Endogenous inclusion in the Demographic and Health Survey anthropometric sample: Implications for studying height within households

How does a ban on sex-selective abortions affect child health?

Bans on sex-selective abortions are typically implemented to make sex ratios more equitable, but they may have adverse effects on surviving children. We examine the impacts of a ban on prenatal sex selection in India on postnatal health outcomes. We first show that the ban increased the share of female children born to mothers, especially among firstborn female families. Strikingly, we also find that the ban led to a worsening of mortality outcomes for both girls and boys in firstborn female families. In terms of mechanisms, we find that fertility increases in firstborn female families after the ban, pointing to the following channel: firstborn female families are disproportionately affected by the ban and are more likely to use the son-biased fertility stopping rule to achieve a desired number of sons. Children in firstborn female families likely face greater competition for parental resources, which may worsen their health.

Birth order and children's health and learning outcomes in India

India has a high prevalence of stunting among children under five years of age, despite marginal improvement over the years. In 2019-21, 35.5 per cent of children below five years were stunted (National Family Health Survey (NFHS), 2019-21). This has been attributed to several factors including open defecation, poor maternal nutrition and food insecurity. This paper examines if the birth order of children is associated with variation in height among them, using nationally representative data from the India Human Development Survey (IHDS 2005 & 2011). The objectives of this paper are to: (i) assess the association of a child's birth order with height (ii) test if the association of birth order with height changes with the degree of son preference (iii) analyse the relationship between birth order and educational outcomes of children. Our results suggest that (i) the height-for-age z score is negatively associated with the birth order of the child (ii) the negative association of birth order with height is stronger for mothers who have a moderate or high degree of son preference, especially when children have an older brother (iii) maternal characteristics such as education could mitigate the negative relationship between birth order and height when son preference is low but not when son preference is high (iv) birth order has a negative association with the reading, writing and mathematical ability of children, especially if the child was stunted in childhood. This indicates that the fertility behaviour of families has both a direct and an indirect impact, which could influence both long term nutrition and education of children.

The Indian Enigma revisited

This paper re-enters the contested discussion surrounding the Indian Enigma, the high prevalence of chronic undernutrition in India relative to sub-Saharan Africa. Jayachandran & Pande (JP) argue that the key to the Indian Enigma lies in the worse treatment of higher birth order children, particularly girls. Analyzing new data, and taking into account issues relating to robustness to model specification, weighting and existing critiques of JP., we find: (1) Parameter estimates are sensitive to sampling design and model specification; (2) The gap between the heights of pre-school African and Indian children is closing; (3) The gap does not appear to be driven by differential associations by birth order and child sex; (4) The remaining gap is associated with differences in maternal heights. If Indian women had the heights of their African counterparts, pre-school Indian children would be taller than pre-school African children; and (5) Once we account for survey design, sibling size and maternal height, the coefficient associated with being an Indian girl is no longer statistically significant.

Child health inequality in Sub-Saharan Africa

We investigate child height inequality and inequality of predicted height in the Sub-Saharan Africa (SSA) region by socioeconomic, demographic and geographical factors. We characterize their changes in age-cohorts (from 0-1 up to 4-5 years old) and determine the contribution of each factor to these changes. We extract data from the Demographic and Health Surveys (DHS) for 33 SSA countries covering the period from 2009 to 2016. Our measure of health is the standardized height of children below the age of five, adjusted by the age and gender distribution in each country. We show that height inequality is lower for older children than for their younger peers. However, the share of inequality caused by our set of factors rises along the age distribution in more than 80% of countries. We find that family background (reflected by maternal education and the household wealth), followed by home infrastructures related to water, toilet and cooking facilities, and the region of residence contribute to explaining the differences observed in child health inequality along the age distribution in SSA.

Mothers' Social Status and Children's Health: Evidence From Joint Households in Rural India

The premise that a woman's social status has intergenerational effects on her children's health has featured prominently in population science research and in development policy. This study focuses on an important case in which social hierarchy has such an effect. In joint patrilocal households in rural India, women married to the younger brother are assigned lower social rank than women married to the older brother in the same household. Almost 8% of rural Indian children under 5 years old-more than 6 million children-live in such households. We show that children of lower-ranking mothers are less likely to survive and have worse health outcomes, reflected in higher neonatal mortality and shorter height, compared with children of higher-ranking mothers in the same household. That the variation in mothers' social status that we study is not subject to reporting bias is an advantage relative to studies using self-reported measures. We present evidence that one mechanism for this effect is maternal nutrition: although they are not shorter, lower-ranking mothers weigh less than higher-ranking mothers. These results suggest that programs that merely make transfers to households without attention to intrahousehold distribution may not improve child outcomes.