COMMENTS ON JENSEN(2011): MALNUTRITION IN SOUTH ASIA ANANDI MANI

COMMENTS ON JENSEN(2011): MALNUTRITION IN SOUTH ASIA ANANDI MANI

Potential Factors affecting Malnutrition MACRO/POLITICAL FACTORS Per Capita Income & Poverty that affects Aggregate Food availability Unequal Distribution of Food & Resources State Capacity to implement effective programs MICRO FACTORS Poverty at HH level Unequal Distribution of Resources within HH CULTURAL FACTORS Diet, Preferences regarding Child Gender

Jensen (2011) Impact of Fertility on Nutrition Outcomes: More kids may reduce resources parents are able to devote to children, which may affect Mn outcome BUT If calories are not too costly, there need not be an impact Uses Secondary Infertility (SI) as a shock to the number of children a woman has, to study the impact on malnutrition related outcomes. SI: Couples unable to conceive for 12 months or more, despite wanting to have more children and making efforts to do so Mn measure: Height-for age, BMI for age measures Causes of SI (and whether it is randomly assigned across couples) are not fully understood, but Maintained Assumption: SI is exogenous to Children s Health

Impact of Fertility on Malnutrition Data Multiple questions trying to get at a woman s (in)fertility status, as compared to the NFHS (which is the standard source for such data). Panel allows them to use child fixed effects The main predictors of secondary infertility are Woman s age Woman s BMI < 20 Secondary infertility results in Higher short run nutrition outcome for girls (BMI-age) There are no long run effects on girls nutrition status The effects on boys nutrition outcomes (short and long run) are small, and not significant

Micro-level issues Maintained Assumption: Factors causing SI are exogenous to Malnutrition/Child Health outcomes There are several reasons this may not be true, e.g. : Migration: of parent may lower chances of conception, but increase HH resources, hence improving child nutrition status. (In urban context too, a busy parent may lack time but have money). Environmental factors: Working in a factory/living near a highway may impair woman s fertility (say due to pollution exposure), but her higher income, or access to better variety of foods may enhance child s nutrition status

Secondary Infertility (SI) Measures SI is self-reported not medical-test based Social norms may influence responses For some couples, it may be inappropriate to admit the desire to have fewer children (particularly in South Asian families where in-laws live with the couple). Other couples may be sensitive/reluctant to report SI. Suggestion: Check whether gender composition of previous child(ren) affects likelihood of reporting SI. There should no such effect, so its one way to check bias in truthful reporting of SI, if any exists.

Other Comments Given that most of the damage from malnutrition is under the age of three, it would be useful to collect height-weight measures for children who below this age cut-off at the time of you first survey. Comparisons with South India Could other variables in your data help open up the black-box of how fertility affects nutrition status It is influenced by a combination of factors, especially (Gragnolati et al(2005)) high levels of exposure to infection inappropriate infant and young child feeding and caring practices Well-predicted by low birth weight

Some Facts about Malnutrition in S.Asia Cross-Country Comparison South Asia vs. Africa Total Fertility Rate (TFR) is much higher in very many countries in Africa than in India. In 2011, most of the countries in the top 25 TFR are from Africa [ (1) Niger 7.6 (25) Senegal 4.78] India has a TFR of 2.62 [Source] -- BUT Malnutrition in India is much higher 30% Indian babies are born with low birth weights,-- compared to approximately 16% in Sub-Saharan Africa (Low birth weight is the single best predictor of malnutrition)

Within Country Patterns Malnutrition in India is not only among the poor Underweight prevalence is as high as 60% in the lowest quintile, but even in the wealthiest fifth of the population 33% of children are underweight and 8.5% are severely underweight. (Based on NFHS I & II data) Micronutrient Deficiency: More than 75 percent of preschool children suffer from iron deficiency anemia (IDA) and 57 percent of preschool children have sub-clinical Vitamin A deficiency (VAD). Iodine deficiency is endemic in 85 percent of districts. So malnutrition in India may not be driven mostly by income/food-scarcity (resulting from competition among kids within a household)

Other Potential Explanations Women s bargaining power in the HH Women in South Asia often have low bargaining power in the HH than in other parts of the world. Areas with more blue (red) indicate sex ratios favorable (unfavorable) to women

Women s status in HH Men (in South India) are willing to sacrifice their own income to ensure that their wives don t earn too much more than themselves. (Mani 2009) Women may choose lower levels of fertility than their husbands. Women in Zambia who were given access to birth control individually, rather than in the presence of their husbands, were 23% more likely to visit a family planning nurse and 28% more likely to receive a concealable form of birth control, leading to a 57% reduction in unwanted births. Couples treatment relative to a control group who received no voucher, they experienced no corresponding reduction in unwanted births. (Ashraf et al(2010) )

Women s status in HH -- 2 Women s bargaining power results in better outcomes for their children, especially girls. (Qian 2008) Both lower BMI of women and low birth weight of children (a strong predictor of malnutrition) could be a consequence of women s weaker status in the HH. Jensen s findings that fewer kids positively affects girls short run nutrition outcomes is also consistent with Qian s findings on how women s bargaining power (via higher earnings) affects sex ratios in favor of girls.

Other Potential Channels Lack of Information/Knowledge? People do not maximize caloric intake (Banerjee-Duflo JEP 2007) (Atkins(2011)) Micronutrient deficiency is a pervasive problem in India, even in the top income quintile. Hygiene and sanitation standards in South Asia are well below those in African countries and have a major role to play in causing the infections that lead to malnutrition in the first two years of life.

Conclusion Opening up the black box of how parental care can improve nutrition outcomes of children will be useful. Emphasizing the right channel through public awareness campaigns could even mean that better nutrition outcomes can be achieved even in somewhat larger families. This paper has taken a useful first step towards trying to understand malnutrition at the HH level. It sets the stage for more work to be done in this area.

Price Volatility & Nutrition outcomes Price Volatility needs to be uncorrelated across goods It is not desirable if many prices move up or down in a positively correlated manner (e.g. exchange rate fluctuations) Price Volatility may itself diminish Habit formation? Price volatility would plausibly be higher under autarky