The Unintended Consequence of the Village Midwife Program in Indonesia

Evidence from the epidemiological literature suggests that male fetuses are more susceptible to changes in maternal health and nutritional status than female fetuses. In 1989, Indonesian government initiated a midwife program which improved the nutritional status of the reproductive age women. Using the four waves of the Indonesian Family Life Survey IFLS and a difference-in-differences strategy, we find that the provision of a midwife program increased the probability of a male birth by 4 percentage points. Moreover, we find that mothers with primary and below levels of education are more likely to give birth to a male child than mothers with higher levels of education after exposure to the program. Further, we examine the impact of the midwife program on the birth weight of the children by gender. We find that provision of a midwife program lead to a decrease in birth weight for male children but no change in birth weight for female children. The results are robust to inclusion of mother level observables, birth month interacted with birth year fixed effects, and various others community level time varying observables; and also when the birth sample is restricted to only first births. The increase in likelihood of a male birth compared to a female birth and the decrease in birth weight imply that positive nutrition shock may lead to increase in births of fetuses with poorer health quality. Therefore, selection in live births due to in utero shocks should be taken into account before examining the impact of those shocks on later life outcomes.