My paper with Bijetri Bose and Shamma Alam, "Impacts of the COVID-19 lockdown on healthcare inaccessibility and unaffordability in Uganda," is now available as Ahead of Print at American Journal of Tropical Medicine & Hygiene.
I have a new working paper on how fertility behavior in Sub-Saharan Africa differ from Latin America, East Asia, and South Asia. The paper examines completed fertility using all DHS and MICS data from the four regions. Abstract is below and the Online Appendix is here.
Sub-Saharan Africa's fertility decline has progressed much slower than elsewhere. However, there is still substantial disagreement about why, partly because four leading potential causes—cultural norms, expected offspring mortality, land access, and school quality—are challenging to measure. I use large-scale woman-level data to infer what role each explanation plays in fertility differences between Sub-Saharan Africa and East Asia, South Asia, and Latin America, based on estimations of fertility outcomes by region, cohort, area of residence, and grade level. I show that the differences in fertility between Sub-Saharan Africa and the other regions first increase and then decrease with years of education. For women without education, fertility rates in Sub-Saharan Africa are comparable to those in Latin America. Similarly, for women with secondary education or higher, fertility rates in Sub-Saharan Africa align with those in South and East Asia. There are substantial and statistically significant differences for women with some primary education for all three comparison regions. The differences are more pronounced for children ever born than for surviving children. Overall, the results suggest that offspring mortality and the lower quality of primary schooling are the dominant reasons why fertility decline in Sub-Saharan Africa lags behind other regions.
Bijetri Bose, Shamma Alam, and I have a new paper, "Impacts of the COVID-19 Lockdown on Healthcare Inaccessibility and Unaffordability in Uganda," forthcoming in the American Journal of Tropical Medicine and Hygiene. The abstract is:
Several studies have reported adverse consequences of the COVID-19 lockdowns on the utilization of healthcare services across Africa. However, little is known about the channels through which lockdowns impacted healthcare utilization. This study focuses on unaffordability as a reason for not utilizing healthcare services. We estimate the causal impacts of the COVID-19 lockdown on healthcare inaccessibility and affordability in Uganda relative to the nonlockdown periods of the pandemic. We use nationally representative longitudinal household data and a household fixed-effects model to identify the impact of the lockdown on whether households could not access medical treatment and whether the reason for not getting care was the lack of money. We find that the lockdown in Uganda was associated with an 8.4% higher likelihood of respondents being unable to access healthcare when treatment was needed relative to the nonlockdown periods. This implies a 122% increase in the share of respondents unable to access healthcare. As lockdown restrictions eased, the likelihood of being unable to access medical treatment decreased. The main reason for the increase in inaccessibility was the lack of money, with a 71% increase in the likelihood of respondents being unable to afford treatment. We find little evidence that the effects of the lockdown differed by wealth status or area of residence. Our results indicate the need for policymakers to consider immediate social support for households as a strategy for balancing the disruptions caused by lockdowns.
Shamma Alam, Ishraq Ahmed, and I have a new working paper out examining the effects on food insecurity from Uganda's two Covid lockdowns. Abstract is below:
We examine the short- and medium-run impacts of two of the strictest Covid-19 lockdowns in the developing world, employing longitudinal data from Uganda. Household fixedeffects estimations show significant, immediate increases in food insecurity after the first lockdown and a continued negative impact three months after its lifting. The second lockdown’s medium-term impact was even worse, likely because of a compounding effect of a concurrent drought. The rising food insecurity was partly the result of the lockdownrelated reductions in the availability of paid work. Agricultural households were more likely to continue working and consequently saw smaller increases in food insecurity. Furthermore, the likelihood of engaging in agricultural work increased after the first lockdown, suggesting a switch to agriculture as a coping mechanism. The other coping mechanisms that households typically rely on for idiosyncratic shocks failed in the face of a worldwide shock, contributing to the sizeable increase in food insecurity.
Some shameless self-promotion: I will be the Howard J. Bosanko Professor of International Economics and Finance for 2020-23.
I plan to organize a series of Bosanko Lectures that will touch on different aspects of the challenges and opportunities that Sub-Saharan Africa faces – population, human capital, and business climate.
If any of you have ideas for speakers, preferably in academia or think tanks, I would love to hear them.
The announcement is at https://www.seattleu.edu/business/news-events/ (scroll down a bit).
My latest paper, on how birth spacing changed in India with the introduction of sex selection, is now available. I am presenting a poster on this paper this coming Friday at the Population Association of America's annual meeting in Denver.
Title:
Abstract:
Strong son preference is typically associated with shorter birth spacing in the absence of sons, but access to sex selection has the potential to reverse this pattern because each abortion extends spacing by six to twelve months. I introduce a statistical method that simultaneously accounts for how sex selection increases the spacing between births and the likelihood of a son. Using four rounds of India’s National Family and Health Surveys, I show that, except for first births, the spacing between births increased substantially over the last four decades, with the most substantial increases among women most likely to use sex selection. Specifically, well-educated women with no boys now exhibit significantly longer spacing and more male-biased sex ratios than similar women with boys. Women with no education still follow the standard pattern of short spacing when they have girls and little evidence of sex selection, with medium-educated women showing mixed results. Finally, sex ratios are more likely to decline within spells at lower parities, where there is less pressure to ensure a son, and more likely to increase or remain consistently high for higher-order spells, where the pressure to provide a son is high.
My paper with Yu-hsuan Su, "Differences in Child Health across Rural, Urban, and Slum Areas: Evidence from India," has been accepted for publication in Demography. The final version is here and the abstract for the paper is below.
The developing world is rapidly urbanizing, but our understanding of how child health differs across urban and rural areas is lacking. We examine the association between area of residence and child health in India, focusing on composition and selection effects. Simple height-for-age averages show that rural Indian children have the poorest health and urban children the best, with slum children in between. Controlling for wealth or observed health environment, the urban height-for-age advantage disappears, and slum children fare significantly worse than their rural counterparts. Hence, differences in composition across areas mask a substantial negative association between living in slums and height-for-age. This association is more negative for girls than boys. Furthermore, a large number of girls are "missing" in slums. We argue that this implies that the negative association between living in slums and health is even stronger than our estimate. The "missing" girls also help explain why slum girls appear to have a substantially lower mortality than rural girls do, whereas slum boys have a higher mortality risk than rural boys do. We estimate that slum conditions–which the survey does not adequately capture, such as overcrowding and open sewers–are associated with 20-37% of slum children's stunting risk.
A new version of my paper on sex-selective abortion, fertility, and birth spacing in India is now available. The major change from the prior version is new theoretical model that better ties the theoretical and empirical parts of the paper together plus many edits throughout the paper. The new version is available here and the new online appendix here.
Shamma Alam and I just finished a paper on the effects of income shocks on the timing of fertility in Tanzania using the Kagera data set. There are significant reductions in the likelihoods of being pregnant and giving birth following shocks, consistent with prior results in the literature. What is new is that we can show that this is predominately the results of an increased use of contraceptives. This is interesting for two reasons. First, it shows that the postponement of fertility following a shock is the result of an conscious decision, rather than being an unintended consequence of the shocks' effect on, for example, health or migration. Second, the postponement is achieved almost entirely through the use of traditional contraceptives. This shows that, once the incentives are strong enough, people are able to control their fertility even in the absence of modern contraceptives. The full abstract is:
This paper examines the relationship between household income shocks and fertility decisions. Using panel data from Tanzania, we estimate the impact of agricultural shocks on pregnancy, births, and contraception use. We estimate individual level fixed effect models to account for potential correlation between unobservable household characteristics and both shocks and decisions on fertility and contraceptive use. The likelihood of pregnancies and childbirth are significantly lower for households that experience a crop shock. Furthermore, women significantly increase their contraception use in response to crop losses. We find little evidence that the response to crop loss depends on education or wealth levels. The increase in contraceptive use comes almost entirely from traditional contraceptive methods, such as abstinence, withdrawal, and the rhythm method. We argue that these changes in behavior are the result of deliberate decisions of the households rather than the shocks' effects on other factors that influence fertility, such as women’s health status, the absence or migration of a spouse, the dissolution of partnerships, or the number of hours worked. We also show that, although traditional contraceptives have low overall efficacy, households with a strong incentive to postpone fertility are very effective at using them.
After working through many and excellent comments from 3 referees, I now have a revised version of my paper on sex-selective abortions in India. There is also now a substantial on-line appendix (89 pages). The new abstract is:
This paper addresses two main questions: what is the relationship between fertility and sex selection and how does birth spacing interact with the use of sex-selective abortions? I introduce a statistical method that incorporates how sex-selective abortions affect both the likelihood of a son and spacing between births. Using India's National Family and Health Surveys, I show that falling fertility intensifies use of sex selection, leading to use at lower parities, and longer spacing after a daughter is born. Women with 8 or more years of education, both in urban and rural areas, are the main users of sex-selective abortions and have the lowest fertility. Women with less education have substantially higher fertility and do not appear to use sex selection. Predicted lifetime fertility for high-education women declined more than 10% between 1985–1994, when sex selection was legal, and 1995–2006, when sex selection was illegal. Fertility is now around replacement level. Abortions per woman increased almost 20% for urban women and 50% for rural women between the two periods, suggesting that making sex selection illegal has not reversed its use. Finally, sex selection appears to be used to ensure one son rather than multiple sons.
A new version of my paper with Kathleen Beegle and Luc Christiaensen on the effectiveness of family planning programs in Ethiopia is now available. You can find it here. The abstract is below.
Although reproductive health advocates consider family planning programs the intervention of choice to reduce fertility, there remains a great deal of scepticism among economists as to their effectiveness, despite little rigorous evidence to support either position. This study explores the effects of family planning in Ethiopia using a novel set of instruments to control for potential non-random program placement. The instruments are based on ordinal rankings of area characteristics, motivated by competition between areas for resources. Access to family planning is found to reduce completed fertility by more than 1 child among women without education. No effect is found among women with some formal schooling, suggesting that family planning and formal education act as substitutes, at least in this low income, low growth setting. This provides support to the notion that increasing access to family planning can provide an important, complementary entry point to kick-start the process of fertility reduction.
I presented preliminary results from Shamma Alam and my work on "Income Shocks, Contraceptive Use, and Timing of Fertility" at University of Oregon in Eugene on 16 November and I will be presenting at the UW labor and development brown bag tomorrow at 12.30. The abstract for the paper is below.
This paper examines the relationship between household income shocks and fertility decisions. Using panel data from Tanzania, we estimate the impact of agricultural shocks on contraception use, pregnancy, and the likelihood of childbirth. To account for unobservable household characteristics that potentially affect both shocks and fertility decisions we employ a fixed effects model. Households significantly increase their contraception use in response to income shocks from crop loss. This comes from an increased use of both traditional contraceptive methods and modern contraceptives. The poorer the household the stronger the effect of income shock on contraceptive use is. Furthermore, pregnancies and childbirth are significantly delayed for households experiencing a crop shock. For both pregnancy and childbirth the likelihood of delay as a result of shocks increases the poorer the household. We argue that these changes in behavior are the result of deliberate decisions of the households rather than income shocks' effects on other factors that influence fertility, such as women's health status, the absence or migration of spouse, and dissolution of partnerships.
I was in Oxford in March for the 2012 CSAE Conference: Economic Development in Africa. I presented my paper on the impact of hurricane risk on fertility and education decisions. The conference was great and the quality of the papers continues to increase. You can find the latest version of the paper under "Research" on this website. A full program can be found here.
It is World Bank Policy Research Working Paper No. 5812 and you can find it either through SSRN or the World Bank. If you pick SSRN I can keep track of the interest, which is always nice.
We (Kathleen Beegle, Luc Christiaensen and I) have just finished revising our paper on the effects of family planning on fertility in Ethiopia. You can find the new version, which has been submitted to a journal, here. The abstract is:
Although reproductive health advocates consider family planning programs the intervention of choice to reduce fertility, there remains a great deal of scepticism among economists as to their effectiveness, despite little rigorous evidence to support either position. This study explores the effects of family planning in Ethiopia using a novel set of instruments to control for potential non-random program placement. The instruments are based on ordinal rankings of area characteristics, motivated by competition between areas for resources. Access to family planning is found to reduce completed fertility by more than 1 child among women without education. No effect is found among women with some formal schooling, suggesting that family planning and formal education act as substitutes, at least in this low income, low growth setting. This provides support to the notion that increasing access to family planning can provide an important, complementary entry point to kick-start the process of fertility reduction.