Essays in Maternal and Child Health Economics
Donato, Katherine Elizabeth
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AbstractOverall, this dissertation studies important issues around the early years of our lives, both in developing and developed countries. With coauthors I first look at how maternity and neonatal care are influenced by what else is going on while a woman is laboring in a hospital. Analyzing a robust dataset covering a 16 year period in Philadelphia, we find that the busyness of a labor floor – measured by the number of other women on the floor – has meaningful adverse effects on the risks of use of interventional procedures such as cesarean sections and of adverse maternal health outcomes. There is no association with adverse neonatal health outcomes, suggesting that the increased use of interventional procedures may be unnecessary from a medical perspective.
After this analysis, I turn to the first years after children are born. During this period nutritional intake is especially important due to the lifetime consequences on cognitive development, health, and physical development. With this motivation, I study the effects of two randomized interventions targeting child nutritional intake in Ethiopia. In the first experiment, with coauthors I analyze how behavioral techniques can be used to translate the development of improved crop varieties (Quality Protein Maize, in this case) into actual behavior change and improvements in nutritional status. Prior efforts in this space have resulted in the development of numerous improved crop varieties that improve children’s nutritional status in controlled settings, but little effect on children in real-world settings. We find that educating caregivers and household heads about the importance of keeping improved crop varieties separate for their young children, combined with tools for earmarking and labeling the grain, effectively improves a number of intermediate outcomes, including the children’s consumption of the improved crop varieties and the caregivers’ cooking and food storage behaviors. However, there were no meaningful improvements in the children’s nutritional status.
In the second experiment, I build on the first trial to study how small nudges grounded in behavioral economics can be used to improve young children’s overall nutritional intake and nutritional status. Specifically, I build on the finding during the first trial that caregivers were often unaware of or unconcerned about their child’s poor nutritional status (i.e., height) and analyze the impact of providing personalized information about the children’s nutritional status to caregivers. Given the economic constraints of the region, I pair this with an orthogonal cash transfer intervention, where the cash transfer is labeled as being specifically for additional food for the young child. I find that both interventions were effective in increasing the children’s consumption of eggs, a key underutilized source of protein in the context. However, the cash transfer was generally more effective in terms of effect size and diversity of impacts (i.e., relevant outcomes other than egg consumption). Both interventions led to improvements in the children’s sex- and gender-standardized weight.
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