Gender disparity in breastfeeding: new research

This post is on Why Do Mothers Breastfeed Girls Less Than Boys? Evidence and Implications for Child Health in India by Seema Jayachandran (Stanford University) and Ilyana Kuziemko (Princeton University), NBER Working Paper No. 15041, http://www.nber.org/papers/w15041, June 2009

Seema Jayachandran and Ilyana Kuziemko’s answer to the question in their title is that (a) breastfeeding acts as a natural contraceptive, (b) Indian mothers are aware of this, (c) they have a preference for male babies, and, therefore, (d) after the (somewhat disappointing) birth of a female baby they cut the nursing period short in order to try again ASAP.

The authors do not speculate on the reasons for Indian mothers’ preference for male babies; they are empiricists par excellence and their data—from the National Family Health Survey (NFHS) in India—do not allow them to go any farther.

The existence of this preference for male babies did not surprise me. What did strike me as valuable about this paper is that it is a brilliant demonstration of how wide the reach of economics can be, how exciting good empirical work in economics can be, and how important the policy implications of such work often is.

First, let us look at how Jayachandran and Kuziemko sleuthed out the answer to their title question. The key to figuring out the reason behind a phenomenon (such as the observed gender disparity in breastfeeding) is variation. If the phenomenon under study is found to exist to the same extent in all manner of situations, we’ve hit a brick wall; its causes cannot be deduced. But if the phenomenon exists strongly in some situations and not so strongly (or perhaps not all) in other situations, then we have in our sights an explanation for the phenomenon.

First, J and K find that higher birth-order children—that is, babies with more siblings that are older—are breastfed more. There is no known biological reason why this should be so; it looks like a deliberate choice. But what’s behind this deliberate choice? J and K conclude reasonably that a mother who already has had many children and has just given birth to another, is more likely to have reached or exceeded her desired number of children and would therefore be less inclined to cut breastfeeding short in order to have yet another baby. In other words, the observed fact that higher birth-order children are breastfed more tells us something important: mothers keep in mind the contraceptive properties of breastfeeding and adjust their breastfeeding behavior according to their personal goals.

Second, J and K find that “daughters are weaned sooner than sons”. What can explain this? We have already seen that Indian mothers regulate weaning to attain a desired family size. So, it is not a stretch to conclude that they wean female babies quicker in order to attain a higher proportion of male children.

Third, “for both sons and daughters, having few or no older brothers results in earlier weaning”. If you are a newborn baby—male or female—and you have no older brothers, you are out of luck in the breastfeeding department. Your mom is not quite done having boys yet. Therefore, she will cut off your supply soon so that she can quickly try to get pregnant again; breastfeeding is nature’s contraceptive, remember.

Finally, Jayachandran and Kuziemko find that gender disparity in breastfeeding has an inverted-U shape when graphed against family size. That is, gender disparity in breastfeeding is low for small families and for large families, and peaks in the middle, close to each mother’s desired family size. What does this pattern of variation tell us?

To an Indian mother, the number of male children matters a lot, but the overall number of children—both male and female—matters too. For a mother who has just given birth to her first child, her desire to have another baby will not depend much on whether her newborn is a boy or a girl. Therefore, her breastfeeding of her first-born will be largely independent of the baby’s gender.

Now assume that this mother’s desired number of children is three and she has just given birth to her second daughter. She will be desperate to try quickly for a boy, and will, therefore, cut the breastfeeding short. Had she given birth to a boy instead, there would have been less of an urge for another baby, and the breastfeeding would have gone on for a while longer.

Finally, if our hypothetical mother—who, remember, would ideally like to have three children—has just given birth to her fourth child, she would have little urgency to cut breastfeeding short to get pregnant again, irrespective of the gender of the newborn.

In this way, J and K are led by the observed variation in breastfeeding behavior across family size and family sex composition to infer the following theory of fertility choice: an Indian mother cares about how many children she has and how many of those children are male, and she will adjust breastfeeding according to the newborn’s birth order, the newborn’s sex, and the sexes of her other children in order to achieve her ideal family.

Okay, so we now know why Indian mothers breastfeed girls less than boys. But why should we care about this?

Apart from the well known health benefits of breast milk compared to its substitutes, “breastfeeding is thought to have greater health benefits for infants who would otherwise consume unsafe drinking water and contaminated food”. J and K argue that the gender disparity in breastfeeding accounts for 14% of the gender gap in mortality rates of Indian children. Tellingly, J and K find that the excess mortality of girls is small for firstborns and for the first six months of a baby’s life and those are exactly when the gender disparity in breastfeeding is small as well. Moreover, J and K find that most of the excess mortality of female children is in families with no access to piped water. In other words, the preference for male babies has a cost: female babies are being denied breast milk and are instead being fed infected water that is killing them. In the measured tones of the best academic research, Jayachandran and Kuziemko write: “Back-of-the-envelope calculations suggest that breastfeeding accounts for 14 percent of the gender gap in child mortality (deaths between ages one and five) in India, or 22,000 missing girls each year.”

This is as good a time as any to remind readers of the economist Amartya Sen’s famous 1990 article in The New York Review of Books, “More Than 100 Million Women Are Missing”. Sen had quantified the extent of this grisly excess mortality of women and speculated that its roots lay in women being denied basic access to the resources that are essential for life. J and K provide a slightly nuanced explanation for (14 percent of) the problem identified by Sen: “Son preference is the underlying cause of this excess female mortality, but in a subtle way: Rather than resulting from parents' explicit decisions to allocate more resources to sons, the missing girls are mainly an unintended consequence of parents' desire to have more future sons.” (Please see this Wikipedia entry on the whole missing women debate.)

Okay, now that we have seen why Indian mothers breastfeed girls less than boys and why it matters, what if anything should we do about all this? What, in other words, are the policy implications of the findings of Jayachandran and Kuziemko?

Perhaps Indian mothers are not entirely well informed about the effects that their breastfeeding behavior can have on their female children. (Actually, I probably should have said this with greater force and certainty because the alternative is the ghoulish idea that Indian mothers are knowingly and deliberately hobbling the lives of their daughters.) In that case an education or advertising campaign would be an obvious solution to try. Other equally obvious remedies to try would be to expand access to clean water (so that weaned babies have healthy alternatives to mothers’ milk) and to provide better medical care for newborns in general and female babies in particular.

A campaign to reduce total fertility may also be in order. The more children a mother seeks to give birth to during her finite reproductive period, the more inclined she may be to cut short the breastfeeding of her children, with all the attendant health problems discussed above.

In case some women are giving birth to more children than they want, expanded access to artificial contraceptives—perhaps through subsidies—may help. But one needs to watch out for the law of unintended consequences. Some women who breastfeed their babies because breastfeeding is nature’s contraceptive may reduce breastfeeding when artificial contraceptives become available. This could worsen the health of children. So, Jayachandran and Kuziemko dutifully attach a warning label to their recommendation: if you expand access to synthetic contraceptives, be sure to expand access to piped water and medical care at the same time, because breastfeeding might decrease.

This is a really nice paper and I am glad I took the time to read it.

One final thought: How many people do you think know that economics may just as easily be about breastfeeding behavior as about the gross domestic product, the inflation rate, or the Dow Jones Industrial Average? Economics is the study of what rational people choose to do when faced with trade-offs and the overall consequences of those choices. Those choices could be involve deciding what stocks and bonds to buy with one’s savings, or how much time to devote to sleep, or when to stop breastfeeding a newborn.

Blue Dog Hell

Paul Krugman's column in today's New York Times is on the same them as my post yesterday. Forget the Republicans in Congress -- they were never going to support Obama on anything anyway. Those who want a public option in helath insurance should focus on the so-called "moderate" Dems.

We Didn't Drink the Kool Aid!

Who would've thunk it! After all the incessant and unbearable MSM propaganda excoriating the supposed cluelessness -- if not the outright un-American-ness! -- of Obama's proposal that John and Jane Q. Public should have the option of joining the same sort of public health insurance plan available to their Congresspersons and Senators, today's New York Times provides a Gestalt altering jolt: The people have tuned out the media whores! They have figured it all out on their own. They want a public option. They are prepared to pay more for the public option, if needed. They are not scared by the bogeymen being paraded on TV by Conservatives for Patients' Rights, the Republican Party, the health insurance industry, their lobbyists, and the bought-and-paid-for media. Maybe they even think Michael Moore was right in "Sicko."

See the article for yourself: "In Poll, Wide Support for Government-Run Health" by KEVIN SACK and MARJORIE CONNELLY, The New York Times, June 20, 2009. Here are the opening paragraphs:

Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering, a government-run insurance plan to compete with private insurers, according to the latest New York Times/CBS News poll.
The poll found that most Americans would be willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down health-care costs than the private sector.

Now, will Sens. Kent Conrad (D-ND), Max Baucus (D-MT), Bill Nelson (D-FL), and other such let's-give-in-even-before-the-fight-has-truly-begun Democrats finally set aside their "co-op plans" and other distractions and fight for the President's plan? Don't bet on it, but at least they can no longer go on TV and say that "the American people" do not support the public option.

That's what friends are for!

Alan Cullison has an interesting report from Afghanistan in today's Wall Street Journal: "Suicide Bombers Tip Afghan War", August 1, 2008. The opening paragraph caught me off guard and made it harder to concentrate on the rest of the article. Here it is:

Earlier this year, Hamza turned 20 years old, and without a job or family where he lived in Pakistan, he confided to a friend that he was considering suicide. His friend had a suggestion: Kill himself along with some American soldiers across the border in Afghanistan.

Philosophical Notes, High and Low

Economists have always been interested in what philosophers -- especially those writing on political philosophy or distributive ethics -- have to say on what our priorities ought to be. This is not just a concern of those living in -- or those who advise those living in -- the White House, or 10 Downing Street, or the Elysee Palace. Anyone with a little bit of cash left over for charity might wonder if there is a sane and systematic way to think about where one's money would do the most good. Any voter heading to the polling booth may worry about the rationale behind the way our government allocates foreign aid in our name.

When faced with humdingers of this kind, economists instinctively reach for three tried and true formulae: Jeremy Bentham's utilitarianism, John Rawls's liberalism, and Robert Nozick's libertarianism. Rawls, who is often acclaimed as the greatest philosopher of the twentieth century, argued that any action, whether by an individual or by a group, should be judged by the extent to which it improves the life of the least well-off person (that the individual or group can reach).

Fans of Rawls will be happy to learn that Google.org, the enormously well-endowed philanthropic arm of Google.com, has taken their side. Writing in Slate, Larry Brilliant, the head of Google.org has recently endorsed the Rawlsian approach.

What caught my eye, however, was that instead of mentioning Rawls, Brilliant invokes Gandhi:

Gandhi was once asked, "How can I know that the decisions I am making are the best I can make?" He answered: "I will give you a talisman. Whenever you are in doubt, or when the self becomes too much with you, apply the following test. Recall the face of the poorest and the weakest man whom you may have seen, and ask yourself if the step you contemplate is going to be of any use to him. Will he gain anything by it?"

The Gandhi quote is dated, in Gandhi, Freedom, and Self-Rule by Anthony Parel (Lexington Books, 2000, ISBN 0739101374), to 1947, several years before Rawls completed his dissertation at Princeton, and a decade before his famous paper on "justice as fairness".

So, without knowing it, Rawls was actually a Gandhian!

***

In a recent article in The New York Times, the Princeton philosopher, Kwame Anthony Appiah, discusses the recent spate of experimental work in philosophy that presents philosophical quandaries -- e.g., Would you kill someone if it would save the lives of four other people? -- to randomly chosen people, notes their answers, and even peers into their brains using sophisticated scanning technology to see what actually goes on inside when people are pondering ethical imponderables. (Incidentally, this is also the subject of Appiah's just published book, Experiments in Ethics.)

While reading Appiah's article, I was reminded of an idea for a cartoon that had occured to me many years ago when I was thinking idly about precisely this issue: the need to do empirical research on the ethical choices that people actually make in their daily lives. Here's the cartoon idea: Two philosophers are seated at adjoining tables, in the dining area at a philosophers' conference, with waiters standing by to take their orders. One philosopher turns to the other and says: "I'll order the egg and you order the chicken. We'll find out which comes first!"

How the media spins Chavez

The Guardian, a highly respected left-of-center British newspaper, still has on its Web site an uncorrected report about Hugo Chavez's notorious speech at the UN in September 2006, during which he had held up a copy of Noam Chomsky's Hegemony or Survival and recommended it to the audience. Towards the end of the report, Rory Carroll writes:

Last week the former paratrooper lamented not meeting Prof Chomsky before he died.

Of course, Chomsky was alive and well and The Guardian's readers would have taken away from the smirk in Carroll's report a portrait of Chavez the ignoramus, of Chavez the buffoon. At that time, many other reports had gleefully amplified the alleged flub. I had read about it in The New York Times and had seen gleefully condescending reports on TV.

Sadly for Chavez haters, the report, it turns out, was false, made up, spun out of whole cloth. Prof. Chomsky explained it all in a recent interview on C-SPAN. Reporters who later went back to the text of Chavez's speech found that Chavez was lamenting the passing of John Kenneth Galbraith and regretting not having had the opportunity to meet the famous liberal economist. Some reporter then substituted Chomsky for Galbraith and wittingly or unwittingly set off a viral lie.

The New York Times later corrected the error but, as is usually the case with such corrections, in a way that guarantees that not two in a hundred readers, if even that, would see it.

So, what does Bill Clinton think of Kazakh dictator Nursultan Nazarbayev?

If you haven't done so yet, please read After Mining Deal, Financier Donated to Clinton, By JO BECKER and DON VAN NATTA Jr., in yesterday's The New York Times. In September 2005, Clinton accompanied a Canadian businessman named Frank Giustra to a meeting with Nursultan Nazarbayev, Kazakhstan's president-for-life. Nazarbayev's brutal suppression of dissent notwithstanding, Bill was positively effusive, according to the article, in his praise for his dinner host:

Mr. Nazarbayev walked away from the table with a propaganda coup, after Mr. Clinton expressed enthusiastic support for the Kazakh leader’s bid to head an international organization that monitors elections and supports democracy [the OSCE].

Within forty-eight hours, Frank Giustra got the lucrative rights to a Kazakh uranium mine. Later, out of the goodness of his heart, Giustra donated $130 million to Clinton's charitable foundation.

As I was working my way through the article, I felt a certain pressure on the back of my neck, as if a few blood vessels back there were about to explode. Luckily, I then came upon the following passage:

After Mr. Nazarbayev won [another elcetion in December 2005] with 91 percent of the vote, Mr. Clinton sent his congratulations. “Recognizing that your work has received an excellent grade is one of the most important rewards in life,” Mr. Clinton wrote in a letter released by the Kazakh embassy. Last September, just weeks after Kazakhstan held an election that once again failed to meet international standards, Mr. Clinton honored Mr. Nazarbayev by inviting him to his annual philanthropic conference.

Laughter had once again been proved to be the best medicine, in this case, for high blood pressure.