The impact of diabetes insurance mandates on infant health

Among the factors thought to contribute to lagging improvements in infant health in recent years are increasing obesity and diabetes prevalence among women of childbearing age. This article uses a difference‐in‐difference‐in‐difference empirical strategy to investigate the impact of mandated insurance coverage for diabetes on adverse pregnancy outcomes. Among educated women, who have high rates of coverage through private insurance that is subject to insurance mandates, diabetes mandates are associated with a reduction in low birth weight and premature birth prevalence. These gains are concentrated among older women and are larger for African‐Americans. There is a weaker effect on the prevalence of high birth weight, potentially because of the deleterious effects of an increased probability of pregnancy weight gain in excess of 35 pounds among diabetic women in states with mandates.     

When left-behind children become adults and parents: The long-term human capital consequences of parental absence in China

This study examines the long-term effects of childhood left-behind experience on human capital outcomes across two generations in China. Using data from the China Family Panel Studies (CFPS), we find evidence that adults with left-behind experience in early life have fewer schooling years, lower cognitive test scores, a lower Big Five personality traits index, but a higher internal locus of control. Meanwhile, they are more likely to report underweight, chronic diseases, depression, and lower levels of perceived health and happiness. Our findings of the negative consequences on personality traits and health outcomes are robust to a battery of specification and validity tests. These effects also differ markedly by adults' gender, birth cohort, hukou status, and the characteristics of left-behind experience (i.e., type, timing, and duration). Further, our results also suggest a potential intergenerational transmission mechanism in which human capital loss is induced by one's early-life exposure to parental absence. Specifically, one's childhood left-behind experience is also inversely associated with their offspring's outcomes such as Big Five noncognitive skills, birth weight, and height-for-age z-score. Although adults with left-behind experience are inclined to spend more time with offspring compared with their non-left-behind counterparts, they also tend to have significantly poorer household socioeconomic outcomes and less offspring educational investment.     

The Costs of Missing the Millennium Development Goal on Gender Equity

At the Millennium Summit, the world community pledged to promote gender equality and chose as a specific target the achievement of gender equity in primary and secondary education by the year 2005 in every country of the world. Based on the findings from a growing empirical literature that suggests that gender equity in education promotes economic growth, reduced fertility, child mortality, and undernutrition, we estimate what the costs in terms of growth, and forgone fertility, mortality and undernutrition reduction, will be for the 45 countries that are, on current projections, unlikely to meet the target. Our estimates suggest that, by 2005, the countries that are off track are likely to suffer 0.1–0.3 percentage points lower per capita growth rates as a result, will have 0.1–0.4 more children per woman, and, by 2015, an average of 15 per 1,000 higher rates of under five mortality, and 2.5 percentage points higher prevalence of underweight children under five. Sensitivity analyses suggest that the results are quite robust to using different specifications and approaches to estimating these losses.     

FAMILY SIZE,UNWANTEDNESS, AND CHILD HEALTH AND HEALTH CARE UTILISATION IN INDONESIA

This paper presents and estimates a model of the determinants of child health and health care utilisation in Indonesia. In particular, it estimates the impact of unwantedness and number of siblings on health outcomes and treatment. It finds evidence that children who are unwanted at birth are more likely than other children to become ill and less likely to receive treatment for illnesses. No evidence is found that children from larger families suffer adverse health consequences.     

The road to pro-poor growth: the Indonesian experience in regional perspective

Indonesia's long-run ‘pro-poor growth’ record is among the best in Asia. It shows that appropriate policies can free societies from poverty's worst manifestations in a generation, a crucial message as democracy begins to influence the policy process. This paper places Indonesia's record in regional perspective, analysing determinants of income distribution in Asia and connecting this analysis to Indonesia's pro-poor growth process and the policy mechanisms that encourage pro-poor growth. Using a data set for eight Asian countries, it examines patterns of change in incomes and distribution across countries and over time. Building on Indonesian experience, the paper presents a pro-poor growth model encompassing three levels: improving the ‘capabilities’ of the poor, lowering transactions costs in the economy, especially between rural and urban areas, and increasing demand for goods and services produced by the poor. It finds that rapid pro-poor growth requires simultaneous and balanced interaction between growth and distribution processes.     

The impact of parental education on children’s outcomes in China

This paper exploits the exogenous shock to basic education during the Chinese Cultural Revolution to estimate the causal relationship between parental schooling and children’s educational attainment in China. Using deviations of cohort graduation rates from predicted education trends as instruments for parents’ education, the results indicate that an additional year of parental education increases children’s probability of completing junior and senior high schools by 7.94 and 9.76%, respectively. Parental education not only has positive and significant effects on children’s schooling outcomes, its importance also increases with children’s education level. These findings suggest that public investment in education has important long-term effects on individual’s educational achievement.     

Inequities in under-five child nutritional status in South Africa: What progress has been made?

Despite the emphasis given to poverty reduction in policy statements and a substantial increase in social spending, money-metric poverty has shown little improvement since South Africa's transition to democracy in 1994. Alternative approaches to measuring well-being and inequality may show a more positive trend. This article uses the 2008 National Income Dynamics Study to assess the magnitude of inequalities in under-five child malnutrition ascribable to economic status. The article compares these results with those of Zere and McIntyre, who analysed similar data collected in 1993. In both cases, household income, proxied by per-capita household expenditure, was used as the indicator of socio-economic status. Children's heights and weights have increased since 1993 and being stunted or underweight has become less common. Furthermore, pro-rich inequalities in stunting and being underweight have significantly declined since the end of apartheid. This suggests that pro-poor improvements in child welfare have taken place. Policies that may have contributed to this include the Child Support Grant, introduced in 1998, and improvements in healthcare and the education of women.     

Political Commitment to Reform: Civil Service Reform in Swaziland

Lack of political commitment has been seen as a principal reason for the failure of development programs, and is the pretext for calls for “selectivity” in the allocation of donor aid. A new model of commitment is proposed, and applied to a case study of civil service reform in Swaziland. The failure of repeated reform attempts there is indeed due to a lack of commitment that has its roots in Swaziland’s unusual political system, in which ‘traditional’ rulers have effective power. Prospects for reform therefore depend either on fundamental political change, or on engaging with those rulers’ fear that reform represents a threat to their interests. Applying the model of commitment to the case study highlights the importance of a political analysis, and suggests constructive forms of engagement with uncommitted governments that go beyond the minimal involvement that the selectivity approach advocates. The model may represent a tool for predicting, and helping to generate, a government’s commitment to a given policy proposal.     

Do home gardens improve the nutrition of rural pre-schoolers in Lesotho?

In this study, the contribution of household gardens to the nutritional status of pre-schoolers in Lesotho was investigated. The anthropometric status of children under five years of age was measured in five randomly selected villages in five districts of Lesotho during November and December 1999. In each district, the nutritional status of an average of 538 children was assessed. Production from household gardens was investigated to determine whether households had access to vegetables throughout the year. Despite a significant association between the presence of home gardens and lower incidences of wasting and underweight, the nutritional status of children in households with or without home gardens in sampled areas is poor. Some 49 per cent of children from households with food gardens were stunted, 29 per cent were underweight, and 24 per cent showed wasting. Many households do not produce enough vegetables rich in vitamin A to meet both their consumption and nutritional needs. Recommendations include intensified production of a wider mix of crops that include starchy crops, vitamin A-rich vegetables and fruit trees to ensure a significant impact on children's nutritional status.     

From philanthropy to a different way of doing business: strategies and challenges in integrating pro-poor approaches into tourism business

Pro-poor tourism means managing a tourism business so that it makes business sense for the operator and at the same time benefits the poor. Based on the Pro-Poor Tourism Pilot Programme conducted in southern Africa, this article argues that ‘mainstream’ commercial tourism can do much to embrace pro-poor approaches. In particular, the tourism sector needs to go further in shifting from philanthropic approaches to pro-poor approaches that entail doing business differently, with more committed changes to strategy and business structures. The pilot programme case studies reveal a range of potential business benefits companies can achieve through pro-poor approaches, such as enhanced social licence to operate and increased brand recognition. They also show that implementing a pro-poor approach depends on the company's context and circumstances. Such a shift entails a number of challenges and companies need to commit to making the necessary effort.     

Does productive microcredit improve rural children's education? Evidence from rural Vietnam

Whether increasing access to microcredit results in better educational outcomes for children’s education in rural areas remains an important but inconclusive topic in development literature. This paper contributes to this strand of research both theoretically and empirically. We develop a theoretical model where a representative household uses microcredit to fund its family business and maximises its lifetime utility. Based on the outcomes of its business, the parents make an optimal decision on the level of their children’s schooling investment. Solving the maximisation problem, we show that a household’s optimal education for its children is directly related to the level of microcredit. Empirically, we utilise the Vietnam Access to Resources Household Survey (VARHS) dataset from 2008 to 2016 to estimate the impact of microcredit on rural children’s schooling. We find that microcredit borrowing by rural households negatively affects their children’s education, which is more profound for boys than girls. Policymakers need to be aware of such side effects in designing microcredit policy and adopt auxiliary measures, such as incorporating a clause on children's education in the borrowing terms, to alleviate the negative impact on children’s educational outcomes.     

The Revenue–Expenditure Nexus: The Experience of 13 African Countries

Abstract: The aim of this paper is to investigate the causal relationship between government revenue and government expenditure for 13 African countries within a multivariate framework using a modified version of the Granger causality test due to Toda and Yamamoto (1995) . The empirical evidence suggests that there was a bi‐directional causality running between expenditure and revenue for Mauritius, Swaziland and Zimbabwe; no causality in any direction for Botswana, Burundi and Rwanda; unidirectional causality running from revenue to expenditure for Ethiopia, Ghana, Kenya, Nigeria, Mali and Zambia; and a uni‐directional causality running from expenditure to revenue for Burkina Faso only.     

Health Expenditures and Health Outcomes in Africa*

Abstract: This paper provides econometric evidence linking African countries’ per capita total as well as government health expenditures and per capita income to two health outcomes: infant mortality and under‐five mortality. This relationship is examined using data from 47 African countries between 1999 and 2004. Health expenditures have a statistically significant negative effect on infant and under‐five mortality rates. The magnitude of our elasticity estimates are in consonance to those reported in the literature. For African countries, our results imply that total health expenditures (as well as the public component) are certainly important contributors to health outcomes. In addition, we find that both infant and under‐five mortality are positively and significantly associated with sub‐Saharan Africa. The reverse is true for North Africa. While ethnolinguistic fractionalization and HIV prevalence positively and significantly affect the health outcomes, higher numbers of physicians and female literacy significantly reduce these health outcomes. These results have important implications for attaining the targets envisioned by the Millennium Development Goals. The data implications are also discussed.     

Parental Education and Child Health: Evidence from China*

This paper examines the effect of parental, household and community character‐istics on the health of children in China. We find that birth order, death of elder siblings, use of prenatal care and alcohol consumption by the mother when pregnant have statistically significant effects on the health of children. Although parental education does not have a significant direct effect on child health, it does affect mothers’ behavior during pregnancy and inflfluences the use of health inputs, indirectly impacting the health of children. The research findings have important implications for both family planning programs and broader social policies in China.     

Migrating for children’s better future: Intergenerational mobility of internal migrants’ children in Indonesia

Internal migration dominates population mobility in Indonesia; according to the 2010 census, there were almost 30 million permanent migrants, around 12.5 percent of the population. The effects of this internal migration on the second generation continue to be under-explored. This paper investigates the long-term impact of parents’ migration on their children’s intergenerational per capita expenditure when adults. We argue that parental migration affects the human capital investment on their children, which has a direct impact on the children’s outcomes when adults and on their deviation from the parents’ economic status, hence their intergenerational mobility. We pooled the five waves of data from the Indonesian Family Life Survey (IFLS), and we tackled the self-selection of parents’ migration using an endogenous treatment regression. Our findings show that despite the fact that parental migration increases the education level of children and their per capita expenditure, it increases intergenerational mobility of the children as adults compared with non-migrants’ children when they live in urban areas as adults, come from the poorest parents, or had migrated during childhood. The left-behind children have more intergenerational mobility only if their father migrated, while there is no significant impact on intergenerational mobility if their mother migrated. The results are consistent with the persistence of Indonesian individual inequality.     

Overpopulation and unemployment in Zimbabwe

The size of Zimbabwe's African population has grown dramatically over the past 50 years, with 5.7 children on average being born per woman. The following factors are responsible for the rapid population growth in Zimbabwe: the country's economic prosperity during the period of the Central African Federation from 1953 to 1963, and its successful food policy before and after independence; the success of the health system, also in both periods; and the fact that women have not been incorporated into the economy as wage-earners. A brief historical overview is presented, followed by sections on the food policy and health system, reasons for the persistence of large families, and the relationship between wage-earning by women and the birth rate. The author also describes some of the problems caused by overpopulation. Engaging more women in regular wage-earning employment is the key to controlling the birth rate in Zimbabwe. Current government policies encouraging female employment in government services and the economy in general, along with the expansion of contraceptive services, could influence female fertility over the long term.     

Birth order effects and parenting behaviors

While it is well known that there are systematic birth order effects on life cycle outcomes, there is less consensus about underlying channels and mechanisms of birth order effects. We find negative birth order effects among Chinese adolescents, favoring earlier-born children within household in academic achievement, cognitive skill measures, and in parenting behaviors including harsh parenting and parental investment. We highlight harsh parenting as a novel channel of birth order effects, in which earlier-born children are less likely to be physically punished by their parents. Heterogeneity analysis results are consistent with parents reinforcing academic advantage of better-performing earlier-born children, but do not support resource dilution, son preference, or reputation concerns as primary mechanisms underlying birth order effects. Our findings are in contrast to positive birth order effects found among earlier generations of Chinese siblings reported in the literature.     

What divides the first and second generations? Family time of arrival and educational outcomes for immigrant youth

In this article, I develop a measure of host country experience, which I call “relative time of arrival,” to explore differences between first- and second-generation immigrants. This measure is finer than immigrant generation and expands on the widely used measures of years since migration and age at migration. It is scaled so that zero indicates that a child was born in the same year that the family migrated, and the negative side of the scale measures parents' host country experience before the child's birth. I then use relative time of arrival to assess whether parents' host country experience before birth matters and generally find that it does not. I also study the dividing line between the first and second generations, specifically, whether there are differences in educational outcomes between early arriving first-generation immigrants and second-generation immigrants whose parents arrived shortly before birth. For most outcomes considered, I find that the transition between the first and second generations is relatively smooth, indicating that these groups are not as distinct as often thought. Thus, observed differences between the first and second generations are driven by the lower performance of late-arriving first-generation children.     

Geography and educational inequality in China

Since the 1980s, educational reforms in China have decentralized administration and finance and privatized costs. These changes have emerged in the context of rapid economic growth and rising regional economic disparities. The reforms have mobilized new resources in support of education, but they have also exacerbated regional disparities in funding for schools. Analyses of trends in school finance and expenditures have emerged, but detailed studies of the shifting ties between geography and educational outcomes in the population have not.Using 2000 census data on year and location of birth and educational attainment, we begin to address this gap. We compare the links between birth province and educational outcomes across 5-year birth cohorts to illuminate trends in region-based inequalities. Results show that the percent of variation in years of schooling explained by birth province declined for cohorts born through the early 1960s, and then increased thereafter.Additional analyses use a dissimilarity index to characterize the strength of the link between geography and access to each level of schooling. This index indicates that the link between geography and access to primary school has greatly increased across cohorts, as the few without access to primary school are ever more concentrated in poor areas. The link between birth province and access to subsequent levels of schooling shows mixed trends through cohorts born in the early 1960s: stability for junior high school and a weakening trend for senior high school and college. Thereafter, the dissimilarity index increased, substantially for junior high school and slightly for senior high school and college.Results attest to the enduring significance of geography as an educational stratifier in China. More broadly, results suggest the importance of regional inequalities in conditioning the relationship between development and educational stratification.     

South African trends in medical aid coverage and stated healthcare-seeking preferences: 2004–14

Using population-weighted general household surveys (GHS) covering the years 2004–14, this study examines trends in medical aid coverage and healthcare facility utilisation across a spectrum of socio-demographic variables. As there are few obvious patterns in the raw health variables' time series, the analysis relies upon both parametric and nonparametric regression analysis to smooth the time series in order to outline a few general trends. Over time, medical aid coverage and the general population's ‘preference’ for public health care decreased by 0.2% and 0.1% per year, respectively. Moreover, the probability that an individual, who is covered by a medical aid scheme, states their willingness to use public health care decreased by 44%.