8/11/2019 AEA Project Poster

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A Child

s Well

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Being: Food Insecurity and Antenatal Care (Nepal)

American Economic Association 2014 Summer Program

Presented by: Yeshanew Belayneh, Jose Ruiz, Julieth Saenz, and Jos B. Santiago

According to WHO, 3.1 million children in the worlddie every year because of poor nutrition. To address

this problem, preliminary studies on antenatal carewere performed and analyzed in Nepal to gauge theoverall health of newborns and their families. Studiesalso show that malnutrition has no significant effect onchildrens BMIs in Nepal.

This study analyzes whether factors like antenatal careand food-insecurity have any effect on childrens BMI.

Gilberto and Michael (2012) used a sample of chil-dren 060 months of age (n =3,433) and found no rela-tionship between HFI and childrens BMI-Z for age orWHZ. Also, a study by Akoto Osei, Pooja Pandey et al

(2010) used a sample of 368 children 6 to 23 monthsold and found that there is no significant associations

between household food insecurity and stunting, under-weight, or anemia.Meanwhile, Nafisa Halim, Alok K Bohara and Xia-omin Ruan (2010) used a sample of 8429 womenaged 1549 who have been married to examine the so-cial determinants of the use of routine antenatal care in

Nepal and estimate the value to child health of a safeand healthy motherhood. They found that education in-creases routine antenatal care utilization and that childhealth improves as a result.

How is child undernutrition in Nepal affectedby food insecurity and antenatal care?

Hypothesis 1: Antenatal care significantly affects childundernutrition.

Hypothesis 2: Food-insecurity significantly affectschild undernutrition.

INTRODUCTIONDataset used: DHS in Nepal (2011)Data restrictions: Rural areas, households with chil-

dren under five years old, pregnancy duration of 9months.Sample Size: 1464 (from 0-60 months)

1294 (from 6-60 months)8.15% of undernutritioned children.11.2% of households report food insecurity.

Two models were estimated with the same dependentand independent variables. Model 1 uses all childrenaged 0-60 months.Given that infants can be breastfed for many months oryears before they start consuming solid foods, Model 2uses children aged 6-60 months in order to better cap-ture the effects of undernutrition on a childs health.

Undernutrition is measured through a food index. Weuse OLS and 2SLS models to deal with the potentialendogeneity of antenatal care.

BMI = f(antenatal care, food insecurity, z) + u

BMI: Standard deviations away from median bodymass index by age.

Antenatal Care: Number of antenatal visits.

Severe Food Insecurity: High score in a ten dichot-omous questions survey about food security.

Z: Mothers age, number of young children in thehousehold, birth order, ecological belt, Brahmin/

Chhetri ethnicity.

Food Insecurity Index includes 10 questions suchas: In the past 12 months, how frequently did you worry that

your household would not have enough food? In the past 12 months, how often was there no food to eat

of any kind in your household because a lack of re-sources to get food?

What was the cause of food deficiency in your householdin the last 12 months? (Drought? Landslide? Crop fail-ure? Flood? Financial problem?)

Wealth Index includes 4 components such as: Communication (mobile phone?)

Home characteristics (type of toilet, floor, walls, etc.)

Electronics (radio, television) Livestock (buffalo, cows, horses)

Based on our results for Model 1c, we found that ante-natal visits have a strong positive impact on BMI and

severe food insecurity has no significant impact onBMI. Model 2c shows a strong negative effect of foodinsecurity. These results also confirm the impact of an-tenatal visits and mothers education on a childs over-all health from previous studies. Other research did notfind significant results for food insecurity because ofmeasurement errors in data.

Using these results, we provide evidence indicatingthat food insecurity programs should focus on infantsolder than 6 months in order to properly combat prob-lems of food insecurity. Undernutrition becomes preva-lent after a mother stops breastfeeding her child. Rec-ognizing mothers habits for antenatal care and improv-ing education and social well-being will also help re-duce Nepals instances of child undernutrition.

Halim, Nafisa, Alok K Bohara, and Xiaomin Ruan. 2010. Healthy Mothers,Healthy Children: Does Maternal Demand for Antenatal Care Matter forChild Health in Nepal?Health Policy and Planning, September.

Kac, Gilberto, Michael M. Schlssel, Rafael Prez -Escamilla, Gustavo Ve-lsquez-Melendez, and Antnio Augusto Moura da Silva. 2012.Household Food Insecurity Is Not Associated with BMI for Age orWeight for Height among Brazilian Children Aged 060 Months. Edited

by Yolanda Sanz. PLoS ONE 7 (9): e45747. doi:10.1371/journal.pone.0045747.

Keino, Susan, Guy Plasqui, and Bart van den Borne. 2014. Household FoodInsecurity Access: A Predictor of Overweight and Underweight amongKenyan Women. Agriculture & Food Security 3 (1): 2.doi:10.1186/2048-7010-3-2.

Osei, Akoto Osei, Pooja Pandey,et al. "Food and Nutrition Bulletin, vol. 31,no. 4 2010, The United Nations University. 483 Household food inse-curity and nutritional status of children aged 6 to 23 months in KailaliDistrict of Nepal." Food and Nutrition Bulletin 31. (accessed July 20,2014).

American Economics AssociationRobert Wood Johnson FoundationDr. Alok Bohara, UNM Department of EconomicsWenmei Guo, Ph.D Candidate, University of NewMexicoJustin Hollis, Graduate Student, University of NewMexicoData provided by: Nepal Study Center at UNM *Prepared in partial fulfillment of the requirements forEcon 409: Intermediate Applied Econometrics(Professor Alok Bohara, Department of Economics,UNM)

Results for Model 1 (0-60 months)

Results for Model 2 (6-60 months)

HYPOTHESIS

RESULTS CONCLUSION

Variable Model 1a Model 1b 2SLS (Model 1c)

# Antenatal Visits 2.380 1.769 18.177***

(1.24) (1.341) (3.913)

Severe Food Insecurity -22.6959* -21.243* -13.636

(9.531) (9.532) (10.125)

Mother over 30 years old - 12.678 18.850

(10.798) (11.426)

# young children - -14.809 -10.112*

(4.427) (4.378)

Birth order - -3.857 2.182

(2.303) (2.760)

Not Hill or Mountain - -16.610 -23.594***

(6.423) (6.8864)

Brahmin / Chhetri - -12.004 -22.853

(6.336) (7.051)

Intercept -65.751*** -21.617 -94.870

(-5.315) (10.575) (19.677)

Instruments: Wealth Index, Mother's education, and Access to health facilities.

Legend: / (se), * p