Healthcare Reform and Gender Specific Child Investment in Developing Countries

Abstract

We estimate whether a large scale health care reform benefits young boys more than young girls in terms of health and cognitive outcomes in the context of a developing country with labor market bias and cultural preferences favoring sons. We use exogenous variation of a health care reform, the National Health Policy, which was implemented in Nepal in 1991 along with data from the Nepal Living Standard Survey 1996. By using healthcare quality measures of health posts that provide primary healthcare as well as a constructed cost measure for accessing hospitals that provide tertiary (curative) care, we evaluate the effects of the health care reform on infant and child mortality by gender. Our results suggest that improvements in primary health care quality and cost reductions in tertiary care reduces the mortality rates of boys but does not affect the mortality rate of girls. Additionally, the findings provide suggestive evidence that differences in child health investments affect educational outcomes. We highlight the household's innate gender preference for sons, neglect of daughters' health, and differences in borrowing patterns across households with sons and daughters as potential drivers of some of the observed differences in the human capital investments of parents into boys vs. girls. Our research highlights the importance of cultural norms in the overall success of health reforms.