Replacing iron-folic acid with multiple micronutrient supplements among pregnant women in Bangladesh and Burkina Faso: costs, impacts, and cost-effectiveness.

Consumption of multiple micronutrient supplements (MMS) during pregnancy offers additional benefits compared with iron-folic acid (IFA) supplementation, but the tablets are more expensive. We estimated the effects, costs, and cost-effectiveness of hypothetically replacing IFA supplements with MMS for 1 year in Bangladesh and Burkina Faso. Using baseline demographic characteristics from LiST and effect sizes from a meta-analysis, we estimated the marginal effects of replacing IFA with MMS on mortality, adverse birth outcomes, and disability-adjusted life years (DALYs) averted. We calculated the marginal tablet costs of completely replacing MMS with IFA (assuming 180 tablets per covered pregnancy). Replacing IFA with MMS could avert over 15,000 deaths and 30,000 cases of preterm birth annually in Bangladesh and over 5000 deaths and 5000 cases of preterm birth in Burkina Faso, assuming 100% coverage and adherence. We estimated the cost per death averted to be US$175-185 in Bangladesh and$112-125 in Burkina Faso. Cost per DALY averted ranged from $3 to$15, depending on the country and consideration of subgroup effects. Our estimates suggest that this policy change would cost-effectively save lives and reduce life-long disabilities. Improvements in program delivery and supplement adherence would be expected to improve the cost-effectiveness of replacing IFA with MMS

Accounting for Relationships in Land and Markets: Three Essays in Development Economics

This dissertation is comprised of three essays in development economics in Burkina Faso and Uganda. The first two chapters explore implications of land rights and customary tenure systems, particularly the ramifications of rights to a single piece of land being held by multiple people. In the first essay, I look at political responses to a decentralization reform that will consolidate and redistribute land rights. In the second, I explore in what contexts multiple rightsholders create tenure insecurity, and how agricultural investment is affected. Finally, the third essay presents descriptive analysis on links between local markets and early childhood nutrition.Decentralization of Land Governance and Elections in Burkina FasoIn the first chapter, I study politicians' responses to the decentralization of land governance in Burkina Faso. To what extent are politicians motivated by private rents versus concerns about constituent welfare? I develop a theoretical model and test its implications using municipal elections data during the experimental pilot phase of a land governance decentralization reform. I find that 0.8 additional political parties contest elections in municipalities randomly slated to receive pilot-phase local land offices, although voter turnout is lower than expected and elections do not become meaningfully more competitive. After implementation and documentation of land rights, both parties and voters behave similarly to control municipality counterparts. From this pattern, and by examining heterogeneity in political responses according to different tensions emerging from customary land rights systems, I argue that politicians are not only driven by their own private rents, but also demonstrate a policy-centric focus on constituent welfare. This speaks to a trade-off inherent in decentralization: despite potential efficiency gains and increased accountability to local citizens, more localized government could be more vulnerable to elite capture, and therefore the motivations of those elites are important.Customary Tenure and Agricultural Investment in UgandaThe second chapter also stems from the fact that in customary tenure systems in Sub-Saharan Africa, multiple actors hold different rights over a given piece of land. These rightsholders interact strategically, so the distribution of rights influences the (perceived) security of tenure: anticipating another's actions can be a source of insecurity. I incorporate this strategic interaction in a model of agricultural investment to make detailed predictions about how farmers under different tenure regimes invest in short- and long-term inputs in different land value environments. I explicitly consider how rising land values, driven by sales options to outsiders, may lead local elites to assert their historic right to sell land to outsiders. The farmer, anticipating this, may actually make fewer long-term investments on customary land as land values rise, in contrast to the freehold case. I empirically test the implications of this model using survey data from four regions of Uganda. I find that long-term investments significantly diverge between freehold and customary parcels as land pressures in an area rise. Unlike many previous papers which have conceptually modeled the impacts of tenure security but then used tenure type as a (poor) proxy, I consider tenure type and the incentives it creates throughout my model, therefore linking more closely to my empirical tests. Markets and Child Nutrition in Rural Burkina FasoThe third chapter shifts focus to the relationships between local markets and early childhood nutritional status in Burkina Faso. By pairing unique data on rural village markets with biometric measurements of children served by those markets, we are able to examine whether and how consumer market access maters for well-being. We find a weak positive correlation between the sophistication of a market and the nutritional outcomes of the children it serves, with patterns generally following our conceptual pathway. We use dimension reduction techniques to characterize multiple features of markets, and find that market breadth (the variety of products available) as well as the size and dynamism of markets are most strongly related to nutritional outcomes. We conclude by presenting suggestive evidence that these documented mean effects may not hold in the left tail of nutritional outcomes, implying that targeted public health interventions are a necessary complement to market-driven growth. This third chapter begins to document the importance of rural markets for consumer welfare in Africa, and particularly for early childhood nutrition which is crucial for long-term outcomes

Accounting for Relationships in Land and Markets: Three Essays in Development Economics

This dissertation is comprised of three essays in development economics in Burkina Faso and Uganda. The first two chapters explore implications of land rights and customary tenure systems, particularly the ramifications of rights to a single piece of land being held by multiple people. In the first essay, I look at political responses to a decentralization reform that will consolidate and redistribute land rights. In the second, I explore in what contexts multiple rightsholders create tenure insecurity, and how agricultural investment is affected. Finally, the third essay presents descriptive analysis on links between local markets and early childhood nutrition.Decentralization of Land Governance and Elections in Burkina FasoIn the first chapter, I study politicians' responses to the decentralization of land governance in Burkina Faso. To what extent are politicians motivated by private rents versus concerns about constituent welfare? I develop a theoretical model and test its implications using municipal elections data during the experimental pilot phase of a land governance decentralization reform. I find that 0.8 additional political parties contest elections in municipalities randomly slated to receive pilot-phase local land offices, although voter turnout is lower than expected and elections do not become meaningfully more competitive. After implementation and documentation of land rights, both parties and voters behave similarly to control municipality counterparts. From this pattern, and by examining heterogeneity in political responses according to different tensions emerging from customary land rights systems, I argue that politicians are not only driven by their own private rents, but also demonstrate a policy-centric focus on constituent welfare. This speaks to a trade-off inherent in decentralization: despite potential efficiency gains and increased accountability to local citizens, more localized government could be more vulnerable to elite capture, and therefore the motivations of those elites are important.Customary Tenure and Agricultural Investment in UgandaThe second chapter also stems from the fact that in customary tenure systems in Sub-Saharan Africa, multiple actors hold different rights over a given piece of land. These rightsholders interact strategically, so the distribution of rights influences the (perceived) security of tenure: anticipating another's actions can be a source of insecurity. I incorporate this strategic interaction in a model of agricultural investment to make detailed predictions about how farmers under different tenure regimes invest in short- and long-term inputs in different land value environments. I explicitly consider how rising land values, driven by sales options to outsiders, may lead local elites to assert their historic right to sell land to outsiders. The farmer, anticipating this, may actually make fewer long-term investments on customary land as land values rise, in contrast to the freehold case. I empirically test the implications of this model using survey data from four regions of Uganda. I find that long-term investments significantly diverge between freehold and customary parcels as land pressures in an area rise. Unlike many previous papers which have conceptually modeled the impacts of tenure security but then used tenure type as a (poor) proxy, I consider tenure type and the incentives it creates throughout my model, therefore linking more closely to my empirical tests. Markets and Child Nutrition in Rural Burkina FasoThe third chapter shifts focus to the relationships between local markets and early childhood nutritional status in Burkina Faso. By pairing unique data on rural village markets with biometric measurements of children served by those markets, we are able to examine whether and how consumer market access maters for well-being. We find a weak positive correlation between the sophistication of a market and the nutritional outcomes of the children it serves, with patterns generally following our conceptual pathway. We use dimension reduction techniques to characterize multiple features of markets, and find that market breadth (the variety of products available) as well as the size and dynamism of markets are most strongly related to nutritional outcomes. We conclude by presenting suggestive evidence that these documented mean effects may not hold in the left tail of nutritional outcomes, implying that targeted public health interventions are a necessary complement to market-driven growth. This third chapter begins to document the importance of rural markets for consumer welfare in Africa, and particularly for early childhood nutrition which is crucial for long-term outcomes