Essays on child mortality and growth faltering in Bangladesh and Kenya.
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文摘
Using survey data from Bangladesh and Kenya with economic status measured by a wealth index and with three different geographic definitions of community, I analyze six competing hypotheses for how economic inequality may affect child stunting. I find little support for the predominant hypothesis that economic inequality as measured by a Gini index is an important predictor of individual health. Instead, I find that the difference between a households wealth and the mean household wealth in the households community is the measure of economic inequality that is most related to stunting in these countries. Using the same survey data, I then analyze general mechanisms and specific mediating factors that may explain the negative relationship between community-relative household wealth and child stunting. Of the two most prominent mechanisms in the literature, I find support for a neomaterial mechanism in both countries, but find no support for a psychosocial mechanism in either country. However, a group of maternal and family planning factors constitutes the most important mechanism in both countries； the most important individual mediators include the mothers BMI, the number of persons per sleeping room, the quality of the mothers prenatal and delivery care, the childs birth order, and, in Kenya, the childs use of a bednet. Finally, I consider young childrens right to health under the Convention on the Rights of the Child. Although the CRC recognizes rights corresponding to almost all of the factors that cause child mortality and growth faltering, its effectiveness has been reduced by substantive limitations on those rights, procedural limitations in enforcing those rights, and an inefficient state party reporting process. In particular, Kenyas few successes in realizing those rights all occurred recently and mainly involved societal factors, which have not yet produced improvements in childrens right to health. By contrast, Bangladesh achieved earlier successes that primarily involved household and proximate factors and has experienced significant decreases in child mortality and growth faltering rates. UN initiatives to amend the CRC by adding a complaints mechanism and to improve the reporting process may not significantly improve the CRCs effectiveness in promoting young childrens right to health.