Height and child survival: measure of family well-being

Responsible researcher: Viviane Pires Ribeiro

Paper title: CHILD SURVIVAL, HEIGHT FOR AGE AND HOUSEHOLD CHARACTERISTICS IN BRAZIL

Article authors: Duncan Thomas, John Strauss and Maria-Helena Henriques

Location of intervention: Brazil

Sample size: 41,233 households

Big topic: Health

Variable of main interest: Height and Infant survival rate

Type of intervention: Study by region of household variables that influence height and child survival

Evaluation method : Experimental Evaluation (RCT)

Assessment Context

The National Family Expenditure Study (ENDEF) is a large-scale household expenditure survey in Brazil. This research was useful to the authors because of the breadth of the data set, which covers a considerable number of families, and the breadth of questions asked of these families. Questions such as: consumption and expenditure, income, height and weight of all members and fertility of each woman. Although the data is tabulated at the regional level, the authors could not find any other work published at the time that explores the richness of the data at the household or individual level.

Intervention Details

Brazil was divided into the same seven regions used in the National Household Sample Surveys (PNAD's). The authors used information from 41,233 households, seeking to determine how household characteristics are related to the height of children under eight years of age. Since a child's height varies according to gender and age, Thomas et al. (1990) observed that within each of the four age groups, the average child height is greater in the urban south, and within each region, the height is greater in urban areas. They also identified important regional differences in child nutrition outcomes that are independent of income; on average, income is higher in the urban Northeast when compared to the rural South.

To analyze the child survival rate, the authors distributed the mothers' ages into four age groups. Differences between the urban and rural South are small, although few mothers lost a child in the urban sector. In the Northeast, mortality rates are higher and the difference increases with age; Furthermore, there is a significant difference between urban and rural sectors.

Methodology Details

Thomas et al. (1990) adopted Becker's (1965) model of domestic behavior, assuming that families exercise choice over consumption, including leisure. In this way, the number of births, the number of child survival and the height of the child can be thought of as being the results of inputs into a health production function. Some of these inputs are under parental control (such as food consumption, breastfeeding time, allocation of parental time, and use of community services); others are predetermined (such as parental height, education, or the incidence of disease in the community).

Result

The authors found a positive and significant impact of maternal education on height and child survival. Both outcomes are affected by paternal education, although in the case of survival, the effect of mother's education is stronger.

The education of the mother and father are significantly associated with the child's height. In the urban Northeast, for example, in relation to having an illiterate mother, a child with a literary mother will be about 1.6% higher, 2.5% higher if the mother has completed primary school and 4.2% higher if have completed secondary school. The marginal effects of maternal education are slightly smaller in the South. The same pattern is identified in rural areas, although the magnitudes are considerably smaller.

The height of the mother and father are important determinants of a child's height, having a greater impact in rural areas. There is also a large effect of maternal height on child survival. The effect of income on survival rates is positive and significant, except in the urban South.

The impacts of household-level variables differ by region and urban or rural residence, particularly on child survival outcomes. Maternal education has a greater impact on child survival in the Northeast when compared to the South; a similar pattern is identified for family income in relation to height and child survival. The impact of maternal height on child survival is greater in rural areas and in the Northeast. Such differences suggest that regional factors play an independent and important role, as well as modifying the impact of domestic-level variables.

Public Policy Lessons

Studies prior to Thomas et al. (1990) were mainly concerned with income inequality in Brazil and paid little attention to other indicators of well-being, such as child survival and height, which are characterized by substantial interregional and interregional heterogeneity. Given this gap, the authors sought to determine the impact of household characteristics on child survival and height, conditional on age. The results indicate that parental education has a positive and significant effect on both outcomes. Although part of this effect is through income, most of the educational effect is independent of family income. Thus, other studies that have focused on the role of education solely as a means of increasing income have underestimated its importance in improving well-being. The authors argue that education can be considered a proxy for the family's socioeconomic characteristics and demonstrate that educational effects remain positive and significant, even after controlling for height and family income.

Parental heights are important determinants of child height and survival. In both cases, the influence of maternal height is greater than that of the father, which may reflect the mother's greater role in raising the child. The results found by the authors support the view that height is a useful predictor of human well-being, even when controlled for income and education. Therefore, policies designed to increase the long-term nutritional status of a population are likely to have complementary effects on long-term child survival.

Reference

THOMAS, Duncan; STRAUSS, John; HENRIQUES, Maria-Helena. Child survival, height for age and household characteristics in Brazil. Journal of Development Economics , vol. 33, no. 2, p. 197-234, 1990.