Health and Fertility among Afghan Women of Reproductive Age

Chapter II: No extant study addresses the persistent detrimental effect of in utero exposure to conflict in countries experiencing protracted conflict. I therefore estimate the impact of in utero conflict exposure on weight-for-age z-score (WAZ) by applying instrumental variable regression to information on Afghan children aged 0-59 months merged with data on district-level fatalities during the intrauterine period. Although like previous research, I find an overall negative effect of violence on WAZ, the effect is stronger for children born in districts where long-term conflict is on average comparatively lower. I attribute these heterogeneous effects to the fact that households living in environments of constant conflict have developed more effective coping strategies. I support this result by showing that physical insecurity in districts in which opium poppy is cultivated, a coping strategy for rural farmers, has a comparatively smaller negative effect on household wealth because of the lower risk of eradication. Chapter III: Although Afghanistan experienced a slight rise in female literacy and some decline in female and infant mortality between 2000 and 2015, these improvements were not great enough to explain the simultaneous dramatic drop in total fertility, from 7.5 to 4.6. In this study, therefore, I test the previously unverified hypothesis that long-term conflict has a negative causal impact on both fertility outcomes and fertility preferences. More specifically, by applying 2SRI GLM Poisson regressions to cross-sectional data for a subsample of ever-married women of reproductive age (15-49) combined with georeferenced information on district level conflict from 1979 to 2015, I estimate the causal impact on fertility of conflict experienced since the time of first union. I find that although long-term conflict does indeed reduce the number of pregnancies and living children, when a woman’s ideal number of children desired over the lifetime is used as the dependent variable, conflict is a relatively small (albeit still statistically significant) determinant of fertility preferences. This finding implies that, given the only modest improvements in women’s health and development, the drop in Afghanistan’s total fertility rate would slow down if the conflict were to cease. Chapter IV (a joint work with Peng Nie and Alfonso Sousa-Poza): This study uses biomarker information from the 2013 National Nutrition Survey Afghanistan and satellite precipitation driven modeling results from the Global Flood Monitoring System to analyze how floods affect the probability of anemia in Afghan women of reproductive age (15–49). In addition to establishing a causal relation between the two by exploiting the quasi-random variation of floods in different districts and periods, the analysis demonstrates that floods have a significant positive effect on the probability of anemia through two possible transmission mechanisms. The first is a significant effect on inflammation, probably related to water borne diseases carried by unsafe drinking water, and the second is a significant negative effect on retinol concentrations. Because the effect of floods on anemia remains significant even after we control for anemia’s most common causes, we argue that the condition may also be affected by elevated levels of psychological stress.