The Anatomy of a Public Health Crisis: Household Responses Over the Course of the Zika Epidemic in Brazil

joint with Ildo Lautharte Junior (World Bank)

May 2020

Abstract The global frequency and complexity of viral outbreaks is increasing. In 2015, Brazil experienced an epidemic caused by the Zika virus. This represents the first known association between a flavivirus and congenital disease, marking a `new chapter in the history of medicine' [Brito 2015]. We use tens of millions of administrative records to document household responses to a public health alert linking the emerging Zika virus and congenital disease. We find a 7% reduction in pregnancies post-alert, a response triggered immediately after the alert, and driven by higher SES women. On responses during pregnancy, we find an increased use of ultrasounds (9%) and abortions (5%), especially late term abortions. However, these impacts are driven by mothers that conceived post-alert -- there is no response to the public health alert during pregnancy among mothers that conceived just pre-alert, despite their unborn children also being at risk. The primary welfare cost of the epidemic is disease avoidance, as households move away from planned fertility paths. We conclude by discussing the extent to which our findings extend to household responses to public health alerts on other emerging viral threats.

Identifying Network Ties from Panel Data: Theory and an Application to Tax Competition

joint with Aureo de Paula (UCL) and Pedro CL Souza (PUC-Rio)

April 2020

Abstract Social interactions determine many economic behaviors, but information on social ties does not exist in most publicly available and widely used datasets. We present results on the identification of social networks from observational panel data that contains no information on social ties between agents. In the context of a canonical social interactions model, we provide sufficient conditions under which the social interactions matrix, endogenous and exogenous social effect parameters are all globally identified. While this result is relevant across different estimation strategies, we then describe how high-dimensional estimation techniques can be used to estimate the interactions model based on the Adaptive Elastic Net GMM method. We employ the method to study tax competition across US states. We find the identified social interactions matrix implies tax competition differs markedly from the common assumption of competition between geographically neighboring states, providing further insights for the long-standing debate on the relative roles of factor mobility and yardstick competition in driving tax setting behavior across states. Most broadly, our identification and application show the analysis of social interactions can be extended to economic realms where no network data exists.

The Impacts of a Multifaceted Pre-natal Intervention on Human Capital Accumulation in Early Life

joint with Pedro Carneiro (UCL), Lucy Kraftman (IFS), Giacomo Mason (CMA), Lucie Moore (OPM) and Molly Scott (OPM)

November 2019

Abstract We present results from a large-scale and long-term randomized control trial to evaluate an intervention targeting early life nutrition and well-being for households residing in extreme poverty in Northern Nigeria. The multifaceted intervention provides: (i) information to mothers and fathers on practices related to pregnancy and infant feeding; (ii) high-valued unconditional cash transfers to mothers, each month from pregnancy until the child turns two. We document two- and four-year impacts among 3600 pregnant women and their children. The intervention leads to large and sustained improvements in anthropometric and health outcomes for children, including an 8% reduction in stunting by endline. These impacts are partly driven by information-related channels (such as improved knowledge, practices and health behaviors of mothers towards new borns). However, the value and certain flow of cash transfers is also key: these induce labor supply responses among women, and allow them to undertake investments in livestock. These are both a source of protein rich diets for children, and generate higher earnings streams for households long after the cash transfers expire. The results show the sustainability and cost-effectiveness of scalable multifaceted pre-natal interventions in even the most challenging and food insecure economic environments.

Parental Responses to Information About School Quality: Evidence from Linked Survey and Administrative Data

joint with Ellen Greaves (Bristol), Iftikhar Hussain (Sussex) and Birgitta Rabe (Essex).

November 2019

Abstract Multiple inputs determine children's cognitive achievement. We study the interaction between family and school inputs by identifying the causal impact of information about school quality on parental time investment into children. Our setting is England, where credible information on school quality is provided by a nationwide school inspection regime. Schools are inspected at short notice, with school ratings using hard and soft information. As such soft information is not necessarily known to parents ex ante, inspection ratings provide news to parents that plausibly shifts inputs into their children. We study this using household panel data linked to administrative records on school performance and inspection ratings. We observe some households being interviewed pre school inspection (control), and others being interviewed post inspection (treatment). Treatment assignment is determined by a household's survey date relative to the school inspection date, and shown to be as good as random. We find that parents receiving good news over school quality significantly decrease time investment into their children (relative to parents that will later receive such good news). Hence on average, beliefs over school quality and parental inputs are substitutes. Our data and design allow us to provide insights on the distributional and test score impacts of the nationwide inspections regime, through multiple margins of endogenous response of parents and children. Our findings highlight the importance of accounting for interlinked private responses by families to policy inputs into education.

Revisions requested, Economic Journal.

The Economic Lives of Young Women in the Time of Ebola: Lessons from an Empowerment Program

joint with Oriana Bandiera (LSE), Niklas Buehren (World Bank), Markus Goldstein (World Bank) and Andrea Smurra (UCL)

December 2018

Abstract We evaluate an intervention to raise young women's economic empowerment in Sierra Leone, where women frequently experience sexual violence and face multiple economic disadvantages. The intervention provides them with a protective space (a club) where they can find support, receive information on health/reproductive issues and vocational training. Unexpectedly, the post-baseline period coincided with the 2014 Ebola outbreak. Our analysis leverages quasi-random across-village variation in the severity of Ebola-related disruption, and random assignment of villages to the intervention to document the impact of the Ebola outbreak on the economic lives of 4,700 women tracked over the crisis, and any ameliorating role played by the intervention. In highly disrupted control villages, the crisis leads younger girls to spend significantly more time with men, out-of-wedlock pregnancies rise, and as a result, they experience a persistent 16pp drop in school enrolment post-crisis. These adverse effects are almost entirely reversed in treated villages because the intervention enables young girls to allocate time away from men, preventing out-of-wedlock pregnancies and enabling them to re-enrol in school post-crisis. In treated villages, the unavailability of young women leads some older girls to use transactional sex as a coping strategy. The intervention causes them to increase contraceptive use so this does not translate into higher fertility. Our analysis pinpoints the mechanisms through which the severity of the aggregate shock impacts the economic lives of young women, and shows how interventions in times of crisis can interlink outcomes across younger and older cohorts.

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