Essays on Child Health in Ghana

The thesis is a collection of five independent but related papers on child health in Ghana. Precisely, this thesis employs various econometric strategies to examine the effect of cohabitation, famine, child work, and ethnic diversity on child health. Cohabitation has emerged as an increasingly prevalent form of union, particularly among the younger adults in many developing countries which carries significant implications for parenting, and childbearing dynamics, impacting child health. In Chapter two, we investigate the influence of a mother’s age at commencing cohabitation on various child health outcomes. Using instrumental variables strategy, we find that an increase in the age at which women commence cohabitation for the first time is associated with improved health outcomes in children. These positive effects are pronounced for children born to women with no formal education. We identify reduced domestic violence, and improved healthcare practices as the pathways through which age at cohabitation improves child health. The third chapter combines three waves from Ghana’s Demographic Health Survey (DHS) to investigate the intergenerational health impact of the 1981–83 Ghanaian famine. We focus on children born to women who survived the famine in childhood, employing a difference-in-difference framework. Identification is based on timing and regional variations in famine intensity across Ghana. Our estimates show that children born to women exposed to the 1981–83 Ghanaian famine in childhood are more likely to have poor health outcomes evident in decreased weight-for-age, and height-for-age. The poor child health effects of the 1981–83 Ghanaian famine is mainly driven by poor health and low educational attainment of the child’s mother who survived the famine in childhood. From a policy perspective, these findings imply that the potential means to attenuate the adverse long-run health implications associated with famine is to implement policies that increase school attainment and health among famine-affected cohorts. The fourth chapter uses Ghanaian household panel data to examine the link between ethnic diversity and child health. Using an index of ethnic fractionalization, we find that unit increase in a heterogenous ethnic group is associated with poor child health outcomes. However, the adverse effect of ethnic diversity on child health is more pronounced among children living in ethnically diverse communities located in rural areas. Poverty and lack of pre-natal healthcare services serve as the transmitting channels for the impact of ethnic diversity on child health. Our findings suggest that policies that reduce poverty and ensure that pre-natal healthcare facilities are available in ethnically diverse societies are important for promoting child health. In the fifth chapter, we examine the impact of child work on cognitive development via transmitting channels, child health and schooling. After addressing endogeneity using several quasi-experimental methods, we find that an increase in child work is associated with low cognitive development. This negative effect is particularly pronounced among children living in low-income households and male children. Mediation analyses show that school attendance and child health are important pathways through which child work affects the cognitive development of children. Targeted interventions that ensure that child workers attend school by working for a few hours may be required to reduce child labour and its adverse health and cognitive development consequences.