The Puzzle of Muslim Advantage in Child Survival in India

The socio-economic status of Indian Muslims is, on average, considerably lower than that of upper caste Hindus. Muslims have higher fertility and shorter birth spacing and are a minority group that, it has been argued, have poorer access to public goods. They nevertheless exhibit substantially higher child survival rates, and have done for decades. This paper documents and analyses this seeming puzzle. The religion gap in survival is much larger than the gender gap but, in contrast to the gender gap, it has not received much political or academic attention. A decomposition of the survival differential reveals that some compositional effects favour Muslims but that, overall, differences in characteristics between the communities and especially the Muslim deficit in parental education predict a Hindu advantage. Alternative outcomes and specifications support our finding of a Muslim fixed effect that favours survival. 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.religion;caste;gender;child survival;anthropometrics;Hindu;Muslim;India

Shadows of the Captain of the Men of Death: Health Innovation, Human Capital Investment, and Institutions

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 star

Maternal Depression, Parenting Behaviors and Child Development: Evidence from a Randomized Control Trial

We evaluate the impacts of maternal depression on children's skill accumulation, exploiting randomized variation in depression created by a cluster-randomized control trial that provided cognitive behavioral therapy to women in rural Pakistan who were diagnosed as depressed in pregnancy. We conducted a followup study when the children were age 7 and assessed their cognitive, socio-emotional and physical development, parental investments in children, indicators of the quality of parenting, and of the home environment. The intervention was successful in reducing maternal depression and this effect was sustained. We also find that treated mothers exhibit better parenting behaviors, provide a better home environment and invest more in their children's education. We nevertheless find, on average, no detectible effects on children's cognitive, socio-emotional or physical development at age 7. We show that this is not because of differential attrition, differential shocks to treated vs control clusters or low power. With the odd exception, we find no evidence that the average results conceal large effects in relevant sub-samples, or in a segment of the distribution of outcomes. Since we find reinforcing parental investments in many domains in the treated group, it is also unlikely that the results are explained by unobserved compensating investments in the control group. We conclude that there are possibly positive but latent effects of the intervention that may be detectible in later life

On the Quantity and Quality of Girls: New Evidence on Abortion, Fertility and Parental Investments

The introduction of prenatal sex-detection technologies in India has led to a phenomenal increase in abortion of female fetuses. We investigate their impact on son-biased fertility stopping behavior, parental investments in girls relative to boys, and the relative chances of girls surviving after birth. We find a moderation of son-biased fertility, erosion of gender gaps in breastfeeding and immunization, and complete convergence in the post-neonatal mortality rates of boys and girls. For every five aborted girls, we estimate that roughly one additional girl survives to age five. The results are not driven by endogenous compositional shifts, being robust to the inclusion of mother fixed effects. Our findings have implications not only for counts of missing girls but also for the later life outcomes of girls, conditioned by greater early life investments in them

Urban water disinfection and mortality decline in lower-income countries

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% to over 90% within 18 months. We estimate that the program reduced childhood diarrheal disease mortality rates by 45 to 67%. However, inadequate sanitation infrastructure and age (degradation) of water pipes may have attenuated these benefits substantially

Effects of a maternal psychosocial intervention on hair derived biomarkers of HPA axis function in mothers and children in rural Pakistan

Objective 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. Methods HPA axis activity was assessed using hair-derived cortisol, cortisone, and dehydroepiandosterone (DHEA). Hair samples were collected from mother-child dyads at one year postpartum from prenatally depressed women randomized to a cognitive-behavioral intervention (n ​= ​35 dyads) or to enhanced usual care (n ​= ​37 dyads), and from a comparison sample of women who screened negative for depression in pregnancy (n ​= ​35 dyads). Results The intervention group had 38 percent (p=0.01) lower maternal cortisol levels and 45 percent (p ​< ​0.01) lower maternal cortisone compared to the EUC group. Maternal DHEA levels were higher among women in the intervention group compared to the EUC group by 29 percent (p ​= ​0.02). Intergenerational intervention effects show higher DHEA levels in infants by 43% (p ​= ​0.03). Infant cortisol and cortisone did not differ across groups. Conclusions Results suggest that the perinatal depression intervention has effects on HPA axis activity in both mothers and children, providing evidence that treating maternal depression may impact physiological stress system functioning intergenerationally. In addition, utilizing hair-derived biomarkers of HPA-axis activity is a potentially useful clinical indicator of intervention impacts on the neuroendocrine system

Modelling the impact of women’s education on fertility in Malawi

Many studies have suggested that there is an inverse relationship between education and number of children among women from sub-Saharan Africa countries, including Malawi. However, a crucial limitation of these analyses is that they do not control for the potential endogeneity of education. The aim of our study is to estimate the role of women’s education on their number of children in Malawi, accounting for the possible presence of endogeneity and for nonlinear effects of continuous observed confounders. Our analysis is based on micro data from the 2010 Malawi Demographic Health Survey, and uses a flexible instrumental variable regression approach. The results suggest that the relationship of interest is affected by endogeneity and exhibits an inverted U-shape among women living in rural areas of Malawi, whereas it exhibits an inverse (nonlinear) relationship for women living in urban areas