Gender under Distress

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Gender under Distress

Essays on Climatic and Familial Determinants of Gendered Outcomes in African Populations

Martin Flatø

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© Martin Flatø, 2016

Series of dissertations submitted to the

Faculty of Social Sciences, University of Oslo No. 622

ISSN 1564-3991

reproduced or transmitted, in any form or by any means, without permission.

Cover: Hanne Baadsgaard Utigard.

Print production: Reprosentralen, University of Oslo.

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I feel extremely fortunate that I have had the opportunity to indulge in fas- cinating research projects and work with brilliant people. First and foremost, I would like to thank my supervisors Øystein Kravdal and Andreas Kotsadam for making it all such a pleasant experience. Øystein has been extremely en- thusiastic and supportive since he encouraged me to join the PhD programme and throughout the process. His feedback has vastly improved the quality of the research in this thesis in terms of both presentation and analysis. His inspiration through teaching and research is of immense importance for demography in Norway, which I hope will continue to be spread to future cohorts of demographers.

Andreas is an incredible capacity in anything from causal methods to feminist theory. It’s been fantastic to work so close together during the last years and to have him as a friend. I have learned a lot from his bold and creative approaches to social research.

I would also like to thank my co-authors. I have really enjoyed working with Sara Cools, who is very resourceful and rigorous in her work. The collaboration with Raya Muttarak has taken me to Kao Lak, Bloemfontein, and Laxenburg, and I’ve benefited from her push for clarity of arguments and policy relevance of research. She also introduced me to André Pelser who shared his profound insights into the functioning of social institutions in South Africa, including excellent Braais.

The PhD also marks the end of five years of employment at the Department of Economics and twelve years in and out of the institution. I would like to thank everyone there, including current and former administrative staff, Anders, Anna, Arne, Askill, Astrid, Eivind, Espen, Frikk, Henning, Kristoffer, Martin, Nina, Pernille, Siv-Elisabeth, Torben, and other fellow PhD students, and Anirban, Edwin, Jo, Monique, Nico, and other scientific staff who have taken an interest in my work. In particular, I’ve been fortunate to be part of ESOP and would like to thank Kalle Moene and Halvor Mehlum for including

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me in their centre. I also enjoyed my stays in Sweden, Austria and South Africa and the company of the great people I met there. Thanks to SUDA and IIES at Stockholm University, Masayuki Kudamatsu, Juho Härkönen and Sven Drefahl for great courses, and Roland and Elisabeth for the friendship and hospitality. Thanks also to the International Institute of Applied Systems Analysis, the South African National Research Foundation, and the Norwegian Research Council for making those stays possible. An institution which has meant a lot to me during these years is the Norwegian Demographic Society with dedicated members such as Arve, Astri, Christin, Henrik, Janna, Lisa, Marianne, Rannveig, Solveig, Torkild, and Vegard.

Not least, I would like to thank Carol who is very relieved that this thesis is now completed. Thanks also to other family and friends for their support.

Blindern, 19 August 2016

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Summary

This dissertation consists of five essays on how gendered outcomes change when stressors put pressure on resources in Sub-Saharan Africa. Three essays consider how deviations in rainfall from what is normally observed in a location affect outcomes for girls and women. Rainfall strongly influences household income and local and national economic activity in Sub-Saharan Africa, as most households engage in agriculture which often lacks irrigation. As yearly variation in relative rainfall is independent of household characteristics, these papers use rainfall to uncover how changes in income affect gender differences in infant mortality and violence against women in Sub-Saharan Africa, and female-headed households in South Africa. Two essays consider stressors coming from within the family, namely failure to achieve a desired gender composition of offspring and restrict fertility to desired levels. Specifically, the articles consider how these stressors affect infant mortality and women’s perceptions of the ideal family size and gender composition.

Written together with Andreas Kotsadam, the first paper uses data from Demographic and Health Surveys (DHS) on 1.5 million infants born 1980-2010 in 29 countries and finds that extreme droughts cause a gender difference in infant mortality with 12 more female than male infant deaths per 1000 live births. We argue that the results are too large to be explained by biological differences between the sexes, which is further supported by the finding that differences are larger in areas where the level of son preference is high and desired fertility rates are low. We also find that the effect is larger for non- working women and in locations where female labour force participation is low, but we do not find different effects by level of education.

The second essay is co-authored by Sara Cools and Andreas Kotsadam and uses variation in rainfall to study how income shocks aﬀect intimate partner violence in Sub-Saharan Africa. We use DHS data with up to 149,000 women in 17 countries who where asked about whether they had experienced violence from their partners. The analysis proves the presence of spatial autocorrela-

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tion in weather shocks when using cross-sectional data, and corrects for this.

We ﬁnd no evidence supporting our theory that unusually low levels of rainfall would increase intimate partner violence. This holds both for the probability of experiencing violence in a given year, and for the risk of experiencing violence for the ﬁrst time during the course of a marriage. We speculate that the collective nature and slow onset of droughts trigger less aggression and more adherence to social norms than other income shocks that might increase violence against women in Sub-Saharan Africa and elsewhere.

In the third essay which is co-authored with Raya Muttarak and André Pelser, we show that an already marginalised group - female-headed households in South Africa - is differentially affected by relatively modest levels of variation in rainfall. Data from three waves of the National Income Dynam- ics Survey in South Africa allow us to follow incomes of 4,162 households from 2006-2012. We find that households where a single head can be identified based on residency or work status are more vulnerable to climate variability than households headed by two adults. Single male-headed households are more vulnerable because of lower initial earnings and, to a lesser extent, other household characteristics that contribute to economic disadvantages. However, this can only explain some of the differential vulnerability of female-headed households.

This suggests that there are traits speciﬁc to female-headed households, such as limited access to protective social networks or other coping strategies, which makes this an important dimension of marginalisation. Households headed by widows, never-married women, and women with a non-resident spouse (e.g.

‘left-behind’ migrant households) are particularly vulnerable.

This fourth essay studies how being born at a parity or of a sex which is undesired by the mother relates to infant mortality in Sub-Saharan Africa, and how the differential mortality attributable to these preferences changes across the demographic transition. Using data from 79 DHS surveys, I find that being undesired according to the mother is associated with a differential mortality which is not due to constant maternal factors, family composition, or factors that are correlated with maternal preferences and vary continuously across siblings. As a share of overall infant mortality, differentials according to undesiredness of children explain 3.3% of male and 4% of female infant mortality. Undesiredness can explain a larger share of infant mortality among mothers with lower fertility desires, and a larger share of female than male infant mortality for children of women whose fertility desire is between 1-3

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children. Undesired gender composition is more important for infant mortality than undesired childbearing and may also lead couples to increase family size beyond the maternal desire, in which case infants of the surplus gender are particularly vulnerable.

Data from the same surveys are used in the fifth essay which asks whether mothers adjust their fertility preferences when having more children. To that end, this paper uses giving birth to twins at first parity and the two first- born children being of the same sex as natural experiments which increase the number of children ever born and the number of live children at interview. I find that having an additional child increases the ideal family size by 0.1 - 0.8 child and that the effects are much stronger for women who have fewer children than they desire than for women who have more children than they desire.

These findings are not consistent with the prevailing theory that rationalisation (i.e. the upwards adjustment in preferences to disguise unwanted childbearing) explains changes in fertility preferences. Rather, I propose that a process of learning about costs and benefits of childbearing could lead to the continuous updating of fertility preferences that we observe. Furthermore, the gender of the first child is used to estimate that having a son or daughter leads to an increase of 0.1 child in the desire for children of that gender.

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1 Introduction

This dissertation is about how gender, understood as a pervasive system of patterned inequality (Riley, 2005), depends on the circumstances within which it is situated. Demographic studies are beginning to treat gender as a social construction which is therefore embedded in the societies and cultural contexts in which people live, with its meaning also changing across time (Riley and McCarthy, 2003; Williams, 2010). The ﬁve essays in this thesis go beyond time and place to identify situations in which the role of gender changes, and in particular the function of external and intra-household stressors in shaping gendered outcomes.

Gender under distress is in this dissertation studied in populations in Sub- Saharan Africa, a large and diverse sub-continent with interesting variation yet also some general patterns in the role of gender in shaping demographic outcomes. For example, sex ratios in infant mortality in the 2000s varied between 106 males per 100 females in the Democratic Republic of Congo and Burkina Faso and 137 males per 100 females in Gabon, which is still above corresponding levels in India (97 per 100) and China (76 per 100) (United Nations Population Division, 2011). The lifetime risk of maternal death is 1 in 36 in Sub-Saharan Africa, more than four times higher than in developing regions all together (World Health Organization et al., 2015). The HIV/AIDS epidemic is an even larger contributor to gender diﬀerences in adult mortality than maternal deaths in Sub-Saharan Africa as a whole, with devastating impacts in southern and central regions (Anderson and Ray, 2010). Intimate partner violence is widespread aﬀecting more than a third of women in Africa during their lifetime, and two thirds in central parts (World Health Organization, 2013).

Other characteristics such as high fertility (United Nations Population Divi- sion, 2015) and high labour participation (Sen, 1990) furthermore contribute to common traits in the role of gender in Sub-Saharan Africa, although as this dissertation also documents, there are vast diﬀerences in how gender should be understood in diﬀerent households and social contexts.

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Gendered outcomes may change in instances when extraordinary circumstances put pressure on existing gender norms and practices. Erratic rainfall is one source of vulnerability which is particularly salient in Sub-Saharan Africa as it causes large year-to-year variations in yields in rain-fed agricultural production. This is a stressor which is becoming more important as climate change interacts with non-climate drivers and stressors to exacerbate vulnerability of agricultural systems (Niang et al., 2014). Existing gender inequality is believed to be heightened as a result of weather events and climate-related disasters intertwined with socioeconomic, institutional, cultural, and political drivers (Olsson et al., 2014). Three essays in this dissertation study how gendered outcomes are inﬂuenced by weather-induced income shocks, providing insights for the global discussion on distributional impacts of climate change.

Pressure on economic resources may also come from within the family. Gender inequalities increases the importance of the composition of the family in terms of the number, age, sex, and health of its members for current and future economic vulnerability, and economic and compositional considerations shape gendered behaviours and outcomes. In southern Africa, a history of economic migration and re-settlement, violence against women, and HIV/AIDS has lead to a breakdown of traditional family structures (Wright, Noble, Ntshongwana, Barnes, and Neves, 2013), which has resulted in a continued increase in the number of female-headed households, currently with more than 40% of households in several countries being female-headed (ICF International, 2015). These households often face a ‘triple burden’ with a gender gap in earnings, a high dependency ratio and other disadvantaged household characteristics, and specific constraints related to female heads managing multiple roles (Rosenhouse, 1989). With gender being of importance for economic and care-taking roles, women are often under pressure to produce a balanced sex composition of offspring, and increasingly also committed to restricting overall family size. This stressor again reveals how gender is a situational concept, as investments in child health and survival may depend on whether there is a surplus of either gender relative to parental preferences. Adding to the complexity of studying gender as situated within the familial context is the notion that preferences for the gender and number of offspring may not be constant throughout a woman’s reproductive career, but may change in response to life events such as the birth or death of a child.

The dissertation contains six chapters corresponding to ﬁve essays. Here

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follows a summary of these.

Chapter 2: Droughts and Gender Bias in Infant Mortality in Sub-Saharan Africa

Are African girls more exposed than boys to risk of infant mortality during crises such as droughts, and is such a diﬀerence due to discrimination? Sub- Saharan Africa is characterised by a large female advantage in infant mortality (Anderson and Ray, 2010) and lack of systematic diﬀerences in breastfeeding and health-seeking behaviour for male and female infants (Garenne, 2003).

Still, Friedman and Schady (2012) ﬁnd that aggregate economic shocks increase infant mortality more for girls than for boys in Sub-Saharan Africa.

Little is known about the mechanisms behind this difference in mortality, although such an understanding is critical to designing effective policies (Fried- man and Schady, 2012). In this chapter which is written together with Andreas Kotsadam, we use exogenous income variation in form of unusually low precipitation relative to what is normally experienced during the rainy season in a particular location to study how income shocks affect gender differences in infant mortality. To that end, we use retrospective fertility data on over 1.5 million births from Demographic and Health Surveys from 29 countries and find a substantial gender difference of 12 more female than male deaths per 1000 live births following a drought below two standard deviations below the mean in the last rainy season before birth. With spatial and temporal correlations controlled for, this measure is unrelated to potential confounders.

Although droughts are exogenous shocks that aﬀect infants through changes in household income, we also carefully consider other channels. First and foremost, droughts may reduce the prevalence of water- and vector-borne diseases, which also potentially aﬀects sex ratios in mortality (Confalonieri et al., 2007;

Rabassa, Skoufias, and Jacoby, 2012). If droughts before birth lead to fewer diseases, this will affect foetal development but is unlikely to have a direct effect on the infant after birth, as the vectors tend to be short lived. Secondly, gender-specific selection into birth may also play a role if pre-conceptional and pre-natal factors influence sex ratios at birth (Pongou, 2013). We analyse and discuss these factors extensively and we find no effects of droughts on the sex ratio at birth, nor on birthweight. Furthermore, calculated bounds on the birthweight results are too small to explain our results and we show that the results

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are not driven by more boys surviving, even in areas with high prevalence of malaria.

We also make use of the large variation in our data to substantiate whether the gender difference observed could be the result of a bias in household prior- ities favouring boys. This gender bias may occur due to preferences for male over female survival, or differences in expected returns of raising a male and female child. To determine whether gender discrimination during crises dif- fers along relevant characteristics is furthermore important to gain a better understanding of the phenomenon, as well as for policy. In particular, we focus on employment, education, and preferences for sons and childbearing as contextual variables that are believed to be important in moderating whether droughts create a gender bias in infant mortality. The contextual analysis supports the proposition that social factors play an important role as we only find a gender bias in areas where the level of son preference is high and desired fertility rates are low. We also find that the effect is larger for non-working women and in locations where female labour force participation is low, but we do not find different effects by level of education. Taken together, the results suggest that there is substantial gender bias in the effects of droughts on infant mortality.

Extreme weather is likely to become more prevalent in Africa in the future due to climate change (Boko et al., 2007). Reducing households’ vulnerability to rainfall shocks and enabling households and communities to cope with income insecurity are therefore major focus areas for development policies. The special vulnerability of young girls during crises should be taken into account in the assessment of such policies. For eﬀective interventions, there is a need for both an understanding of the extent to which crises increase gender diﬀerences in mortality and of the conditions under which this occurs. This study con- tributes to this end. It also sheds light on which factors are important for the exceptionally low levels of gender discrimination in infant mortality in the sub- continent and whether this exceptionalism is likely to hold in the future. Our results are consistent both with theories arguing that discrimination between infants and at birth is relatively rare in Africa due to a high level of female employment (Sen, 1990), and theories arguing that parts of Africa with strong son preferences will see increased discrimination when exposed to pressure to limit family size and/or gaining access to sex-selective technologies (Bongaarts, 2013).

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Chapter 3: Weather Shocks and Violence Against Women in Sub-Saharan Africa

Sub-Saharan Africa has one of the highest levels of violence against women among the regions of the world (World Health Organization, 2013). Why that is the case is an intriguing question, and the region has been plagued with other factors that are commonly thought to aﬀect violence, such as conﬂicts and poor institutional quality. As Sub-Saharan Africa is also the world’s poorest region, a plausible hypothesis is that violence is so widespread there because households are poor (Cools and Kotsadam, 2014). In this chapter which is co- authored with Sara Cools and Andreas Kotsadam, we seek to contribute to this understanding by using one of the most common sources of income variation in the developing world, namely variation in rainfall (e.g. Burke, Gong, and Jones (2015); Harari and La Ferrara (2013)).

The strategy of using rainfall variation as a proxy for income shocks has several potential advantages, mainly in terms of identification. As poor areas are different from rich areas on many dimensions, such as having poor institutions and poor schools, it is hard to disentangle the causal effects of contextual poverty from the effects of these other factors. Similarly, at the individual level it is hard to distinguish the effects of poverty on violence from factors that may cause both poverty and violence such as low impulse control or self-esteem. By using deviations in rainfall relative to what is normally observed in each location, we are exploiting an exogenous source of variation in income. Whether a rainfall shock occurs in one year or the next at a particular location is random, and we are able to exploit this random variation using a fixed effects framework.

We combine data on precipitation from the ERA-Interim project with the best available data on domestic violence, namely the Demographic and Health Surveys (DHS). In recent years, the DHS surveys include questions on domestic violence, and they also contain GPS coordinates at the level of the primary sampling unit. This enables us to connect experiences of abuse to rainfall shocks. Our complete sample consists of 149,000 women in 17 countries. Despite being the best available large scale data set on domestic violence, DHS is still limited in time as the respondents exposed to the domestic violence module are surveyed between 2003-2013. Furthermore, we have repeated observations on domestic violence for nine countries only. We therefore analyse the data using several diﬀerent empirical strategies, with their respective

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advantages and disadvantages.

Our main variable of interest is whether the women have experienced violence during the last year before the survey. We believe that this measure is the most accurate as it is easiest recalled, and that year-to-year changes in violence against women would be the most responsive to climatic variation. However, we also investigate two measures of violence on the extensive margin, i.e. reﬂecting whether climatic shocks create more victims of intimate partner violence. These are the probability of having ever experienced violence in a relationship, and the probability of experiencing violence for the ﬁrst time in a marriage or cohabiting union in a given year.

We start by using variation in weather shocks in the total cross-sectional sample, and analyse whether rainfall shocks are correlated with the risk of having been abused last year. This strategy uses a large sample but has serious drawbacks in terms of internal validity. Since rainfall is determined by large weather systems, places that are close to each other are likely to be aﬀected by shocks at the same time. As places close in space are likely to share many characteristics, including culture and institutions, areas that experience a shock are likely to diﬀer from areas that do not. We prove that this indeed causes the residuals to be spatially autocorrelated, and add spatial polynomials to correct for this, as suggested by Lind (2015).

As it is not possible to control for area fixed effects in the pooled cross- sectional analysis, we proceed to use two other strategies that enable us to control for grid level fixed effects. The second strategy consists of using a limited sample from nine countries for which we have repeated surveys. Even though the surveys are not longitudinal in the sense that each household is followed over time, it is a repeated cross section whereby we have observations from two time periods at the grid level. Aggregating the data to the grid level and measuring the effects of droughts and floods on the change in the probability of women experiencing violence essentially controls for all time invariant confounders. Using this model, we cannot reject spatial independence of residuals in our most elaborate specification. We can also verify that droughts increase the likelihood of observing a level of household wealth within the two lowest quintiles of the wealth distribution. This strategy is thereby stronger in terms of identification, but the drawbacks are a limited sample size and that the two samples in the same areas might differ in the different years.

The third strategy instead exploits the fact that women who have experi-

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enced partner violence are also asked how many years passed after marriage before they were abused for the first time. Since we also know how long each woman has been married, we can combine our weather data with the timing of first abuse and see whether weather shocks affect the risk of being abused for the first time. We deem this strategy to be strongest in terms of internal validity as we are exploiting a 10-year time series within the same sample. This analysis identifies climatic determinants of the extensive margin of abuse, i.e.

factors that contribute to husbands crossing the important boundary it is to start becoming abusive towards their wives. However, it does not capture the intensity or the likelihood of re-occurrence of violence within a relationship.

Contrary to our expectations, we generally do not ﬁnd any association between droughts and intimate partner violence. This holds both on the intensive margin when studying violence during the last year before each survey, and on the extensive margin when studying the probability of ever having experienced violence in a relationship or the propensity of a marriage to turn violent. In the latter case, the most severe droughts may even reduce the likelihood that violence is initiated. The lack of association is in spite of evidence that droughts cause relative wealth loss in aﬀected communities. We can only speculate why this is the case. First, the strong association between wealth and intimate partner violence in Sub-Saharan Africa may be related to other aspects of relative deprivation than the economic situation itself in this narrow sense, such as historical violence and extortion. Secondly, there may be aspects of the particular income shock from lack of rainfall which makes it less likely to trigger intimate partner violence than other income shocks. In particular, the collective nature and slow onset of droughts may trigger less aggression and more adherence to social norms than other income shocks.

The chapter concludes that if there is a relationship between poverty and violence against women in Sub-Saharan Africa, it is likely to be a complex and contextual one. More data is needed to uncover such patterns, preferably panel data, which would allow for following a marriage through better and worse with detailed accounts of violence. In the chapter, we take full advantage of the spatial and temporal aspects found in currently available data and use an exogenous source of income variation to identify causal eﬀects. Through these means, we are not able to identify any stable and statistically signiﬁc- ant relationship between droughts and violence against women in Sub-Saharan Africa.

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Chapter 4: Women, Weather, and Woes: The Triangular Dynamics of Female-Headed Households, Economic

Vulnerability, and Climate Variability in South Africa

In this chapter which is co-authored with Raya Muttarak and André Pelser, we show that an already marginalised group - female-headed households in South Africa - is diﬀerentially aﬀected by relatively modest levels of variation in rainfall, which households experience on a year to year basis. Data from three waves of the National Income Dynamics Survey in South Africa (Southern Africa Labour and Development Research Unit, 2014a,b,c) allow us to follow incomes of 4,162 households from 2006-2012.

Much of the vulnerability to poverty literature is troubled by being unable to distinguish differential vulnerability of female-headed households from heterogeneity which not only makes this group worse off, but may also create a different income trajectory over time, and which may have contributed to establishing the household as female-headed in the first place. In this study, we are able to control for all observable and unobservable characteristics of the household through fixed effects and also take into account that different headship groups may have diverging time trends. As we observe all household characteristics and most notably headship at the start of our time series in 2006, our analysis is not troubled by the potential reverse causality problem in which an income shock leads to a change in household structure. Furthermore, by observing how household income is affected by variation in rainfall relative to what is normally experienced during the rainy season in each district, our study employs a series of naturally occurring experiments that allow us to identify causal effects.

The study uses objective headship definitions rather than self-reported headship (Fuwa, 2000), and through this, we are able to clarify what types of household structures matter for economic vulnerability. We find that households where a single head can be identified based on residency or work status are more vulnerable to climate variability than households headed by two adults. Single male-headed households are more vulnerable because of lower initial earnings and, to a lesser extent, other household characteristics that contribute to economic disadvantages. However, this can only explain some of the differential vulnerability of female-headed households. This suggests that there are traits specific to female-headed households, such as limited access to protective social

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networks or other coping strategies, which makes this an important dimension of marginalisation to consider for further research and policy in South Africa and other national contexts. Households headed by widows, never-married women, and women with a non-resident spouse (e.g. ‘left-behind’ migrant households) are particularly vulnerable. Of these, the never-married female-headed households is the largest group. Using the Agricultural Stress Index of the Food and Agriculture Organization (Rojas, Vrieling, and Rembold, 2011) at the district level in South Africa, we are able to show that precipitation variability is significantly associated with variation in agricultural outputs across time within a district. Consequently, we also find the greatest impacts of rainfall on incomes and the largest differentials by headship groups in the districts where it causes the greatest loss in yields.

The number of female-headed households is on the rise in South Africa and the frequency and intensity of abnormal weather events is increasing because of climate change. Under both wetter and drier climate futures, significant socio-economic implications are expected for vulnerable groups and communities in South Africa, including female-headed households. These implications will largely manifest through impacts on water resources and a higher frequency of natural disasters (flooding and drought) with cross-sectoral implications for household income, consumption, and food security (Tibesigwa, Visser, Collinson, and Twine, 2015). There is little doubt that such implications call for strong, coordinated interventions by various ministries and government de- partments, specifically those in the social, economic, and environmental sectors.

Although it is not necessarily possible to generalise from our results whether female-headed households are more economically vulnerable to aspects of climate change in other national contexts, we show that it is important to clearly distinguish the causes of female headship and consider heterogeneity between diﬀerent types of female-headed households in vulnerability analyses.

Chapter 5: Survival of the Fitting? The Diﬀerential Mortality of Undesired Infants in Sub-Saharan Africa

With high rates of infant mortality in Sub-Saharan Africa, investments in infant health are subject to tough prioritisations within the household, in which maternal preferences may play a part. How these preferences will aﬀect infant mortality as African women have ever lower fertility is still uncertain, as

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increased female empowerment and increased difficulty in achieving a desired gender composition within a smaller family pull in potentially different direc- tions. This chapter studies whether being born at a parity or of a sex which is undesired by the mother matters for infant survival in Sub-Saharan Africa, and how the differential mortality attributable to these preferences changes across the demographic transition. Undesiredness is here assessed by relating the number of brothers and sisters each infant has at birth to statements made by the mother about the ideal family size and gender composition, found in 79 Demographic and Health Surveys conducted in 33 countries in the period 1992-2012.

The differential mortality of undesired children is in this chapter first identified by controlling for mother fixed effects, as mothers with e.g. high fertility desires often have higher mortality for all their children. Furthermore, mortality is higher among the first-borns and very late borns (Mosley and Chen, 1984) and there may be resource competition or benefits of scale in larger families which may also depend on gender (Kravdal, Kodzi, and Sigle-Rushton, 2013).

Hence, this study controls for the number of older brothers and sisters at birth, as well as the mother’s age at birth and interactions between maternal age and family composition. Further confounders that vary between siblings and are correlated with the mother’s preferences remain uncontrolled for in the fixed effects framework, which would for instance be present if mothers update their preferences for the number and gender composition of children in response to life events. A second strategy therefore uses a regression discontinuity design where trends in mortality by distance from the ideal are controlled for separ- ately for wanted and unwanted children, effectively comparing siblings who are just below versus just above the ideal family size and composition as stated by the mother.

The analysis distinguishes between infants who are born in excess of the mother’s preferences for family size and gender composition as well as those born in excess of both these preferences, and allowed the differentials to vary by gender. I find that being undesired according to the mother is associated with a differential mortality for all undesired children, and the gender of the child or the type of preference which the infant is born in excess of seems unimportant for the size of the individual disadvantage. As a share of overall infant mortality, differentials according to undesiredness of children explain 3.3% of male and 4% of female infant mortality. Undesiredness can explain a much larger share of

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infant mortality among mothers with lower fertility desires, and a larger share of female than male infant mortality for children of women whose fertility desire is between 1-3 children. Some socially determined alteration of sex ratios in mortality may thus be expected, yet ratios are unlikely to reach similar levels as seen in India or China.

When considering policies to address infant mortality in Sub-Saharan Africa, the findings in this paper highlight the relevance of maternal agency and the mothers’ concepts of the ideal family for infant mortality. The findings suggest that limiting unwanted childbearing may reduce some of the differential mortality of undesired children and that achieving the Sustainable Develop- ment Goal of universal secondary education may by and large remove excess mortality coming solely from this channel. However, exclusive focus on unwanted childbearing would miss a dimension of undesiredness which is much more important for aggregate mortality differentials, namely the gender composition. Undesired gender compositions both seem more directly relevant for infant mortality differences, as well as being a major cause of rapid further childbearing (Rossi and Rouanet, 2015). When this leads couples to increase family size beyond the maternal desire, children of the surplus gender are particularly vulnerable and the differential mortality experienced by children in excess of both preference types is the most important determinant of infant mortality at the population level. As undesiredness is likely to become a more important issue for infant mortality in Africa in the future, further research is needed to study how the prevalence and implementation of maternal preferences for gender composition may be altered. It is here important to consider gender-based discrimination not as an issue affecting only girls, but also to consider the problematic aspects of balanced gender preferences in the African context.

Chapter 6: Do Mothers Adjust Their Fertility Preferences When Having More Children? Evidence from Sub-Saharan Africa Based on Natural Experiments

Whether women’s stated preferences about the number and gender of their oﬀspring depends on actual childbearing has implications for assessments of the scope for family planning programmes as well as studies of outcomes of unwanted children. Nowhere is this more important than in Sub-Saharan Africa

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where the number of unwanted children per woman is the highest in the world.

To that end, this chapter uses natural experiments which increase the number of children ever born and the number of live children at interview, and changes the sex composition of children, in 79 Demographic and Health Surveys from 33 countries.

The variation in childbearing comes from the finding that mothers whose first two children are twins or of the same sex tend to have more children than mothers with singleton first-borns and whose first two children are of different gender, respectively. This causes random variation in childbearing in the case of same sex children and much randomness in the case of twinning although twin mothers are a slightly selected group, something which is addressed by controlling for other factors associated with this phenomenon.

These instruments have previously been used to provide random variation in fertility to study how having an additional child affects female labour participation (Angrist and Evans, 1998; Cáceres-Delpiano, 2012) and how family size affects outcomes of offspring (Rosenzweig and Wolpin, 1980; Angrist, Lavy, and Schlosser, 2010; Black, Devereux, and Salvanes, 2010; Li, Yi, and Zhang, 2011).

By using two instruments, I obtain estimates of the impact of childbearing in two quite diﬀerent sub-populations, namely women who have not altered their fertility behaviour although receiving an unexpected additional child, and women who have deliberately increased their fertility to achieve a more balanced sex composition. It is found that having an additional child increases the ideal family size by about 0.1 child when using twinning and 0.6 when using same sex children as instrument, which are signiﬁcant increases. Having an extra live child at interview leads to larger increases of 0.4 and 0.8 in the two groups.

The eﬀects are much stronger for women who have fewer children than they desire than for women who have more children than they desire, and there is no robust diﬀerence between women with varying number of deceased children, educational attainment, and age at interview.

These ﬁndings are not consistent with the prevailing theory that rationalisation (i.e. the upwards adjustment in preferences to disguise unwanted childbearing) explains changes in fertility preferences (Lightbourne, 1985; Bon- gaarts, 1990; Casterline and El-Zeini, 2007; Bongaarts, 2013; Smith-Greenaway and Sennott, 2016). Rather, I propose that a process of learning about costs and beneﬁts of childbearing could lead to the continuous updating of fertility preferences that we observe.

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The chapter also studies how having an additional boy or girl affects preferences for children of each gender by using the sex of the first born child as an instrument. An additional born or live son or daughter (at the expense of the other sex) increased the ideal number by 0.1 child of the relevant gender. This is due to an increased desire among women who have just barely exceeded their preference and who do not have any schooling beyond primary education, and a reduced desire among those who have far exceeded their preference and who have completed secondary or higher education. We can only speculate why adjustments in response to fertility and sex composition are seemingly different processes with different character traits predicting changes in either. Most obviously, the number of children is a feature which is more directly control- lable by the women. Women with high fertility desires may be content with an additional son or daughter even if it exceeded their initial plan and adjust their preference for children of that gender upwards in response, as having the son or daughter does not threaten their fulfillment of a minimum number of children of the other gender. Those who want few children or women who have by far exceeded their gender-specific ideal may, on the other hand, be careful in what they wish for.

The patterns that have been discovered give some implications for further research. It has been suggested that better estimates of ‘true preferences’ can be obtained by limiting the analysis to women who have not (yet) completed their wanted fertility through limiting the analysis to women aged 20-35 years (Bongaarts, 2011, 2013). These findings show that, quite on the contrary, women who have accomplished their wanted fertility have more stable preferences than women who are early in their fertility career. Limiting the analysis to the middle age group seems arbitrary at best as this group does not adjust their fertility preferences to a significantly different degree than younger or older women, and may result in a less accurate estimate as the tendency is rather that the preferences of older women are more stable. A separate issue is whether it is justified to disregard the less stable preferences in any analysis.

There is a clear argument to be made against including observations which are manipulated as is the case with rationalisation, or if a group of respondents mis-interpret the question. However, if preferences are rather shaped by experience, one would for most purposes wish to incorporate those preferences into an estimate, however unstable they may be. Risking to remove important characteristics of human behaviour from what should ultimately reﬂect the

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wishes of women calls for caution in attempting such delimitations.

Sub-Saharan Africa is the region of the world with the largest number of unwanted births per woman in the world (Günther and Harttgen, 2016). Bongaarts (2014) has already argued that the potential impact of family planning programmes on fertility is larger than the elimination of unwanted fertility, as the implementation of such programmes may influence preferences directly. In ad- dition, any initial reduction in fertility which they may cause is likely to lead to further reductions in the desires. Given the up-scaling of preferences in response to childbearing that this research documents, a substantial multiplier of reduced fertility may be expected. One would expect that larger multiplier effects could be obtained if targeting women with high fertility desires who are early in their fertility career. The second common usage of data on preferences is to evaluate outcomes of undesired children. Changes in preferences makes stated preferences at interview an unreliable measure of preferences at the time of each birth. However, some comfort can be found in that the changes do not appear to be caused by manipulation and are independent of characteristics such as the number of deceased children. Furthermore, the finding that children tend to be more desired once born than they were before childbearing is, perhaps, good news for these children.

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2 Droughts and Gender Bias in Infant Mortality in

Sub-Saharan Africa

with Andreas Kotsadam

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Droughts and Gender Bias in Infant Mortality in Sub-Saharan Africa

By Martin Flatø

^∗

and Andreas Kotsadam

^{† ‡}

Abstract

Are African girls more exposed than boys to risk of infant mortality during crises and is such a difference due to discrimination? We combine retrospective fertility data on over 1.5 million births from Demographic and Health Surveys with data on rainfall variability and find a substantial gender difference favouring boys following droughts. The article carefully considers biological theories and finds little support for that such factors can explain the difference, as we can rule out large effects on the sex ratio at birth and on birthweight. We substantiate that this difference has social determinants by showing that the difference is only present in contexts in which we would expect discrimination of daughters. As communities with strong son preferences, low fertility preferences, and low female employment display gender bias after crises also in Africa, the results are consistent with these factors explaining differences in gender biases between countries across the world.

Keywords: Rainfall, Drought, Gender, Infant mortality, Africa JEL: I15, J13, J16, O55, Q54

∗Corresponding author. Department of Economics, University of Oslo

†Department of Economics, University of Oslo and the Ragnar Frisch Centre for Economic Research

‡Acknowledgements: The paper has beneﬁted from comments by conference participants at the European Population Conference in Budapest, the CSAE conference in Oxford, the IUSSP Conference on Demographic Vulnerability to Natural Disasters in the Context of Cli- mate Change Adaptation in Kao Lak, and Lund University’s research school in economic demography as well as seminar participants in Oslo. We would like to thank Henning Fin- seraas, Øystein Kravdal, Masayuki Kudamatsu and Viggo Nordvik for helpful comments.

The project is part of the research activities at the Centre for the Study of Equality, Social Organization, and Performance (ESOP) at the Department of Economics, University of Oslo.

ESOP is supported by the Research Council of Norway.

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1 Introduction

Intra-household allocation of resources, and particularly factors that determine differential investments in female and male offspring, is an important topic in economics (e.g. Becker, 1981; Björkman-Nyqvist, 2013; Duflo, 2012) and demography (Hill and Upchurch, 1995; Riley, 2005). Sub-Saharan Africa is characterised by a large female advantage in infant mortality (Anderson and Ray, 2010) and lack of systematic differences in breastfeeding and health-seeking behaviour for male and female infants (Garenne, 2003). Still, Friedman and Schady (2012) find that aggregate economic shocks increase infant mortality more for girls than for boys in Sub-Saharan Africa. Little is known about the mechanisms behind this difference in mortality, although such an understanding is critical to designing effective policies (Friedman and Schady, 2012). In this paper, we use exogenous income variation to study how income shocks affect gender differences in infant mortality and we test well established theories on factors shaping that relationship.

Several studies find that differential treatment of girls and boys is more prevalent when households face extreme circumstances such as illness or loss of income than in everyday life (Duflo, 2012). Rose (1999) finds that excess mortality of girls in India is highest in periods of drought, and Maccini and Yang (2009) find that rainfall around birth affects health outcomes of women later in life in Indonesia. Excess female mortality in periods of crisis at the macro level also seems to be present in Africa as shown by Friedman and Schady (2012).

Aggregate growth rate fluctuations are, however, likely to be endogenous with respect to infant mortality since a number of variables that affect both economic growth and infant mortality are omitted in the analysis, e.g. health care policies, institutions and political stability. For example, female political participation is shown to reduce infant mortality using historical data from the U.S. (Miller, 2008) and is also correlated with higher growth (Duflo, 2012).

We instead use variation in rainfall to identify effects of droughts on gender differences in infant mortality. As African communities mostly rely on rain-fed agriculture, droughts induce severe income shocks that may affect both consumption and time use with implications for infant survival in the household.

The shocks are deﬁned as unusually low or high precipitation relative to what is normally experienced in a particular location. With spatial and temporal correlations controlled for, this measure is unrelated to potential confounders.

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Several previous studies have investigated how gender differences in African mortality relate to climatic variation. Miguel (2005) finds that murders of old women by their relatives double in rural Tanzania in periods with droughts or floods, and Neumayer and Plumper (2007) find that female life expectancy is more affected than male life expectancy by droughts and famines in developing countries. On the other hand, Kudamatsu et al. (2012) do not find a robust gender difference in the effect of weather induced maternal health on infant mortality in Africa.

There is a gap in the previous literature calling for a thorough investiga- tion into the presence and social determinants of gender diﬀerences in infant mortality during crises in Sub-Saharan Africa, which is the focus of the present paper. We combine rainfall data with retrospective fertility data for more than 1.5 million births from 68 Demographic and Health Surveys (DHS) to study whether droughts cause gender diﬀerences in infant mortality in Sub-Saharan Africa.

Although droughts are exogenous shocks that affect infants through changes in household income, it is important to also note the possible presence of other channels. First and foremost, droughts may reduce the prevalence of water- and vector-borne diseases, which is likely to benefit infant survival and potentially affects sex ratios in mortality (Confalonieri et al., 2007; Rabassa et al., 2012). Secondly, gender-specific selection into birth may also play a role if pre-conceptional and prenatal factors influence sex ratios at birth (Pongou, 2013). We analyse and discuss these factors extensively and we find no effects of droughts before birth on the sex ratio at birth, nor on birthweight. Further- more, calculated bounds on the birthweight results are too small to explain our results and we show that the results are not driven by more boys surviving, even in areas with high prevalence of malaria.

We also make use of the large variation in our data to substantiate whether the gender diﬀerence observed could be the result of a bias in household prior- ities favouring boys. This gender bias may occur due to preferences for male over female survival, or diﬀerences in expected returns of raising a male and female child. To determine whether gender discrimination during crises dif- fers along relevant characteristics is furthermore important to gain a better understanding of the phenomenon, as well as for policy. In particular, we focus on employment, education, and preferences for sons and childbearing as contextual variables that are believed to be important in moderating whether

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droughts create a gender bias in infant mortality.

We find that droughts cause significantly higher female infant mortality than male infant mortality. The contextual analysis supports the proposition that social factors play an important role as we only find a gender bias in areas where the level of son preference is higher and desired fertility rates are low.

We also find that the effect is larger for non-working women and in locations where female labour force participation is low, but we do not find different effects by level of education. Taken together, the results suggest that there is substantial gender bias in the effects of droughts on infant mortality.

Extreme weather is likely to become more prevalent in Africa in the future due to climate change (Boko et al., 2007). Reducing households’ vulnerability to rainfall shocks and enabling households and communities to cope with income insecurity are therefore major focus areas for development policies. The special vulnerability of young girls during crises should be taken into account in the assessment of such policies. For eﬀective interventions, there is a need for both an understanding of the extent to which crises increase gender diﬀerences in mortality and of the conditions under which this occurs. This study con- tributes to this end. It also sheds light on which factors are important for the exceptionally low levels of gender discrimination in infant mortality in the sub- continent and whether this exceptionalism is likely to hold in the future. Our results are consistent both with theories arguing that discrimination between infants and at birth is relatively rare in Africa due to a high level of female employment (Sen, 1990), and theories arguing that parts of Africa with strong son preferences will see increased discrimination when exposed to pressure to limit family size and/or gaining access to sex-selective technologies (Bongaarts, 2013).

2 How droughts aﬀect infant mortality

It is not obvious how rainfall and income shocks affect infant mortality. Fried- man and Schady (2012) find that a reduction in GDP per capita increases infant mortality for girls, but they do not find a significant effect for boys.

Similarly, Harttgen et al. (2013) ﬁnd that economic growth has improved levels of stunting among children under age ﬁve in Sub-Saharan Africa, but that the magnitude has been very small. Working with historic European data,

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Oris et al. (2004) do not find effects of cereal prices and real wage fluctuations on mortality of infants under six months. Still, we argue in this section that droughts may increase infant mortality by affecting constraints on consumption and time usage, and reduce infant mortality through effects on the disease environment. It is these constraints that may lead to a gender bias if the survival of female and male infants is differentially prioritised during lean times, and diseases may also affect male and female infants differently. We therefore review the literature on how droughts and income shocks may affect infant mortality at different stages of inuterine and infant development, as the theories of causality differ according to gestational and postnatal age.

Droughts affect the yield of farmers, reducing their income, increasing food prices, reducing the nutritional quality of the food produced and negatively affecting the local economy (Haile, 2005). With incomplete consumption smooth- ing, the subsequent consumption shocks may lead to maternal and infant malnutrition. Maternal malnutrition during the last two trimesters of pregnancy causes low birthweight, which is an important determinant of infant mortality and morbidity (Strauss and Dietz, 1999). As lower birth weight affects male mortality more than female mortality for biological reasons (Hoffmann, 2014), this effect should bias any estimated drought effect towards a female advantage.

Thereafter, maternal undernutrition has little eﬀect on the volume and composition of breast milk unless malnutrition is severe, although the concentration of micronutrients (particularly vitamin A) may be aﬀected and cause infant depletion (Black et al., 2008; Alien, 1994). The fraction exclusively breastfeeding for the recommended six months is as low as 20 % in Western and Central Africa and 41 % in Eastern and Southern Africa, although the rates sharply increased through the 1990s (UNICEF, 2006). This gives additional importance to the nutritional value of complementary food for infant mortality, which is particularly poor in Sub-Saharan Africa and is more than ever in the life cycle important for infants as their rapid development implies very high nutritional requirements (Lartey, 2008; Dewey, 2003).

In a study using data from Colombia, Miller and Urdinola (2010:116) argue that in developing countries, ’the most important determinants of child health are inexpensive but require large amounts of time (e.g. bringing pure water from distant sources, practicing good hygiene, and traveling to distant facilities for free preventive and primary health services). Kim (2010) also ﬁnds that the opportunity cost of time matters for infant survival in West Africa. In

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particular, Kim (2010) ﬁnds that positive rainfall shocks increase mortality for children born in the rainy season, which she attributes to increased opportunity costs of labour when yields are high, resulting in less breastfeeding. This could imply that in a year with low yields, mothers work less and more infants survive.

However, commonly found coping strategies after droughts are both to diversify into non-agricultural work Burke, Gong, and Jones (2015) and to increase the workload of less productive family members (Haile, 2005). Distress, illness, and exhaustion due to increased poverty may also reduce child care efforts even if time allocated to labour declines. A particularly dramatic effect of drought is expected if time constraints result in earlier termination of breastfeeding (Black et al., 2008). A final income effect is that income shocks may lead to less health-seeking behaviour if the infant gets ill, as the practices may be expensive and/or time consuming. Khanna et al. (2003) find that differences in health-seeking behaviour following diarrhoea is the main cause of excess female infant mortality in three socioeconomically deprived areas of Delhi.

Both Rabassa et al. (2012), who study the effect of droughts on child health in Nigeria, and Henry and Santos (2013), who considered rainfall and child mortality in Burkina Faso and Mali, discuss the effect of rainfall on the disease environment as a possible confounding factor. More rainfall in developing countries is typically linked to higher incidence of important water- and vector-borne diseases (Confalonieri et al., 2007). The evidence on how droughts affect health through vector-borne diseases is ’not definitive and quite sparse’

according to a review (Stanke et al., 2013). Water scarcity during dry seasons in Sub-Saharan Africa is however associated with higher prevalence of diarrhoea due to increased consumption of unsafe water and reduced hygiene practices (Bandyopadhyay et al., 2012), yet there is no indication that this also holds in the rainy season which we consider.

It is unclear how a changed disease environment will affect sex differences in infant mortality. Newborn girls have a biological advantage in survival over newborn boys, with lesser vulnerability to perinatal conditions, congenital anomalies, and some infectious diseases (Hill and Upchurch, 1995; Waldron, 1998; United Nations Population Division, 2011). The latter advantage may mean that fewer disease vectors is particularly beneficial to boys’ survival. On the other hand, as communicable diseases account for a smaller share of infant mortality, a larger share of the disease burden will be due to perinatal and congenital causes where the female advantage is strong. That is why the

Gender under Distress