interest in the early life origins of chronic disease. We track individuals from birth to death, and are able to identify age and cause of death. The intervention was pioneered in Sweden in 1931–1933, and appears to have been pivotal in the emergence of universal infant care programmes in the Scandinavian countries during the creation of the Welfare State. It provided information and support to mothers, with an emphasis on nutrition and sanitation, while monitoring infant care through home visits and clinics. We estimate that the average duration of programme exposure in infancy led to a 1.56% point decline in the risk of infant death (24% of baseline risk) and a 2.56% point decline in the risk of dying by age 75 (7.0% of baseline risk), and these impacts are much larger for children born out of wedlock. Intervention-led declines in the risk of dying after the age of 50 are dominated by reductions in cancer and cardiovascular mortality. We find no evidence of selective utilisation, and the estimates are similar when we exploit within-mother variation in outcomes.

Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition". The Lancet. Asserts that early-life health and nutritional interventions, including those that act to improve the health and nutritional status of potential mothers and pregnant women and those that directly treat children in early life, have significant impacts on schooling, earnings, and productivity over the lifecycle in low- and middle-income countries (LMICs). Estimates of benefit-cost ratios for such interventions, obtained under a range of plausible parameters, consistently exceed one, suggesting that the present discounted value of gains exceeds costs. These results motivate the case for placing early-life health and nutrition high on the policy agenda. Causal estimates of impacts of early-life nutritional interventions mostly stem from small-scale local interventions, however, and will likely prove sensitive to (1) population heterogeneity (social, economic, and cultural differences); (2) differences in program implementation (administrative capacity and trust); and (3) differences in the wider political economy of reform. Benefits may not scale up, however, and the benefit-cost ratio for nationwide implementation may prove lower.

We address the significant gaps in knowledge of prevalence and correlates of child mental health (CMH) problems outside of high income countries. We describe the prevalence of CMH problems and their correlates with a focus on the association with maternal depression in a sample of seven-year-old children in rural Pakistan.

Perinatal depression has been linked with deleterious child development outcomes, yet maternal depression interventions have not been shown to have lasting effects on child development, and evidence is not available from countries of low or middle income. In the Thinking Healthy Programme cluster-randomised controlled trial, a perinatal depression intervention was assessed in Pakistan in 2006–07. The intervention significantly reduced depression levels 12 months post partum compared with a control. We aimed to assess the effect of this same intervention on the cognitive, socioemotional, and physical development of children at around age 7 years.

This paper investigates whether the religious identity of state legislators in India influences development outcomes, both for citizens of their religious group and for the population as a whole. To allow for politician identity to be correlated with constituency level voter preferences or characteristics that make religion salient, we use quasi-random variation in legislator identity generated by close elections between Muslim and non-Muslim candidates. We find that increasing the political representation of Muslims improves health and education outcomes in the district from which the legislator is elected. We find no evidence of religious favoritism: Muslim children do not benefit more from Muslim political representation than children from other religious groups.

Interventions that improve childhood health directly improve the quality of life and, in addition, have multiplier effects, producing sustained population and economic gains in poor countries. We suggest how contemporary global institutions shaping the development, pricing and distribution of vaccines and drugs may be modified to deliver large improvements in health. To support a justice argument for such modification, we show how the current global economic order may contribute to perpetuating poverty and poor health in less-developed countries.

We investigate whether women's political representation in state legislatures improves public provision of antenatal and childhood health services in the districts from which they are elected, arguing that the costs of poor services in this domain fall disproportionately upon women. Using large representative data samples from India and accounting for potential endogeneity of politician gender and the sample composition of births, we find that a 10 percentage point increase in women's representation results in a 2.1 percentage point reduction in neonatal mortality, and we elucidate mechanisms. Women's political representation may be an underutilized tool for addressing health in developing countries. (JEL D72, I12, I15, J16, O15, O17)

We exploit exogenous variation in the risk of waterborne disease created by implementation of a major water reform in Mexico in 1991 to investigate impacts of infant exposure on indicators of cognitive development and academic achievement in late childhood. We estimate that a one standard deviation reduction in childhood diarrhea mortality rates results in about a 0.1 standard deviation increase in test scores, but only for girls. We show that a reason for the gender differentiated impacts is that the water reform induces parents to make complementary investments in education that favor girls, consistent with their comparative advantage in skilled occupations. The results provide novel evidence of the potential for clean water provision to narrow test score gaps across countries and, within countries, across gender.

This paper investigates the sensitivity of the intergenerational transmission of health to changes in the socioeconomic and public health environment into which children are born using individual survey data on 2.24 million children born to 600,000 mothers during the period 1970 to 2000 in 38 developing countries merged by country and cohort with macroeconomic data. We find that children are more likely to bear the penalty exerted by poor maternal health if they are conceived or born in adverse socioeconomic conditions. Equivalently, shocks to the child's birth environment are more damaging of children born to women with weaker health at birth. [PUBLICATION ABSTRACT]

The Nigerian civil war of 1967-70 was precipitated by secession of the Igbo-dominated south-eastern region to create the state of Biafra. It was the first civil war in Africa, the predecessor of many. We investigate the legacies of this war four decades later. Using variation across ethnicity and cohort, we identify significant long-run impacts on human health capital. Individuals exposed to the war at all ages between birth and adolescence exhibit reduced adult stature and these impacts are largest in adolescence. Adult stature is portentous of reduced life expectancy and lower earnings.

A recent literature highlights the uncertainty concerning whether economic growth has any causal protective effect on health and survival. But equal rates of growth often deliver unequal rates of poverty reduction and absolute deprivation is more clearly relevant. Using state-level panel data for India, we contribute the first estimates of the impact of changes in poverty on infant survival. We identify a significant within-state relationship which persists conditional upon state income, indicating the size of survival gains from redistribution in favour of households below the poverty line. The poverty elasticity declines over time after 1981. It is invariant to controlling for income inequality but diminished upon controlling for education, fertility and state health expenditure, and eliminated once we introduce controls for omitted trends. [PUBLICATION ABSTRACT] Tdiv>

This paper is motivated to investigate the often neglected payoff to investments in the health of girls and women in terms of next generation outcomes. This paper investigates the intergenerational persistence of health across time and region as well as across the distribution of maternal health. It uses comparable microdata on as many as 2.24 million children born of about 0.6 million mothers in 38 developing countries in the 31 year period, 1970–2000. Mother's health is indicated by her height, BMI and anemia status. Child health is indicated by mortality risk and anthropometric failure. We find a positive relationship between maternal and child health across indicators and highlight non-linearities in these relationships. The results suggest that both contemporary and childhood health of the mother matter and that the benefits to the next generation are likely to be persistent. Averaging across the sample, persistence shows a considerable decline over time. Disaggregation shows that the decline is only significant in Latin America. Persistence has remained largely constant in Asia and has risen in Africa. The paper provides the first cross-country estimates of the intergenerational persistence in health and the first estimates of trends.

The socioeconomic status of Indian Muslims is, on average, considerably lower than that of upper-caste Hindus. Muslims nevertheless exhibit substantially higher child survival rates, and have done for decades. This paper analyses this seeming puzzle. A decomposition of the survival differential confirms that some compositional effects favour Muslims but that, overall, differences in characteristics and especially the Muslim deficit in parental education predict a Muslim disadvantage. The results of this study contribute to a recent literature that debates the importance of socioeconomic status (SES) in determining health and survival. They augment a growing literature on the role of religion or culture as encapsulating important unobservable behaviours or endowments that influence health, indeed, enough to reverse the SES gradient that is commonly observed.

This paper investigates the impact of aggregate income shocks on infant mortality in India and investigates likely mechanisms. A recent OECD-dominated literature reports the provocative finding that mortality at most ages is pro-cyclical. Similar analyses for poorer countries are scarce, and both income risk and mortality risk are greater in poor countries. This paper uses data and methods designed to avoid some of the specification problems in previous studies and it explores mechanisms and extensions that have not been previously considered. It uses individual data on infant mortality for about 150,000 children born in 1970-1997, merged by cohort and state of birth with a state panel containing information on aggregate income. Identification rests upon comparing the effects of annual deviations in income from trend on the mortality risks of children born at different times to the same mother, conditional upon a number of state-time varying covariates including rainshocks and state social expenditure. Rural infant mortality is counter-cyclical, the elasticity being about -0.33.

This paper highlights an aspect of the enormous and little-exploited potential of the Demographic and Health Surveys, namely the use of data on siblings. Such data can be used to control for family-level unobserved heterogeneity that might confound the relationship of interest and to study correlations in sibling outcomes. These uses are illustrated with examples. The paper ends with a discussion of potential problems associated with the sibling data being derived from retrospective fertility histories of mothers.

This paper reports an analysis of micro-data for India that shows a high correlation in infant mortality among siblings. In 13 of 15 states, we identify a causal effect of infant death on the risk of infant death of the subsequent sibling (a scarring effect), after controlling for mother-level heterogeneity. The scarring effects are large, the only other covariate with a similarly large effect being mother's (secondary or higher) education. The two states in which evidence of scarring is weak are Punjab, the richest, and Kerala, the socially most progressive. The size of the scarring effect depends upon the sex of the previous child in three states, in a direction consistent with son-preference. Evidence of scarring implies that policies targeted at reducing infant mortality will have social multiplier effects by helping avoid the death of subsequent siblings. Comparison of other covariate effects across the states offers some interesting new insights.

A set of time-bound targets for human development were agreed by 189 countries at the Millennium Summit held in New York in September 2000, and these are referred to as the Millennium Development Goals (henceforth MDGs). They represent an unprecedented commitment on the part of both rich and poor countries. One of the eight targets is to reduce under-5 mortality by two-thirds by the year 2015, relative to its level in 1990. This requires an annual rate of decline of about 4.3 per cent per annum.

Using microdata on 30,000 childbirths in India and dynamic panel data models, we analyse causal effects of birth-spacing on subsequent neonatal mortality and of mortality on subsequent birth intervals, controlling for unobserved heterogeneity. Right censoring is accounted for by jointly estimating a fertility equation, identified by using data on sterilization. We find evidence of frailty, fecundity, and causal effects in both directions. Birth intervals explain only a limited share of the correlation between neonatal mortality of successive children in a family. We predict that for every neonatal death, 0.37 additional children are born, of whom 0.30 survive.

There are severe inequalities in health in the world, poor health being concentrated amongst poor people in poor countries. Poor countries spend a much smaller share of national income on health expenditure than do richer countries. What potential lies in political or growth processes that raise this share? This depends upon how effective government health spending in developing countries is. Existing research presents little evidence of an impact on childhood mortality. Using specifications similar to those in the existing literature, this paper finds a similar result for India, which is that state health spending saves no lives. However, upon allowing lagged effects, controlling in a flexible way for trended unobservables and restricting the sample to rural households, a significant effect of health expenditure on infant mortality emerges, the long run elasticity being about −0.24. There are striking differences in the impact by social group. Slicing the data by gender, birth order, religion, maternal and paternal education and maternal age at birth, I find the weakest effects in the most vulnerable groups (with the exception of a large effect for scheduled tribes). Copyright © 2007 John Wiley & Sons, Ltd.

Data from a range of environments indicate that the incidence of death is not randomly distributed across families but, rather, that there is a clustering of death among siblings. A natural explanation of this would be that there are (observed or unobserved) differences across families, e.g. in genetic frailty, education or living standards. Another hypothesis that is of considerable interest for both theory and policy is that there is a causal process whereby the death of a child influences the risk of death of the succeeding child in the family. Drawing language from the literature on the economics of unemployment, the causal effect is referred to here as state dependence (or scarring). The paper investigates the extent of state dependence in India. distinguishing this from family level risk factors that are common to siblings. It offers some methodological innovations on previous research. Estimates are obtained for each of three Indian states, which exhibit dramatic differences in socio-economic and demographic variables. The results suggest a significant degree of state dependence in each of the three regions. Eliminating scarring, it is estimated, would reduce the incidence of infant mortality (among children who are born after the first child) by 9.8% in the state of Uttar Pradesh, 6.0% in West Bengal and 5.9% in Kerala.

A majority of individuals in poor countries have volatile incomes and are often unable to maintain adequate levels of consumption. There has nevertheless been limited interest in academic and government circles in state-guided provision of social security in these countries. Historians and historical demographers have created an exciting literature on the manner in which the poor laws operated and, independently, on changes in fertility and mortality rates in pre-industrial England. However, the two have not been brought together, partly because of data constraints. This paper argues that there is a research agenda there with considerable unexploited potential.

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