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The Puzzle of Muslim Advantage in Child Survival in India

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The Puzzle of Muslim Advantage in Child Survival in India IZA DP No. 4009 The Puzzle of Muslim Advantage in Child Survival in India Sonia Bhalotra Christine Valente Arthur van Soest DISCUSSION PAPER SERIES DISCUSSION PAPER February 2009 Forschungsinstitut zur Zukunft der Arbeit Institute for the Study of Labor The Puzzle of Muslim Advantage in Child Survival in India Sonia Bhalotra University of Bristol and IZA Christine Valente University of Nottingham Arthur van Soest Tilburg University and IZA Discussion Paper No. 4009 February 2009 IZA P.O. Box 7240 53072 Bonn Germany Phone: +49-228-3894-0 Fax: +49-228-3894-180 E-mail: [email protected] Any opinions expressed here are those of the author(s) and not those of IZA. Research published in this series may include views on policy, but the institute itself takes no institutional policy positions. The Institute for the Study of Labor (IZA) in Bonn is a local and virtual international research center and a place of communication between science, politics and business. IZA is an independent nonprofit organization supported by Deutsche Post Foundation. The center is associated with the University of Bonn and offers a stimulating research environment through its international network, workshops and conferences, data service, project support, research visits and doctoral program. IZA engages in (i) original and internationally competitive research in all fields of labor economics, (ii) development of policy concepts, and (iii) dissemination of research results and concepts to the interested public. IZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author. IZA Discussion Paper No. 4009 February 2009 ABSTRACT The Puzzle of Muslim Advantage in Child Survival in India* The socio-economic status of Indian Muslims is, on average, considerably lower than that of upper caste Hindus. Muslims have higher fertility and shorter birth spacing and are a minority group that, it has been argued, have poorer access to public goods. They nevertheless exhibit substantially higher child survival rates, and have done for decades. This paper documents and analyses this seeming puzzle. The religion gap in survival is much larger than the gender gap but, in contrast to the gender gap, it has not received much political or academic attention. A decomposition of the survival differential reveals that some compositional effects favour Muslims but that, overall, differences in characteristics between the communities and especially the Muslim deficit in parental education predict a Hindu advantage. Alternative outcomes and specifications support our finding of a Muslim fixed effect that favours survival. The results of this study contribute to a recent literature that debates the importance of socioeconomic status (SES) in determining health and survival. They augment a growing literature on the role of religion or culture as encapsulating important unobservable behaviours or endowments that influence health, indeed, enough to reverse the SES gradient that is commonly observed. JEL Classification: O12, I12, J15, J16, J18 Keywords: religion, caste, gender, child survival, anthropometrics, Hindu, Muslim, India Corresponding author: Sonia Bhalotra Department of Economics University of Bristol 8 Woodland Road Bristol BS8 1TN United Kingdom E-mail: [email protected] * Sonia Bhalotra acknowledges funding from ESRC and DFID under research grant RES-167-25-0236 held at the CMPO in Bristol. Earlier versions of this paper were presented at a DFID and CMPO funded workshop on Child Health in Developing Countries in Bristol in June 2005 and at the European Society of Population Economics Conference in Verona in June 2006. The Puzzle Of Muslim Advantage In Child Survival In India Sonia Bhalotra, Christine Valente, Arthur van Soest 1. Introduction Hindus and Muslim have cohabited in India for centuries, with Muslims ruling most of the Indian subcontinent from the early 16th to the mid-19th centuries under the Mughal Empire. However, today, their socioeconomic condition is thought to be not much better than that of low caste Hindus, who have a long history of deprivation (Government of India 2006).1 But despite being, on average, less educated and poorer, Indian Muslims exhibit a substantial advantage in child survival. This paper documents and analyses this seeming puzzle. It shows that the Muslim advantage is large, persistent, and hard to explain. A number of recent studies document socioeconomic status (SES) gradients in health and survival, across countries, across SES groups within country and within groups over time; for a survey see Cutler et al. (2006). Previous analyses of health inequalities along ethnic or religious lines tend to start out with a differential consistent with SES differences, as is the case, for example, with black-white differences in health in the United States. While it has been recognised that unhealthy behaviours like smoking or drinking may vary positively with SES (e.g. Rogers et al., 2000, p. 245), these are seldom large enough to alter the raw differential in favour of the lower-SES group. The case of Muslims in India is, in this respect, most unusual. By age five, the Muslim survival advantage over Hindus is as high as 2.31%- points, which is about 17% of baseline mortality risk amongst Hindus. Restricting the comparison to upper-caste Hindus, who enjoy unambiguously higher social status than Muslims, the differential is 1.30%-points, or about 10% of baseline mortality risk. Based on the total number of births recorded in 2000 (Census of India 2001), and on the proportions of high- and low-caste children born that year (obtained from representative survey data used in this paper), this differential translates into an annual 127,955 (244,535) excess under-5 deaths amongst high-caste (low-caste) Hindus. To put the size of this differential in perspective, consider that the more widely discussed gender differential in under-5 mortality is 0.30%-points. Also, the average annual rate of decrease in under-5 mortality risk between 1960 and 2001 in India was 0.61%-points p.a., 1 This is topical because the last two decades have witnessed renewed conflict between Hindus and Muslims (Varshney 2002), and this has also been a period of considerable political and socio-economic change. 2 which is about half the differential between Muslims and high-caste Hindus. The Muslim-Hindu survival differential is not a new or an isolated phenomenon. It is evident for most of the last half century. It has nevertheless claimed little public or academic attention. Although it is flagged by Shariff (1995), Bhat and Zavier (2005), Bhalotra and van Soest (2008) and Deolalikar (forthcoming), we know of no previous research that carefully investigates this phenomenon. This paper attempts to fill this gap, using microdata on more than 0.6 million children born to about 200,000 Indian women during 1960-2006. The data and context are described in Section 2. Section 3 profiles the seeming puzzle, showing how the Muslim advantage varies by gender, age and birth order, how it has evolved over time, and how it differs across Indian states and between rural and urban areas. Section 4 presents the estimation methods used. We use existing techniques for decomposition of outcome differentials to investigate the extent to which the mortality differential can be explained by the sorts of characteristics that are commonly used to explain or predict child mortality rates (results are in Section 5). We then investigate alternative outcomes and specifications (Section 6). Section 7 concludes. Our main finding is that the Muslim advantage over high caste Hindus cannot be explained by the usual covariates included in the model. It is possible that there are omitted variables that improve survival and that are inversely correlated with SES, but that have no particular relation to religion. The layering of religion and caste in Indian society provides us with an opportunity to investigate this. We do this by considering the extent to which the Muslim advantage over low caste Hindus (of lower SES) is explained by the same set of characteristics. We find that less than half of their advantage is explained. Overall, the evidence points to a persistent Muslim “fixed effect” that favours child survival. The fixed effect survives our attempts to include further controls for socio-economic status, access to health services and rural infrastructure, maternal health and diet, and it is evident again when we examine differences between Hindu and Muslim communities in child nutritional status. Our findings suggest a research agenda that investigates what attitudes, behaviours or unobserved traits Muslims might have, unlocking the key to which would make an enormous impact on average mortality rates in India. We suggest that some of the Muslim advantage may stem from their lower degree of son-preference, their closer kinship, their more non-vegetarian diet, the better health of Muslim mothers and their lower propensity to work outside the home. 3 The results contribute to a recent literature that argues that socioeconomic status may not be as important a determinant of health or survival as attitudes at the individual level and medical technology and services at the aggregate level (Cutler et al. 2006, Fuchs 2004). It extends this discussion to incorporate the importance of culture or community. Although there is a surge of interest amongst economists in ethnicity effects, especially in education (e.g. Fryer and Levitt 2004, Wilson et al 2005), there remains limited research on religion effects. The effects of religion on fertility have been analysed, for example, for India (Bhat and Zavier 2005) and historical Europe (Guinnane 2005), but there is little work on religion and health. The analysis leads us to reconsider the power of commonly estimated equations for mortality and health that neglect unobserved heterogeneity between communities.
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