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Women Reservation in Bihar and Children’s HealthOutcomes
Santosh Kumar & Nishith Prakash
University of Washington & Cornell University
December 15, 2011)Bihar Growth Week, Patna
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 1 / 26
Motivation
Huge variation in growth rate across countries.
Neo-classical growth model emphasize the role of physical capitaland labor.
The difference in access to capital and labor are not enough toexplain the difference.
Role of human capital- education, health.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 2 / 26
Motivation
How does better health affect economic growth .
Better health increases workforce productivity and hence higherwages.
Good health helps to forge improved levels of education byincreasing levels of schooling and scholastic performance.
Resources that would otherwise be used for preventative healthtreatments are freed for alternative uses (knock-on effect).
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 3 / 26
Objective of the paper
Does women reservation in panchayats lead to improved healthoutcomes?
Specifically, do districts with more female leaders perform bettercompared to districts with fewer female leaders?
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 4 / 26
Context
About 50 percent of world’s population are women.
However, their participation in political process is far below thanparity.
As per the latest estimate, women accounted for 18.4 % ofparliamentarians worldwide (IPU, 2008) ?
Barriers: Institutional barriers, cultural norms, voter discrimination,low education.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 5 / 26
Context and Motivation
To prevent this inequity, many countries have adopted electoralgender quotas.
In 1993, India introduced quota-based political reservations forwomen in rural areas (73rd amendment).
Promote gender equality in human development by making ruralservice provision and local governance inclusive and responsiveto the needs of women.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 6 / 26
Efficacy of Gender quotas
The efficacy of these policies is still disputed by many policymakers.
Pro- needed to correct preexisting gender inequalities.
Against- Undemocratic, Less effective leaders, elite capturing.
More evidence needed to truly evaluate the impact of thesepolicies.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 7 / 26
Bihar
Bihar has been a laggard in implementing 73rd amendment.
The first panchayat election was held in April 2001 after a gap of23 years.
Fifty per cent seats are reserved for women since the 2006panchayat election.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 8 / 26
Existing evidence
Chattopadhyay & Duflo - Women leaders are more likely to investin drinking water facilities across rural India.Some recent papers report public good investments by femaleleaders either on non-water related goods (Munshi andRosenzweig, 2008).
Being sensitive to institutional features (Ban and Rao, 2008b).
Bardhan et al. (2010) exploit within-village (over time) variation inreservation in West Bengal and find no impact of femalereservation.Beamen et al. women increases investment in drinking waterinfrastructure, significant effect on availability of public good butinsignificant effect on the quality of public good (water, education,transport, fair price shop, public health facilities.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 9 / 26
Outcomes
Ante-natal care (ANC).
Children vaccination (DPT3, Measles).
Health knowledge.
Institutional deliveries.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 10 / 26
Data
Household survey: 2nd and 3rd rounds District level householdsurvey.
DLHS 2 was conducted in 2001-02.
DLHS 3 was conducted in 2007-08.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 11 / 26
Empirical strategy- DIDDesign 1: Employ double-difference (DID)
Design 2: Exploit the variation in policy intensity
2007-08 (DLHS 3)
2001-02 (DLHS 2)
Difference
Jharkhand (Control)
A
B
A- B
Bihar (Treatment)
C
D
C - D
Difference
C-A
D-B
DID: C-D- (A-B)
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 12 / 26
ANC utilization
0
10
20
30
40
50
Bih
ar
Ara
ria
Au
rangabad
Bank
a
Begu
sara
i
Bhagalp
ur
Bhojp
ur
Bu
xar
Darb
hanga
Gaya
Gopalg
unj
Jam
ui
Jehanabad
Kaim
ur
Kati
har
Khagari
a
Kis
hangu
nj
Lak
his
ara
i
Madhepu
ra
Madhu
bani
Mu
nger
Mu
zaff
arp
ur
Nala
nda
Naw
ada
West
Cham
para
n
Patn
a
East
Cham
para
n
Pu
rnea
Rohta
s
Sahars
a
Sam
ast
ipu
r
Sara
n
Sheik
pu
ra
Sheohar
Sit
am
arh
i
Siw
an
Su
pau
l
Vais
hali
Women receiveing at least
three visits for ANC DLHS 2
Women receiveing at least
three visits for ANC DLHS 3
Increase in
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 13 / 26
Full Immunization
01020304050607080
Bih
ar
Ara
ria
Au
rangabad
Bank
a
Begu
sara
i
Bhagalp
ur
Bhojp
ur
Bu
xar
Darb
hanga
Gaya
Gopalg
anj
Jam
ui
Jehanabad
Kaim
ur
Kati
har
Khagari
a
Kis
hanganj
Lak
his
ara
i
Madhepu
ra
Madhu
bani
Mu
nger
Mu
zaff
arp
ur
Nala
nda
Naw
ada
Pash
chim
Cham
para
n
Patn
a
Pu
rba C
ham
para
n
Pu
rnia
Rohta
s
Sahars
a
Sam
ast
ipu
r
Sara
n
Sheik
hpu
ra
Sheohar
Sit
am
arh
i
Siw
an
Su
pau
l
Vais
hali
Full
Immunization
DLHS 2
Full
Immunization
DLHS 3
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 14 / 26
Institutional deliveries
010203040506070
Bih
ar
Ara
ria
Au
rangabad
Bank
a
Begu
sara
i
Bhagalp
ur
Bhojp
ur
Bu
xar
Darb
hanga
Gaya
Gopalg
anj
Jam
ui
Jehanabad
Kaim
ur
Kati
har
Khagari
a
Kis
hanganj
Lak
his
ara
i
Madhepu
ra
Madhu
bani
Mu
nger
Mu
zaff
arp
ur
Nala
nda
Naw
ada
Pash
chim
Cham
para
n
Patn
a
Pu
rba C
ham
para
n
Pu
rnia
Rohta
s
Sahars
a
Sam
ast
ipu
r
Sara
n
Sheik
hpu
ra
Sheohar
Sit
am
arh
i
Siw
an
Su
pau
l
Vais
hali
Institutiona
l Delivery
DLHS 2
Institutiona
l Delivery
DLHS 3
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 15 / 26
RESULTS (MATERNAL HEALTH)
Results are from adjusted Diff-in-Diff analysis.
Antenatal Care.
During the period of 2001-2007, the percentage of mothers whohave received any ante-natal care has increased by 23.2 percent.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 16 / 26
RESULTS (MATERNAL HEALTH)
Antenatal Care.
During the period of 2001-2007, the percentage of mothers whohad antenatal check-up in first trimester has increased by 3.1percent.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 17 / 26
RESULTS (MATERNAL HEALTH)
Antenatal Care.
During the period of 2001-2007, the percentage of Mothers whohad three or more ANC has increased by 10.6 percent.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 18 / 26
RESULTS (MATERNAL HEALTH)
Antenatal Care.
During the period of 2001-2007, the percentage of Mothers whohad at least one tetanus toxoid injection has increased by 21.3percent.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 19 / 26
RESULTS (MATERNAL HEALTH)
Antenatal Care.
During the period of 2001-2007, the percentage of Mothers whoseBlood Pressure (BP) taken has increased by 5.4 percent.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 20 / 26
RESULTS (MATERNAL HEALTH)
Antenatal Care.
During the period of 2001-2007, the percentage of Mothers whohad full antenatal check-up has increased by 0.5 percent.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 21 / 26
RESULTS (MATERNAL HEALTH)
Institutional Deliveries.
The percentage of Institutional Deliveries has increased by 12.3percent.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 22 / 26
RESULTS (MATERNAL HEALTH)
The percentage of Child birth at home has decreased by 12.7percent.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 23 / 26
RESULTS (CHILD HEALTH)
Childhood Immunization from Vaccine Preventable Diseases(VPDs).
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 24 / 26
RESULTS (CHILD HEALTH)
Children 12-23 months who have received BCG vaccineincreased by 7.7 percent.
Children 12-23 months who have received 3 doses of DPTvaccine decreased by 3.6 percent.
Children 12-23 months who have received 3 doses of DPTvaccine decreased by 7 percent.
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 25 / 26
SUMMARY
Bihar has made substantial progress in health in the last decade,particularly maternal health.
However, many health indicators are still less than nationalaverage.
Child health, particularly vaccination, is the matter of concern.
The take-up is low- needs intervention on the demand side(incentivising households)- Udaipur experiment, Guna model
Santosh Kumar & Nishith Prakash (University of Washington & Cornell University) 26 / 26