Parental Health, Households, Communities and Fetal Health in India

Fetal health is an important determinant of subsequent health or later life outcomes. In this paper, we examine whether parental human capital can substitute for low provision of quality health infrastructure in the areas of India, which are suffering from adverse disease environment. We use the second and third waves of the National Family Health Survey and restrict sample to first birth and born within last five year from the survey to minimize recall bias. Along with the common measures of fetal health such as birth weight and neonatal mortality, we examine two less frequent measures - likelihood of a male birth as a measure of fetal survival to term, based on the medical evidence of male fragility in utero and birth size which reflects fetal health and nutrition. For the rural areas in high infant mortality states which have low provision of quality health infrastructure and are suffering from adverse disease environment, a 10 centimeter increase in mother height is associated with more than 2% increase in likelihood of having a male child at first birth. Maternal education and stature are positively associated with other fetal health outcomes as well in this area. These associations are weaker in the areas of India where either low provision of health quality or adverse disease environment are less of a concern. Our results suggest gender specific selection in live birth can also occur purely due to biological reasons and gender of the first child may not be random in India. Moreover, intergenerational persistence in poor health status of women can arise due to biological reasons, along with son preference, given the cultural and economic context of the country. Income, access to information and other community characteristics are also associated with various dimensions of fetal health, although the relationships are not always strong or consistent.