Social networks, bargaining power within couples, and maternal health care in Tanzania

Includes bibliographical referencesThis thesis focuses on the use of maternal health services and child health in Tanzania. The main focus is on how these issues relate to social networks and bargaining power within couples. These issues are interrelated and are discussed in three essays. The first essay investigates the impact of information externalities in social networks on the use of antenatal services. Particular emphasis is placed on the extent to which the probability of early antenatal check-up and antenatal completion are affected by social networks. Adopting an econometric technique that minimises the problem of omitted variable bias, the analysis suggests that these network effects increase the probability of antenatal care completion by an additional 6 to 35 percent, and may be as high as 59 percent. The study further finds that without adequate control of omitted variables, the network impact would be understated. It is also evident that failure to control for individual and household observable characteristics overstates the impact of networks. Results from the two approaches used in this study confirm that irrespective of the definition of social network, having a high quality contacts increase the probability of utilising maternal health services. The second essay examines the effect of bargaining power within couples on the probability of delivering in a health facility (public and private), as opposed to a home birth. It further investigates the effect of bargaining on the probability of health care provider choice at childbirth using a multinomial nested logit. Evidence suggests that cooperation within couples in decision-making, female discretion over household resources, and freedom from domestic violence increases the probability of childbirth in a facility, as opposed to home. The study finds that a woman's influence on service use varies if she is better educated than her partner. In addition, while cooperation in household decision and the incidence of domestic violence significantly affect private facility use, female discretion over household resources has a strong effect on public facility choice. Finally, antenatal completion, health knowledge, and maternal specific factors increase the probability of delivering in a public and private facility. ii The third essay empirically explores the contribution of intra-household bargaining, to the rural-urban gap in child nutrition. The study analyses the effect of parental bargaining indicators (cooperation in household decisions, the incidence domestic violence and discretion over household resources) on the probability of child stunting in both rural and urban areas. The essay contributes to the literature by demonstrating empirically that differences in intra-household bargaining increase the rural-urban gap in child health. It further contributes to the literature by correcting for possible sample selection bias. The results suggest that the significant effects of household bargaining indicators on child stunting in Tanzania are mainly from the rural and not the urban population. It provides evidence that weak bargaining power within couples in rural areas account for 5 percent of the rural-urban gap in child nutrition. The contribution reduces to 4 percent after correcting for sample selection bias. The results also suggest that failure to adequately correct for selection bias leads to a substantial underestimation of the overall rural-urban gap in child nutrition by 11 percent

The effects of price and non-price policies on cigarette consumption in South Africa

The health consequences of smoking are serious and have been frequently detailed. A reduction in tobacco-related mortality hinges upon the ability to reduce tobacco usage. There is overwhelming evidence that higher cigarette prices reduce cigarettes demand, but little is known about the combined e⁄ect of price and non-price policies. This paper extends the analysis of price elasticities by estimating the e⁄ect of changes in price and non-price legislations in South Africa. Annual time-series data from 1961 to 2016 are used, with a policy index constructed to capture the instances of non-price tobacco legislation. The combined impact is estimated using a vector error correction model and a two-stage least squares (2SLS) model. The long-run own-price elasticities lie between -0.55 and -0.72, while the income elasticities lie between 0.39 and 0.49. The coefcients of the changing tobacco policies and changing market structure show that they contribute to a modest reduction in cigarette consumption. The short-run deviations from the steady state are presented using the error correction term. Cigarette demand is responsive to prices and non-pricing policies but failure to control for non-pricing policies overstates the price e⁄ect. This suggests that both prices and non-pricing legislation are e⁄ective in reducing cigarette consumption

Lifestyle and Income-related Inequality in Health in South Africa

BACKGROUND: Many low- and middle-income countries are experiencing an epidemiological transition from communicable to non-communicable diseases. This has negative consequences for their human capital development, and imposes a growing economic burden on their societies. While the prevalence of such diseases varies with socioeconomic status, the inequalities can be exacerbated by adopted lifestyles of individuals. Evidence suggests that lifestyle factors may explain the income-related inequality in self-reported health. Self-reported health is a subjective evaluation of people's general health status rather than an objective measure of lifestyle-related ill-health. METHOD: The objective of this paper is to expand the literature by examining the contribution of smoking and alcohol consumption to health inequalities, incorporating more objective measures of health, that are directly associated with these lifestyle practices. We used the National Income Dynamic Study panel data for South Africa. The corrected concentration index is used to measure inequalities in health outcomes. We use a decomposition technique to identify the contribution of smoking and alcohol use to inequalities in health. RESULTS: We find significant smoking-related and income-related inequalities in both self-reported and lifestyle-related ill-health. The results suggest that smoking and alcohol use contribute positively to income-related inequality in health. Smoking participation accounts for up to 7.35% of all measured inequality in health and 3.11% of the inequality in self-reported health. The estimates are generally higher for all measured inequality in health (up to 14.67%) when smoking duration is considered. Alcohol consumption accounts for 27.83% of all measured inequality in health and 3.63% of the inequality in self-reported health. CONCLUSION: This study provides evidence that inequalities in both self-reported and lifestyle-related ill-health are highly prevalent within smokers and the poor. These inequalities need to be explicitly addressed in future programme planning to reduce health inequalities in South Africa. We suggest that policies that can influence poor individuals to reduce tobacco consumption and harmful alcohol use will improve their health and reduce health inequalities

Peer Networks and Tobacco Consumption in South Africa

This paper deepens the empirical analysis of peer networks by considering their effects on both smoking participation and smoking intensity in South Africa, a country where majority initiate smoking at adolescent age. Peer networks are key in determining the smoking behaviour of youths, but the magnitude of the effects is still debated, questioned and inconclusive. I used a control function approach, a two‐stage least square and the fixed effect method to address the potential endogeneity of peer network. The results suggest positive and significant peer effects on smoking participation and smoking intensity. While the network effects are consistently positive and significant, the magnitude of the estimates varies across methodological approaches with the instrument variable estimates generally lower. Including older adults in the peer reference group increases the peer effect estimates. Finally, using clusters as an alternative measure of network size in wave one, I show that peer effects are independent on network size but rather on network quality. Relative to the results of this paper, previous literature has documented larger peer effects on the decision to smoke. The findings suggest that policies (excise tax) that directly affect the decision to smoke and the smoking intensity of the peer reference group are likely to affect own smoking behaviour

Estimating Income-Related Health Inequalities Associated with Tobacco and Alcohol Consumption in Namibia

Disparities in resources and access to material opportunities are important determinants of income-related health inequality. This paper hypothesises that the gradient of the inequality in health between the poor and the rich is likely to depend on differences in lifestyle practices including tobacco use and alcohol abuse. Using the 2015/16 Namibia Household Income and Expenditure Survey and the Erreygers corrected concentration index, we estimate the effect of tobacco and alcohol use on income-related health inequalities. A decomposition technique was used to estimate the separate and joint contribution of tobacco and alcohol use to income-related health inequalities. The results indicate that tobacco use widens the income-related health inequality gap while alcohol consumption reduces health disparities. The simultaneous consumption of these goods has a stronger multiplicative effect on income-related health inequality. For instance, the simultaneous consumption of both goods contribute up to 1.03% of the inequality in health while tobacco use alone contributed only 0.6%. While policy options for each of these goods could be essential in reducing inequalities in health, there is a need to advocate additional measures that could simultaneously control the consumption of both goods

Social networks and technology adoption: Evidence from mobile money in Uganda

Innovative financial technologies are becoming a pathway to inclusive economic participation for individuals and firms. This paper presents evidence on how individuals’ decisions to adopt such technology, particularly mobile money, relate to the adoption choices of their network of family and friends. Using the Uganda Financial Inclusion Insights (FII) Tracker Survey for 2013, we find that mobile money adoption decisions are closely linked to the network of an individual’s family and friends. Networks are defined in two ways: by the source of information on mobile money services and by the average number of adoptions in one’s neighbourhood. Like many other studies, we find a positive correlation between mobile money adoption and the adoption decisions of one’s network. The correlation persists across the different measures of networks and even when we control for unobservable (neighbourhood fixed effects) characteristics. However, the magnitude of the point estimates decreases as the model becomes saturated. Despite having more mobile money users than adopters in our sample, we do not find evidence that networks can stifle technology adoption due to the possibility of piggybacking on early adopters within the network

Institutional dynamics and forest use practices in the Santchou Landscape of Cameroon

Forest-linked institutions are rapidly changing in sub-Saharan Africa – suggesting the need for renewed evidence. While growing qualitative evidence suggests changes in forest-linked institutions, there is the dearth of quantitative evidence on the extent of change in institutions and how this shapes forest use practices. To stem this knowledge gap, we draw from a representative sample of 200 forest-dependent households around the Santchou forest landscape, complemented by key informant interviews (N = 17) and focus group discussions (N = 11). We quantitatively analyzed changes in forest-linked institutions and their effects on forest use practices using a twostage least square (2SLS) approach with heteroscedasticity-based instruments. We corroborate the evidence with thematic analysis ad narratives. We first identified and characterized the structural and functional attributes of forest-linked institutions, and then estimate the effect of structural and functional changes on forest use practices. The results suggest the following: First, traditional council and secret society exhibit similar functional attributes and are dominant forest-linked institutions in the Santchou landscape. Second, endogenously-rooted institutional structures and processes have an exogenous origin. Institutions which were hitherto not designed to regulate forest use have installed themselves as influential regulators of forest use. Third, more than half of the customs and norms have changed over time; some are in a state of dormancy, others have witnessed numerical increase, and others have declined. Functional attributes negatively and significantly explain forest use practices; however, the effect varies between attributes. Finally, farm-based occupation significantly intensifies the level of forest dependency. Future studies are required to uncover the extent to which the different types of farm practices influence forest use practices. From a policy standpoint, emphasis should be placed on the promotion of cultivable NTFPs to complement and reverse the current positive association with farm-based occupation

Households’ Assets Dynamics and Ecotourism Choices in the Western Highlands of Cameroon

Ecotourism is increasingly accepted as a suitable alternative for sustaining rural livelihoods. In spite of this trend, quantitative assessments of relationships between household assets and ecotourism choices, and the policy implications thereof, currently account for only a negligible number of studies in sub-Saharan Africa. This paper contributes to this evidence gap by analyzing the extent to which households’ assets drive ecotourism choices on a representative sample of 200 households in Cameroon. The Principal Component Analysis (PCA) and the Human Development Index (HDI) were used to construct indices for ecotourism choices. The ordinary least square and logit models were also employed to estimate the effect of various household assets on ecotourism choices. A high preference was observed for the production and sale of arts and crafts items and the promotion of cultural heritage sites as key ecotourism choices. More women are found to participate in conservation education, as opposed to culture-related activities such as arts and crafts. Access to education and training were inversely related to cultural festival promotion. The results suggest the need to: (i) stem the overdependence on conservation sites for wood supply to the arts and crafts sector, (ii) enforce endogenous cultural institutional regulations, including those that increase female participation in guiding future ecotourism choices. This paper contributes to ecotourism development and conservation theory, with regards to unbundling household level predictors of ecotourism choices, and has implications on the design of policies to implement environmentally less-demanding ecotourism activities

Forest resource endogenous cultural institutions in rural Cameroon: compliance determinants and policy implications

Scholarly and policy interest on endogenous cultural institutions (ECIs) in sub-Saharan Africa (SSA) is gaining traction, albeit with a lack of robust empirical evidence on compliance determinants. This article contributes in this regard, by drawing from a sample of 200 forest-dependent households in the Santchou Landscape of Cameroon, complemented by key informant interviews (N = 17) and focus group discussions (N = 11). Using the ordinary least square and the logit model, we (i) analyze forest use practices shaped by ECIs, (ii) assess forest-based ECIs compliance determinants, and (iii) estimate the effect of compliance determinants on forest-based ECIs. We find that while norms and customs shape the harvesting of wood-based and vegetal based NTFPs, they are less likely to shape the exploitation of seed based NTFPs. Second, demographic and economic factors override socio-political determinants of ECIs. Third, elites are less likely to affect forest-based ECI compliance. Policy should leverage culturally sensitive ECIs in regulating forest resource use