Fatal fluctuations? Cyclicality in infant mortality in India

This paper investigates the impact of aggregate income shocks on infant mortality in India and investigates likely mechanisms. A recent OECD-dominated literature reports the provocative finding that mortality at most ages is pro-cyclical. Similar analyses for poorer countries are scarce, and both income risk and mortality risk are greater in poor countries. This paper uses data and methods designed to avoid some of the specification problems in previous studies and it explores mechanisms and extensions that have not been previously considered. It uses individual data on infant mortality for about 150,000 children born in 1970-1997, merged by cohort and state of birth with a state panel containing information on aggregate income. Identification rests upon comparing the effects of annual deviations in income from trend on the mortality risks of children born at different times to the same mother, conditional upon a number of state-time varying covariates including rainshocks and state social expenditure. Rural infant mortality is counter-cyclical, the elasticity being about − 0.33. This is despite the finding that relatively high-risk women avert birth or suffer fetal loss in recessions. It seems in part related to recessions stimulating distress labor amongst mothers, in contrast to the case in richer countries, where they discourage labor market participation. Health-care seeking declines in recessions, and this appears to be related to the opportunity cost of maternal time. Disaggregation reveals that the average results are driven by rural households in which the mother is uneducated or had her first birth in teenage, and that it is only girls that are at risk; boys are protected from income shocks. Exposure to poor conditions in the fetal and neonatal period appears to have a larger effect on infant mortality than similar exposure in the postneonatal period.