Can Educating Girls lead to Long Run Gains in Health? Evidence from a Conditional Cash Transfer Program in Pakistan

Pakistan has the highest infant mortality rate in the world; one in every twenty-two infants die within the first month of birth. Among surviving children under five, one third are underweight, 44% are stunted and half are anemic. This is largely attributable to lack of demand for health services and very low utilization rates. Only one in three expectant mothers gets a pre-natal checkup, and only half are attended by skilled health personnel at birth.

In this study we look at the role that education, specifically secondary education for girls, can play in improving maternal and child health in Pakistan. Estimating the impact of education on health is often difficult due to endogeneity concerns. We overcome this issue by exploiting the exogenous variation in girls’ education in Pakistan introduced by a Conditional Cash Transfer (CCT) program targeted towards girls in secondary schools. The Punjab Female Stipend Program was implemented in 2004 in 15 out of the 39 districts in the province of Punjab. Districts with literacy rates below 40% were eligible for the program, while those above the threshold were not. Under the program, girls attending secondary schools received a monthly stipend based on maintaining an 80% attendance rate. We use this variation in treatment across districts to estimate the causal impact of secondary education on health behaviors and outcomes related to maternal health, as well as the inter-generational transmission of human capital.

The study employs the Multiple Indicators Clusters Survey (MICS) data for Punjab. which provides detailed information regarding women’s fertility and maternal health as well as anthropometric measures of their children’s health. We estimate the impact of secondary education on women’s own fertility and long run health and on their children’s health (infant and under five mortality, immunization, stunting and wasting) and education outcomes (enrollment in school), using the instrumental variable approach.

Most of the existing literature relies on college openings and compulsory schooling laws in developed countries. Very little evidence exists for developing countries where such problems are arguably more acute. Our study bridges this gap by presenting the first evidence on the causal impact of education on health for Pakistan. In addition, unlike existing studies we also examine possible mechanisms that might be contributing to better outcomes including ante- and post-natal care, age of marriage, fertility and health related knowledge. Lastly this study contributes to the upcoming literature on long run impact of CCTs by documenting first evidence from gains of a non-means tested CCT.