Stunting, Cognitive Development, and Educational and Health Outcomes: Intended and Unintended Consequences of Policies

Paper Session

Saturday, Jan. 7, 2017 10:15 AM – 12:15 PM

Hyatt Regency Chicago, Grand Suite 5
Hosted By: International Health Economics Association & American Economic Association
  • Chair: Adam Wagstaff, World Bank

When The Money Runs Out: Do Cash Transfers Have Sustained Effects?

Sarah Baird
,
George Washington University
Craig McIntosh
,
University of California-San Diego
Berk Ozler
,
World Bank

Abstract

We examine the effects of a two-year cash transfer program for adolescent girls on a broad range of outcomes during and after the intervention. During the program, unconditional cash transfers (UCT) caused significant reductions in child marriage, teen pregnancy, and HIV prevalence among the beneficiaries, while improving their mental health and nutritional intake. However, two years after the cessation of transfers, these substantial short-term effects had completely disappeared: in fact, UCT recipients were less empowered and had worse marriage market outcomes than the control group. On the other hand, for those who had already dropped out of school at baseline, conditional cash transfers (CCT) produced a large long-term increase in educational attainment, a sustained reduction in the total number of births, and a more educated pool of husbands. Even in this group, however, there were no gains in health, labor market outcomes, or empowerment. Finally, consistent with the literature on exposure to safety net programs in utero and during early childhood, we find that children born to UCT beneficiaries during the program were significantly taller for their age. These findings suggest that the current enthusiasm for the promise of cash transfers as a tool for transformative changes is overstated.

Exploiting Externalities to Estimate the Long-Term Effects of Early Childhood Deworming

Owen Ozier
,
World Bank

Abstract

I investigate whether a school-based deworming intervention in Kenya had long-term effects on young children in the region. I exploit positive externalities from the program to estimate impacts on younger children who were not directly treated. Ten years after the intervention, I find large cognitive effects – comparable to between 0.5 and 0.8 years of schooling – for children who were less than one year old when their communities received mass deworming treatment. I find no effect on child height or stunting. Because treatment was administered through schools, I also estimate effects among children whose older siblings received treatment directly; in this subpopulation, effects on cognition are nearly twice as large.

Early Childhood Nutrition, Availability of Health Service Providers and Life Outcomes as Adults: Evidence from Indonesia

John Giles
,
World Bank
Elan Satriawan
,
Gadjah Mada University
Firman Witoelar
,
SurveyMeter-Indonesia

Abstract

An emerging body of research in the development literature demonstrates that shocks to nutritional status experienced in utero or in early childhood may have adverse impact on the cognitive development of children, and have persistent long-term effects on educational attainment, employment outcomes and well-being as adults. This paper examines the extent to which access to community-based health services in infancy and early childhood may mitigate these long-term consequences. After first demonstrating the relationship between stunting and a number of outcomes, including cognitive test scores, school attainment and early adult employment outcomes, the paper next examines whether access to a community-based health provider (midwife) in infancy and/or early-childhood mitigates the effects of poor nutritional status (stunting). Nutritional status in early-childhood is identified using rainfall shocks during a child’s second and third trimesters in utero and first three months after birth, and the effects of midwives are identified by exploiting the phased introduction of Indonesia’s village midwife program between 1989 and 1998. The paper exploits five waves of the Indonesia Family Life Surveying (IFLS), which facilitate identifying the effects of stunting among children born between 1989 and 1993 on schooling, cognitive ability and life outcomes in the 2000, 2007 and 2014 waves of the survey.

Local Price Externalities from Cash Transfer Programs: Food Price Increases and Nutrition Impacts on Non-beneficiary Children

Deon Filmer
,
World Bank
Jed Friedman
,
World Bank
Eeshani Kandpal
,
World Bank
Junko Onishi
,
World Bank

Abstract

Cash transfer programs targeted to poor households may increase price levels if local markets are not fully integrated into larger regional markets. Using data from the evaluation of a Philippine cash transfer program, we show that the prices of perishable protein rich foods exhibit moderate increases after the introduction of the program. Likely as a result, anthropometric measures of child health, notably stunting rates, worsen among non-beneficiary children. These effects are not short-run but persist up to 31 months after program introduction. Failing to consider the effect of such local price increases on non-beneficiaries’ wellbeing can overstate the impact of cash transfers. For very poor areas, where household targeting of cash transfers covers a majority of the households, geographic targeting may avoid the consequences of local market price spillovers and consequently prevent welfare declines at relatively little cost.
Discussant(s)
Seema Jayachandran
,
Northwestern University
Dean Yang
,
University of Michigan
JEL Classifications
  • I0 - General