A Four-Country Study on the Relationship Between Parental Educational Homogamy and Children’s Health from Infancy to Adolescence

This study explores the relationship between parental educational similarity—educational concordance (homogamy) or discordance (heterogamy)—and children’s health outcomes. Its contribution is threefold. First and foremost, I use longitudinal data on children’s health outcomes tracking children from age 1 to 15, thus being able to assess whether the relationship changes at key life-course and developmental stages of children. This is an important addition to the relevant literature, where the focus is solely on outcomes at birth. Second, I look at different health outcomes, namely height-for-age (HFA) and BMI-for-age (BFA) z-scores, alongside their dichotomized counterparts, stunting and thinness. Third, I conduct the same set of analyses in Ethiopia, India, Peru, and Vietnam, thus providing multi-context evidence from countries at different levels of development and with different socio-economic characteristics and gender dynamics. Results reveal important heterogeneity across contexts. In Ethiopia and India, parental educational homogamy is associated with worse health outcomes in infancy and childhood, while associations are positive in Peru and, foremost, Vietnam. Complementary estimates from matching techniques show that these associations tend to fade after age 1, except in Vietnam, where the positive relationship persists through adolescence, thus supporting the homogamy-benefit hypothesis not only at birth, but also across the early life course. Insights from this study contribute to the inequality debate on the intergenerational transmission of advantage and disadvantage and shed additional light on the relationship between early-life conditions and later-life outcomes in critical periods of children’s lives.

     

Sex Differentials in Undernutrition: A Look at Survey Evidence

This note seeks indirect evidence regarding possible sex biases in food intake for adults and children, through large‐scale survey findings for anthropometric indicators. Among adults, excess female undernutrition is a serious problem in view of the large populations concerned (rural China, India), but data are still needed to assess the situation in many countries. Regarding preschool children, the anti‐female biases once noted for China, India, and other countries seem to have disappeared. Where differences exist, boys fare worse than girls (probably because girls, given a less than adequate food supply, tend to cope with it better than boys). Anti‐female discriminatory practices either are limited in magnitude or apply in groups that are too few or too small to be detectable in large populations.     

Variations in Women’s Heights across Social and Religious Groups Among Indian States

This paper uses the Indian National Family Health Survey data for the year 2005–2006 to draw comparisons of height among adult women across regions for minority groups like caste and religion. Inter-personal, regional and temporal comparisons are easier and effective using a non-monetary indicator of well-being like height which is also an indicator of long term nutritional status. The results of this study show that Muslim women have significant height advantage but with substantial variations across Indian states. Compared to Hindu women, differences in mean heights are lower across wealth quintiles and levels of educational attainment among Muslim women. Child birth during teens affects the final heights attained but only for the Hindus wherein this difference disappears after education level of the woman is controlled for, indicating that schooling delays early childbirth. The quantile regression model shows that Muslim women are taller than Hindu women across bottom, middle and top quartiles after controlling for other factors and that the gap increases over the quartiles.     

Religion,Contraceptive Method Mix,and Son Preference Among Bengali-Speaking Community of Indian Subcontinent

This paper examines the influence of religion on contraceptive method mix in the context of son preference among Bengali-speaking population of eastern India (i.e., West Bengal and Tripura) and Bangladesh. In spite of cultural similarity and parallel programmatic approach to family planning in these two distinct geopolitical spaces, differential use of contraception is evident. Using National Family Health Survey (2005–2006) and Bangladesh Demographic Health Survey (2007) and by employing sequential logit model, the paper finds evidence of latent son preference in adoption of modern contraception in Bengali-speaking Hindu and Muslim communities of eastern India. However, such practice is observed only among Hindus in Bangladesh. The paper further argues that although diffusion of the culture of son preference cuts across religious groups among Bengali-speaking community in eastern India, religious identity dominates over region in Bangladesh, encouraging minority Hindus to adopt a distinct pattern of contraceptive behavior with reference to sons. Such finding calls for further research in understanding the pros and cons of behavioral diffusion in majority–minority population mix in similar tradition and culture.     

Differences in Child Health Across Rural,Urban, and Slum Areas: Evidence From India

The developing world is rapidly urbanizing, but an 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 have the best, with slum children in between. With wealth or observed health environment held constant, 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, whereas slum boys have a higher mortality risk than rural boys. We estimate that slum conditions (such as overcrowding and open sewers), which the survey does not adequately capture, are associated with 20 % to 37 % of slum children’s stunting risk.     

Sex preference and fertility: what is the link?

It is argued that investment in programs for changing attitudes toward sex preference may not have the greatest impact on reducing fertility or increasing fertility control. Arnold's new method of analysis of determining sex preference was applied to data from a 1977 Egyptian survey of 36,000 rural households in Menoufia Governorate. Findings indicated that couples increased their use of modern contraceptives in direct proportion to an increase in the number of sons. Arnold determined that a large majority of all couples would have at least one boy early in their childbearing years. Thus sex preference would not have a large effect on fertility. Arnold's analysis among 27 countries found that without any sex preference, contraceptive usage would increase by an average of less than 3.7 percentage points. Arnold found that sex preference was strongest in Asia, particularly in South Korea and Taiwan that already have reduced fertility levels. In Africa, where fertility is high, the total elimination of sex preference would have only a 2.9 percentage point difference in contraceptive use. Sex preference had small effects on the percent of women who practice contraception, the percent who desire no more children, and the average number of additional children wanted. For example, in Bangladesh having no sex preference would show a percentage difference of 1.6 percentage points for contraceptive use, 4.7 percentage points difference for women desiring no more children, and -0.1 percentage point difference for the average number of additional children wanted. The effect of having no sex preference was strongest in India compared with Bangladesh, Indonesia, Nepal, the Philippines, Thailand, Ghana, Kenya, Costa Rica, Haiti, Paraguay, and Peru. The effect of no sex preference in India would have the respective percentage point effect of 3.7, 8.9, and -0.2. Public policy should be directed to information, education, and communication with other social goals.     

Fertility and Financial Development in South Asia

The paper empirically examines old-age security hypothesis to explain fertility rates in South Asia. Panel data is used for the period 1972–2013 for seven South Asian countries which include Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka. The estimated results reveal that in South Asia fertility rate decreases with the increase in financial development. Thus, the findings support old-age security hypothesis that parents use children as financial instruments to secure their old age. This paper validates the theory that the availability of alternative financial tools reduces the incentives of households to have large offspring. Infant mortality is also shown an important factor for high fertility rate in South Asia. This implies that households cover their risk from losing children by producing more children. The results also reveal that fertility rate decreases with the increase in per capita income, which implies that households treat children as inferior good in this region. In other words, households prefer quality of children over quantity of children when their income level increases. The results have also shown that fertility decreases with the increase in education, urbanization, agriculture productivity and industrialization. The study has some important policy implications.     

Muslim and Non‐Muslim Differences in Female Autonomy and Fertility: Evidence from Four Asian Countries

On the basis of research on paired Muslim and non‐Muslim communities selected in India, Malaysia, Thailand, and the Philippines, the authors test the hypothesis that greater observed Muslim pronatalism can be explained by less power or lower autonomy among Muslim women. Indeed, wives in the Muslim communities, compared to the non‐Muslim ones: 1) had more children, 2) were more likely to desire additional children, and 3) if they desired no more children, were less likely to be using contraception. However, the authors do not find that Muslim communities consistently score lower on dimensions of women's power/autonomy. Thus, aggregate‐level comparisons provide little evidence of a relationship between lower autonomy and higher fertility. Individual‐level multivariate analysis of married women in these paired settings similarly suggests that women's autonomy differentials do not account for the higher fertility, demand for more children, and less use of contraception among Muslim wives. These results suggest that explanations for Muslim/non‐Muslim fertility differences lie elsewhere.     

Selective gender differences in childhood nutrition and immunization in rural India: The role of siblings

This article examines the role of the sex composition of surviving older siblings on gender differences in childhood nutrition and immunization, using data from the National Family Health Survey, India (1992-1993). Logit and ordered logit models were used for severe stunting and immunization, respectively. The results show selective neglect of children with certain sex and birth-order combinations that operate differentially for girls and boys. Both girls and boys who were born after multiple same-sex siblings experience poor outcomes, suggesting that parents want some balance in sex composition. However, the preference for sons persists, and boys who were born after multiple daughters have the best possible outcomes.     

One Size May Not Fit All: How Obesity Among Mexican-Origin Youth Varies by Generation,Gender, and Age

Immigrants’ health (dis)advantages are increasingly recognized as not being uniform, leading to calls for studies investigating whether immigrant health outcomes are dependent on factors that exacerbate health risks. We answer this call, considering an outcome with competing evidence about immigrants’ vulnerability versus risk: childhood obesity. More specifically, we investigate obesity among three generations of Mexican-origin youth relative to one another and to U.S.-born whites. We posit that risk is dependent on the intersection of generational status, gender, and age, which all influence exposure to U.S. society and weight concerns. Analyses of National Health and Nutrition Examination Studies (NHANES) data suggest that accounting for ethnicity and generation alone misses considerable gender and age heterogeneity in childhood obesity among Mexican-origin and white youth. For example, second-generation boys are vulnerable to obesity, but the odds of obesity for first-generation girls are low and on par with those of white girls. Findings also indicate that age moderates ethnic/generational differences in obesity among boys but not among girls. Overall, ethnic/generational patterns of childhood obesity do not conform to a “one size fits all” theory of immigrant health (dis)advantage, leading us to join calls for more research considering how immigrants’ characteristics and contexts differentially shape vulnerability to disease and death.     

Women's Autonomy in India and Pakistan: The Influence of Religion and Region

This article compares the lives of women and explores dimensions of their autonomy in different regions of South Asia—Punjab in Pakistan, and Uttar Pradesh in north India and Tamil Nadu in south India. It explores the contextual factors underlying observed differences and assesses the extent to which these differences could be attributed to religion, nationality, or north–south cultural distinctions. Findings suggest that while women's autonomy—in terms of decision‐making, mobility, freedom from threatening relations with husband, and access to and control over economic resources—is constrained in all three settings, women in Tamil Nadu fare considerably better than other women, irrespective of religion. Findings lend little support to the suggestion that women in Pakistan have less autonomy or control over their lives than do Indian women. Nor do Muslim women—be they Indian or Pakistani—exercise less autonomy in their own lives than do Hindu women in the subcontinent. Rather, findings suggest that in the patriarchal and gender‐stratified structures governing the northern portion of the subcontinent, women's control over their lives is more constrained than in the southern region.     

The effect of female education on marital matches and child health in Bangladesh

This paper examines the effects of female education on marriage outcomes by exploiting the exogenous variation generated by the Female Secondary School Stipend Program in Bangladesh, which made secondary education free for rural girls. Our findings show that an additional year of female education leads to an increase in 0.72 years of husband’s education and that better educated women pair with spouses who have better occupations and are closer in age to their own, suggesting assortative mating. Those educated women appear to experience greater autonomy in making decisions on receiving their own health care and visiting their family. Furthermore, educated women have lower fertility and use more maternal health care, and their children have better health outcomes than those of less-educated women. Overall, our results suggest that the marriage market is one of the channels through which women’s education affects their life outcomes.     

Sex Differentials in Childhood Feeding,Health Care,and Nutritional Status in India

Strong preference for sons in South Asia is well documented, but evidence on female disadvantage in childhood feeding, health care, and nutritional status is inconclusive. This article examines sex differentials in indicators of childhood feeding, health care, and nutritional status of children under age 3 by birth order and sex composition of older living siblings. Data are from India's 1992–93 and 1998–99 National Family Health Surveys. The analysis finds three reasons for inconclusive evidence on female disadvantage in aggregate analyses. First, discrimination against girls is limited to the relatively small fraction of children of certain birth orders and sex compositions of older siblings. Second, discrimination against girls when boys are in short supply and discrimination against boys when girls are in short supply cancel each other to some extent. Third, some discrimination against girls (e.g., in exclusive breastfeeding at 6–9 months) is nutritionally beneficial to girls. Separate analyses for North and South India find that gender discrimination is as common in the South as in the North, where son preference is generally much stronger.     

Effects of Childhood Mortality and Morbidity on the Fertility Transition in sub‐Saharan Africa

Child mortality rates have fallen substantially in developing countries since 1960. The expected fertility decline has followed only weakly in sub‐Saharan Africa compared to other recent and historic demographic transitions. Disease and anthropometric data suggest that morbidity remains prevalent in Africa despite child survival improvements. The uniquely high infectious disease burden among children in Africa reduces population health and diminishes the returns to human capital investment, thwarting the quantity–quality tradeoff for children that typically accompanies the mortality transition. Individual‐level data from the Demographic and Health Surveys are used to show that persistent morbidity has weakened the positive relationship between child mortality and total fertility rates throughout the region, slowing Africa's demographic transition.     

Adolescent fertility programs: responding to the needs of today's youth

The 1983 conference on Adolescent Fertility Management in Asia and the Pacific provided a forum for sharing information and experiences. The project was designed to stimulate interest in and strengthen existing programs on adolescent fertility in participating countries, i.e., Bangladesh, Fiji, India, Indonesia, Nepal, Philippines, Sri lanka, and Thailand. Specifically, the conference sought to identify adolescent fertility problems and share experiences in managing adolescent fertility programs, identify gaps in the development and implementation of adolescent fertility programs and projects, and formulate plans to meet the adolescent fertility needs of the participating countries. Capsule presentations of the experiences of the participating countries are presented. Focus is on the projects they have undertaken and proposed activities. In Bangladesh Jatio Tarum Sangha, the national youth organization, seeks to get youth involved in family planning activities through information/education/motivation programs and community development projects. Fiji proposes to establish a youth center to be operated by the Ministry of Health to reduce the incidence of unplanned pregnancy and sexually transmitted diseases in adolescents and to make them more aware of sex-related health problems and the importance of responsible sex. India's Family Planning Association has initiated population education programs for youth. Several projects have been launched in Jakarta to cope with adolescent fertility problems including the adolescent health project, the Consultation Center for Adolescents, and the university-based family health project. The Family Planning Association of Nepal has completed some major programs under its youth project. The Philippines' proposed youth centers are planned to respond to the fertility related needs and problems of Filipino adolescents. Innovations of the center are: the operation of several youth-serving government and private agencies under 1 roof, and encouragement of youth participation in designing and running the center. Sri Lanka does not have much of an adolescent fertility problem. Virtually all fertility is said to occur within marriage. A study on adolescent fertility is planned. Thailand has launched several government and nongovernment programs to reach adolescents both in and out of school. Government programs include counseling services and the National Family Planning Communication for Premarriage adolescents. Key issues are identified and recommendations are made.     

Women--the deciding factor in family planning?

Prominent women from Korea, Nepal, India, Philippines, Thailand, and Afghanistan discuss family planning attitudes in broad terms. Educated women in urban areas make decisions regarding birth control and family size, but the tradition in most developing countries is that of the man in the authority role. Family planning is intrinsically a joint decision. Obligations to family and family lineage prohibit family planning. In the Philippines, Catholicism is the dominant religion and because of population density, encourages family planning. For economic and social reasons, rural families prefer more children. The changing role of women to include jobs and education will have a positive effect on family planning. The representative from Nepal points out that it is necessary to have family planning in order to have changing women's roles. Rather than emphasizing smaller family size, it is recommended by concensus, that family planners communicate health and nutritional benefits for each individual child.     

Policies for fertility reduction: focus on Asia

Fertility can be affected by many factors. Over the long run, socioeconomic development has a decisive effect on reducing fertility. But in the short run, its effects are mixed. Providing greater educational opportunities, particularly for women, typically leads to lower fertility. Urban fertility tends to be much lower than rural fertility since urban residents have better access to information and health care. To the degree that governments are able to extend the reach of the modern sector to rural areas, they may be able to reduce fertility without encouraging urban growth. The effects of income on fertility are mixed: given sufficient time, higher incomes lead to lower fertility; but rising incomes in developing countries can, in the short run, increase fertility. Socioeconomic development factors, however, have less effect on fertility than do fertility dynamics at the individual level. Age at marriage, duration of breastfeeding, and use of contraceptives have important implications for fertility reduction policies. The contribution of of these factors to fertility control have been analyzed for a number of Asian and Pacific countries. Breastfeeding plays a key role in controlling fertility in Pakistan, Nepal, Bangladesh, and Indonesia. Later marriages compensate for lower breastfeeding levels in controlling fertility in other Asian and Pacific countries. The contribution of contraception to fertility control varies from 2% in Nepal to as much as 28% in Thailand. A low total fertility rate is almost always the result of relatively widespread use of contraceptives. Fertility rate reduction in India, Thailand, Indonesia, and Korea in he 1970s can largely be explained by increases in contraceptive usage.     

Birth order and health of newborns

We examine birth order differences in health of newborns and follow the children throughout childhood using high-quality administrative data on individuals born in Denmark between 1981 and 2010. Family fixed effects models show a positive and robust effect of birth order on health at birth; firstborn children are less healthy at birth. During earlier pregnancies, women are more likely to smoke, receive more prenatal care, and are more likely to suffer a medical pregnancy complication, suggesting worse maternal health. We further show that the health disadvantage of firstborns persists in the first years of life, disappears by age seven, and becomes a health advantage in adolescence. In contrast, later-born children are throughout childhood more likely to suffer an injury. The results on health in adolescence are consistent with previous evidence of a firstborn advantage in education and with the hypothesis that postnatal investments differ between first- and later-born children.     

Maternal Age and Offspring Adult Health: Evidence From the Health and Retirement Study

Advanced maternal age is associated with negative offspring health outcomes. This interpretation often relies on physiological processes related to aging, such as decreasing oocyte quality. We use a large, population-based sample of American adults to analyze how selection and lifespan overlap between generations influence the maternal age?Coffspring adult health association. We find that offspring born to mothers younger than age 25 or older than 35 have worse outcomes with respect to mortality, self-rated health, height, obesity, and the number of diagnosed conditions than those born to mothers aged 25?C34. Controls for maternal education and age at which the child lost the mother eliminate the effect for advanced maternal age up to age 45. The association between young maternal age and negative offspring outcomes is robust to these controls. Our findings suggest that the advanced maternal age?Coffspring adult health association reflects selection and factors related to lifespan overlap. These may include shared frailty or parental investment but are not directly related to the physiological health of the mother during conception, fetal development, or birth. The results for young maternal age add to the evidence suggesting that children born to young mothers might be better off if the parents waited a few years.     

Fertility estimation from retrospective surveys: Biases attributable to pregnancy-related movement of mothers

In a number of developing countries, especially in South Asia, there is a custom for a pregnant woman to go to her mother's home for delivery and remain for some months afterwards. In this context, estimates of various fertility measures, based on data from a sample survey of resident women, will be seriously biased. Inclusion of data for visitors to the sample households does not fully compensate for this bias. The presence and magnitude of the bias is illustrated by the analysis of data from large-scale sample surveys conducted in the state of Orissa in India and by World Fertility Survey data from Bangladesh and Nepal.