Determinants of Child Well-Being in Developing Countries

My thesis focuses on the determinants of child health outcomes. I examine both the incentives and constraints that households in developing countries face when making use of both public and private goods and services that benefit their children. The first chapter examines the effect of the World Health Organization's recommended number of prenatal care visits for developing countries on birth outcomes. It accounts for the endogenous nature of prenatal care decisions by using an instrumental variable approach based on the accessibility of prenatal services. The source of exogenous variation is the accumulated unexpected rainfall levels during pregnancy. These shocks increase commuting times and can even make roads impassable affecting the mother's time availability and capability to seek prenatal care. To address previous shortcomings in the literature I constructed a measure of prenatal care that accounts for both the timing and intensity of use. I find that prenatal care only has a positive impact on child birth weight in urban areas. These results are highly robust to alternative methods to remove the systematic effect of gestation on birth weight. In addition, I show that having the desirable number of visits reduces the probability of experiencing poor birth outcomes such as being born prematurely. Prenatal care appears to have no impact in rural areas due to the inferior quality of services received there. I conclude that policy makers and researchers should focus not only on the frequency but also on the quality of prenatal care interventions.;The second chapter tries to answer the question: why is the urban-rural gap in child malnutrition increasing in Peru despite government efforts to improve the provision of public services? This paper examines the impact of regional public expenditure on the nutritional outcomes of young children. To account for policy endogeneity, I instrument for public expenditures using the level of natural resource royalties assigned to each region. The exogenous variation in this study comes from the interaction between natural resource endowments in each region and the world prices of these resources. In contrast to health input prices, typically used in the health economic literature, the instrument chosen does not directly alter individual regional migration. I consider separately supply and demand restrictions that diminish the effectiveness of public expenditure. I find that public spending has a positive impact on children's outcomes only in urban areas. This statement is true regardless of the type of expenditure analyzed. However, worse off urban households do not benefit from public good provision. This suggests that the poor face constraints that limit their ability to make use of public goods and services. In rural areas, there is no effect for either the poor or the non-poor. This is likely due to the lower quantity and quality of public services in rural areas. Over seventy percent of the increase in malnutrition disparities between rural and urban areas can be explained by the increase in total public expenditure during the two rounds. This result is shown to be due to the lower quantity and quality of public services and the crowding out of private expenditure in rural areas.;The third and final chapter analyzes the impact of indoor air pollution on child health outcomes for children younger than 6 years old. I use a panel of children which allows me to control for unobserved household/child heterogeneity. One of the main shortcomings in the indoor air pollution literature has been the inability to control for a series of confounding variables, such as socioeconomic status, that could bias the impact of this hazard on child health. This paper improves on previous work by using longitudinal micro data and exploiting a rich set of controls. Using this data I find a positive, statistically significant and important impact of indoor air pollution on the probability of suffering serious illnesses and acute respiratory infections. In addition, this paper differs from the existing literature because it provides analysis by gender and child frailty. I provide evidence that indicates indoor air pollution is a much more severe problem among young boys and less resilient children.