 | Department of Economics |
PeopleResearch Themes
Health
MPhil Theses
Impact of Temporary Migration & Remittances on Child Health Outcomes in Punjab, Pakistan
Researcher: Myda Aslam (ongoing)
Abstract
Temporary migration in developing countries like Pakistan is generally in response to the income constraint faced by the households. In an attempt to relax the resource constraint, migrants tend to remit back to their families of origin. This study attempts to look at the impact of temporary migration and remittances on the health outcomes of children as measured by height-for-age z scores (HAZ) and weight-for-age z scores (WAZ) in Punjab. The data has been taken from Multiple Indicator Cluster Survey (MICS) 2011, Bureau of Emigration and Overseas Employment and State Bank of Pakistan. The study uses an Instrumental Variable Approach with Two Stage Least Square and Instrumental Variable Approach estimated through Treatment Effect Model. Historic migration rates and number of banks in each district is used as an IV for migration and remittances. Our results suggest significant and positive impact of migration, external migration and remittances on both the indicators of child health outcomes (Height for Age z-scores and Weight for Age z-scores).
Geographical Constraints and Health Facility Choice: Evidence from Kashf's Health Micro Insurance Program
Researcher: Dareen Latif (Ongoing)
Abstract
Low income individuals are vulnerable to risk arising from health induced income shocks, which entail sizeable economic costs for the poor, such as, loss of income, inadequate consumption and high out of pocket expenditures. Moreover, modern medicines and quality health facilities are inaccessible for one billion people across the globe, and therefore these result in a detrimental impact on health outcomes. This low utilization and inaccessibility of health services is especially true in the case of Pakistan. In light of this; health micro insurance offers a promising mechanism to protect the poor against risk and vulnerability. This paper, therefore, studies the impact of physical distance to panel facilities on utilization of health services in panel versus non-panel hospitals in the context of Kashf Health Micro Insurance (HMI) Program offered in collaboration with Jubilee Insurance. Thus, we will address three main research questions: First, what is the impact of physical distance on choice of health facility? Second, whether the burden of physical distance is greater for women, especially those with gynecological conditions? Third, whether information and transportation constraints could be possible mechanisms through which distance impacts facility choice. We will employ administrative data compiled using Kashf and Jubilee records on 30,000 hospitalization claims made by Kashf clients and their respective family members covered by the HMI program in Punjab. The time period considered is 2014-2017 which is the length of time the HMI program has been in operation. Additionally, the data on distance also comes from Kashf's records and alternatively, travel time is being tentatively calculated through GPS co-ordinates between the hospital and branches using geographic information system (GIS) software. Furthermore, district statistics related to length of metalled road network and government health infrastructure comes from Punjab Development Statistics (PDS) 2014.
Impact of Prenatal Exposure to Fasting on Cognitive Development of Children.
Researcher: Beenish Amir (Ongoing)
Abstract
Evidence has shown that prenatal nutritional shocks have a long lasting impact on health, cognitive ability and adult out comes. I would try to prove this by looking at the effect of prenatal exposure to fasting on cognitive development of children aged 5-15 years. In order to obtain valid results, fasting would be considered during the month of Ramadan, which relative to famines and natural disasters is a mild shock. Fasting in Ramadan takes place every year but the time is different each year because Ramadan follows the lunar calendar. The difference in days each year ensures that pregnancy decisions are exogenous to Ramadan occurrence. LEAPS study data collected by World Bank for different regions of Punjab would be used. Intent to treat analysis would be done to deal with noncompliance due to non-availability of data on whether all pregnant women fasted during Ramadan or not.
Child Nutrition, Education & Child Labor: Impact on Human Capital Accumulation
Researcher: Sara Khan (2018)
Abstract
This study constructs a two-period overlapping generation's model which incorporates both child nutrition as a measure of health and education to observe the complementing nature and nexus between them and how it alters parent's fertility decisions. The results of the model show that in the intermediate phase, the economy experiences a demographic transition. In this interval the child quantity-quality trade-off is observed but at a later stage the continuing process of increasing human capital allows agents to generate adequate resources to rear more children and simultaneously endowing them with the capacity of providing the children with education and nutrition. Minimum level of fertility in the model is attained when maximum child nutrition and time devoted towards education are attained. When human capital exceeds the maximum threshold level time devoted to education becomes a constant i.e. further increases in human capital has no effect on the time devoted to education pertaining that maximum capacity to learn has been reached. Moreover, the model also proposes insights on child labor policies which has implications for both human capital and economic growth.
Impact of Temporary Migration & Remittances on Child Health Outcomes in Punjab, Pakistan
Researcher: Myda Aslam (2018)
Abstract
Temporary migration in developing countries like Pakistan is generally in response to the income constraint faced by the households. In an attempt to relax the resource constraint, migrants tend to remit back to their families of origin. This study attempts to look at the impact of temporary migration and remittances on the health outcomes of children as measured by height-for-age z scores (HAZ) and weight-for-age z scores (WAZ) in Punjab. The data has been taken from Multiple Indicator Cluster Survey (MICS) 2011, Bureau of Emigration and Overseas Employment and State Bank of Pakistan. The study uses an Instrumental Variable Approach with Two Stage Least Square and Instrumental Variable Approach estimated through Treatment Effect Model. Historic migration rates and number of banks in each district is used as an IV for migration and remittances. Our results suggest significant and positive impact of migration, external migration and remittances on both the indicators of child health outcomes (Height for Age z-scores and Weight for Age z-scores).
The Impact of Early Childbearing on Child Health in Punjab
Researcher: Aeman Nadeem (2017)
Abstract
Early Childbearing is a major social and public health concern. Empirical studies have focused on both the consequences and causes of early childbearing. Much of the empirical work has focused on the impact of early childbearing on children's developmental and academic outcomes. However, there is limited research pertaining to the effect of early childbearing on child health outcomes in Pakistan. Using the newly available data, Multiple Index Cluster Survey for Punjab 2014; the paper aims to test if early childbearing affects child health outcomes, both in the short and long term. In addition to this, studies have established that the decision of early childbearing is influenced by a wide array of factors which include individual and household level characteristics as well as social and cultural norms. The paper also deals with the issue of omitted variable bias concerning early childbearing. As part of the estimation strategy, the paper employs ordinary least square, cluster fixed effects and household fixed effects. The empirical results shows that early childbearing exerts negative impact on child health outcomes. However; controlling for unobserved characteristics at household and cluster level shrinks the size of the coefficient of early childbearing compared to a simple ordinary least square estimate; indicating the influence of important household and cluster unobserved factors on early childbearing decision. The results of the paper also confirms that the analysis is robust to changing the specifications of early childbearing as well as the data set used in the analysis.
Link to the Paper:
http://121.52.153.178:8080/xmlui/bitstream/handle/123456789/15803/Aeman
%20Nadeem.pdf?sequence=1&isAllowed=y
The Impact of Prenatal Exposure to Fasting on Child Health Outcomes
Researcher: Azka Sarosh Mir (2017)
Abstract
Early-life factors play an important role in fetal development, according to Barker's (1990) 'womb-with-a-view' hypothesis. This study examines how prenatal exposure to fasting in the month of Ramadan has an impact on child health outcomes in terms of height-for-age and weightfor-age z-scores. In the absence of actual reported fasting behaviors, we use the 'intent-totreat' (ITT) approach, as applied in randomized control trials. This allows one to measure the unbiased impact of an intervention, even when there is imperfect compliance with random assignment into control and treatment groups. While the ITT approach does not require or assume that all women pregnant during Ramadan necessarily fast, it is critical for Ramadan to remain exogenous to the timing of pregnancy. In other words, we assume that women do not intentionally time their pregnancies to fall outside of Ramadan. The ITT framework is used to compare the health outcomes of two groups of children under five in the Punjab - those whose period in utero coincided with the month of Ramadan (the treatment group) and those who were not exposed (the control group). This is done without using any information on maternal fasting behavior. In each case, the child's date of birth establishes whether the pregnancy overlapped with the month of Ramadan and this information is used to construct a set of gestational month-of-exposure variables. The data for this analysis is drawn from the Multiple Indicator Cluster Survey for 2008 and 2011, carried out by the (Punjab) Bureau of Statistics. The study's results indicate that prenatal exposure to fasting during the first two trimesters has negative implications for children's height-forage. In addition, children who were prenatally exposed to fasting in the second and third trimesters were, on average, thinner than nonexposed children. We find no evidence of selection bias arising from the decision to selectively time a pregnancy to avoid Ramadan - a major concern of our study.
Published Paper: CREB Working Paper No. 01-18.
Female Empowerment and the Uptake of Maternity Care Services in Pakistan
Researcher: Amber Masood (2015)
Abstract
According to the UNICEF Report (2013), the maternal mortality ratio (MMR) in Pakistan is very high as opposed to the MDG 5 target1. This high maternal mortality can be reduced considerably if the females utilize the required maternity care services. However, in terms of the uptake of antenatal care, skilled birth attendants and post-natal care, Pakistan is lagging behind other South Asian Countries (UNICEF Report, 2013).This brings us to the question that despite such high mortality rates, why are females not utilizing the required services for the sake of their own and their newborn's health? One of the factors, which is a rising focus of demographic and health research and needs to be explored in much more detail for Pakistan, is the empowerment of females. Using information from Pakistan Demographic and Health Survey (2012-13), on currently married females (aged 15-49), who had a baby within five years prior to the survey, this study aims to look at the impact of different dimensions of empowerment on maternity care uptake. Female empowerment is divided into three dimensions: behavioral, attitudinal and exposure to domestic violence. To address the possible endogeneity, an IV Approach combined with Cluster Fixed Effects is used and couple's age difference and female's premarital empowerment status (proxied through her mother's exposure to domestic violence) are used as instruments. According to the results, all dimensions of female empowerment have a significant impact on antenatal care but safe delivery postnatal care remains unaffected by it.
Link to the Paper:
http://121.52.153.178:8080/xmlui/bitstream/handle/123456789/14168/Upload-Amber%20Masood-%20oct%206-15.pdf?sequence=1&isAllowed=y
Effects of Birth Order on Child Nutritional Status
Researcher: Maha Khan (2014)
Abstract
Birth order and the associated parental discrimination are evidenced to detrimentally affect a child's long-term nutritional status. This research explores the in depth role of birth order in determining child nutritional status through a between- and intra- family analysis of stunting, wasting, and underweight in children. It further tries to evaluate whether the child's height-for-age varies with gender; and if the drop off in height with each additional birth order can be attributed to pre and post-natal health disinvestments in pregnancies and births. The Punjab Multiple Indicator Cluster Survey for 2011, a household-level dataset gathered by the Punjab Bureau of Statistics, provides our sample data. The results of this study imply that birth order has negative effects on child health, with child height and weight gradient monotonically declining with increasing birth order children. Moreover, birth order effects become stronger in larger families, even after controlling for birth spacing. Yet, we find only limited evidence of gender based postnatal disinvestment on mothers in household fixed effects regressions, while no gender specific effects were observed for child health investments.
Link to the Paper:
http://121.52.153.178:8080/xmlui/bitstream/handle/123456789/14051/upload-MPhil%20Thesis%202014%20-%20Maha%20Khan.pdf?sequence=1&isAllowed=y
The Impact of Remittances and Parental Absence on Children's Wellbeing in Rural Punjab
Researcher: Nida Jamil (2014)
Abstract
This study examines the impact of migration on children left behind in terms of schooling and child labor by quantifying both aspects of migration, i.e., remittances and parental absence. In particular, it focuses on cases where the father is the migrant. The study is based on a panel analysis of data drawn from the Multiple Indicator Cluster Survey for 2007 and the Privatization in Education Research Initiative survey for 2011. The sample comprises 820 households with children aged 5-14 years. The study uses the instrumental variable approach as well as household fixed effects and random effects to resolve any possible endogeneity. Exogenous variations in parental absence and remittances sent by migrants from a given kinship network are employed as instrumental variables. The study finds that (i) an increase in remittances of PRs 1,000 ($10) raises the probability of being enrolled in school by 13 percentage points, and (ii) the absence of the father increases the probability of a child engaging in labor by 25 percentage points. Remittances, while benefiting the household, emerge as an incomplete substitute for the absent father. This effect is particularly strong for children who already lack a mother due to death or divorce. The mother's presence, however, compensates fully for the father's absence. Moreover, the father's absence has worse consequences for girls in terms of increased child labor, where even the money coming in through remittances is more likely to be spent on boys.
Published Working Paper: CREB Working Paper No. 03-15.
The Determinants of Child Health and Nutritional Status in Punjab: An Economic Analysis
Researcher: Uzma Afzal (2012)
Abstract Child health is considered a key indicator of economic development and the quality of life in developing countries. It is also closely related to other development indicators such as adult health, educational attainment, income, and occupational productivity. In the past few years, despite having had clear health targets in the form of the Millennium Development Goals, Pakistan has been unable to attain significant progress in improving child and maternal health. This study focuses on the health and nutritional status of children in Punjab. It attempts to identify the socioeconomic factors that affect child health at the household level, and presents policy recommendations based on its findings. The study's theoretical framework is based on the household production model, and we use the instrumental variable technique for estimation purposes. The Multiple Indicator Cluster Survey for 2007/08, a household-level dataset gathered by the Punjab Bureau of Statistics, provides our sample data. The study's results imply that maternal education and health knowledge are important determinants of child health, among other significant indicators.
Published Working Paper: CREB Working Paper No. 02-12.
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