The GiveWell Blog

Malnutrition and income

Over the last few days I have been wondering just how severe and how fixable developing-world malnutrition may be. For a striking illustration, see “Grandmothers and Granddaughters: Old Age Pension and Intra-household Allocation in South Africa” by Esther Duflo.

This paper analyzes a survey of 9000 families in the early 1990s in South Africa, when a public pension program was broadened significantly, and tries to look at how the program (significant cash transfers to low-income, elderly people) affected child nutrition. Its key argument is that cash transfers to women significantly improved the nutrition of female children (but that cash transfers to men had no discernible effect on child nutrition).

I’m not convinced that the data support this argument (my chief concern is Figure 1, which makes it look like the children of eligible women got healthier before but not more than other children, and that the observed effect is an artifact of the time period studied). However, the argument reflects three key themes that, from the paper’s references and a few other things I’ve seen, seem to have significant research supporting them:

1. Malnutrition is widespread and severe among the very poor. Table 3 shows that prior to the program’s expansion, these low-income South African children were far shorter (for their age) than American children: their height-for-age averaged around -1.5 standard deviations (under standard assumptions, this would put the average South African child around the 7th percentile of American children). Height-for-age is strongly linked to nutrition in early childhood, as Duflo explains (with references) starting on Page 13.

2. Curbing malnutrition is not necessarily a thorny problem. Regardless of whether Duflo’s hypothesis about female vs. male recipients is correct, there is no question that the height gap described above fell sharply (down to 0.5 standard deviations, which corresponds to the 30th rather than 7th percentile of the general population) after the introduction of the pension program. Bear in mind that the program was no elaborate health intervention, but merely a cash transfer to families.

3. In the developing world, not all household income is equivalent. Duflo argues that income that comes to women is more likely to improve children’s health. This is the most questionable claim in the paper for me (for reasons outlined above), but the general idea is also argued in this study of Cote d’Ivoire, and possibly in other literature as well; this would give some explanation of why so many microfinance programs explicitly focus on women.


  • Gena Rotstein on July 27, 2008 at 12:12 pm said:

    Hi Holden,
    I was recently at a meeting for a fund that supports local organizations and the comment was made that if you want things to get done on a committee you make sure that there are women in key leadership roles. I think this speaks to your last comment.

    Taking things to a cultural level in Africa, we know that women bear the brunt of the household labour so it makes sense that if you want child nutrition to be addressed you focus on the mothers since they are the ones that control the household activities.

    I hope you are having a good day! Thanks for sharing this post.


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