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Child Health & Conflict in Cote d’Ivoire

Child Health & Conflict in Cote d’Ivoire. Camelia Minoiu IMF Institute International Monetary Fund. Olga Shemyakina School of Economics Georgia Institute of Technology. July 28th, 2011. Motivation. Large scale physical destruction arising from armed conflicts and natural disasters

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Child Health & Conflict in Cote d’Ivoire

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  1. Child Health & Conflict in Cote d’Ivoire Camelia Minoiu IMF Institute International Monetary Fund Olga Shemyakina School of Economics Georgia Institute of Technology July 28th, 2011

  2. Motivation • Large scale physical destruction arising from armed conflicts and natural disasters • Macro level studies suggest rapid catch-up growth in physical capital and macroeconomic outcomes • (Miguel & Roland, 2011; Davis and Weinstein, 2002) • However, the direct and indirect consequences of these events along human dimensions could be more persistent and serious than physical impacts.

  3. War & Human Capital: Education • Europe: • Loss in school attainment for individuals from war-affected countries • Germany & Austria vs. Sweden & Switzerland (Ichino & Winter-Ebmer, 2004) • Tajikistan: • 100,000 killed, hundred thousands displaced. • Lower enrollment rates and completion of mandatory nine grades of schooling by young women in Tajikistan (Shemyakina 2011) • Rwanda: • 10% of population were killed • Cohorts of children exposed to this conflict completed 18.3 percent fewer years of education. • Non-poor, male individuals were more negatively affected. (Akresh & de Walque, forthcoming)

  4. War & Human Capital: Health • Burundi: • Civil war and crop failure in Burundi (Bundervoet, Verwimp, and Akresh, 2009) • an extra month of war exposure decreases children’s HAZ by 0.047 standard deviations compared to non-exposed children. • Rwanda: • Effects of genocide in Rwanda (Akresh, Verwimp and Bundervoet, forthcoming) • Decrease in the stature of affected children

  5. Nutrition and Health in Early Childhood • There is no reversal of poor nutrition early in life and the damage to health is permanent (Barker 1999). • Programming process: • a fetus adjusts to short-term changes in his or her environment • and while such adaptation is beneficial in the short run, it is detrimental to long-term health (Godfrey and Barker, 2000).

  6. This study • We use the 2002-2007 conflict in Cote d’Ivoire as a quasi experiment to analyze the effect of the conflict on child’s health • measured by height-for-age z-scores • while controlling for province of residence and year of birth

  7. Main findings • Children from the northern regions of CIV that were controlled by the rebels and that were more affected by the war suffered health set-backs as compared to children from the lesser affected south. • The effect is especially pronounced for children born soon after the start of the conflict (born in 2003-2005) and who were exposed to the negative impacts of the conflict for a longer period of time, • This is consistent with other studies (Bundervoet et al., 2009).

  8. 2. Background of the Conflict

  9. Civil war in CIV • An unusually high international involvement by the neighboring nations, the United Nations, France, and Burkina Faso. • Relatively small number of casualties: • the best estimates of annual battle fatalities reaching about 600 in 2002 and 2003. • Civilians affected by the conflict: • 2.7 million, including the internally displaced and • 4 million (includes foreign residents evacuated to Liberia and Sierra Leone and those who fled to Mali, Guinea, Burkina Faso and elsewhere (UNOCHA, 2003)).

  10. Figure 1 – Real GDP Growth Rate in Cote d’Ivoire, 1990-2010. Source: World Economic Outlook (October 2010). The figure for 2010 is a projection.

  11. The conflict: 2002-2007 • Prelude: • Political unrest followed the death of long-standing President Felix Houphouet-Boigny in 1993, with a number of coups d’état taking place during the 1990s. • The start: • September 19, 2002 • multiple attacks in several cities (Abidjan in the south, Bouake in the center, and Khorogo in the north) • by military forces protesting against plans towards demobilization.

  12. The conflict: 2002-2007 • Tension caused by • 26% of population is of foreign origin (Burkina Faso, Sierra Leone) • Unemployment, return of many urban migrants to the fields that were tended by migrants • xenophobia: suppressed during the previous presidency • “Ivorian” • An economic downturn due to a deterioration of the terms of trade between Third World and developed countries worsened conditions, exacerbating the underlying cultural and political issues.

  13. Catalyst to the conflict • The law quickly drafted by the government and approved in a referendum immediately before the elections of 2000 • required both parents of a presidential candidate to be born within Côte d'Ivoire. • This excluded the northern presidential candidate Alassane Ouattara from the race. • Ouattara represented the predominantly Muslim north, particularly the poor immigrant workers from Mali and Burkina Faso working on coffee and cocoa plantations.

  14. The conflict: 2002-2007 • During the conflict: • After the initial attacks, the rebel forces retreated to the northern and western parts of the country, while the south was under government control. • The conflict ignited widespread harassment of foreigners in CIV, including migrant workers from the region and refugees from Liberia and Sierra Leone living on the outskirts of cities. • The end: • The crisis ended officially with the March 2007 Ouagadougou Political Accord, although fighting had ceased about three years before that, with the interim period being marked by isolated bouts of violence and a tense atmosphere.

  15. Figure 3 - The « buffer zone » separating the rebel-held north and the government-controlled south in Cote d’Ivoire, 2002–2007

  16. 3. Data

  17. 3. Household and Individual Data • The cross-sectional 2002 and 2008 Household Living Standards Surveys (HLSS) • The National Institute of Statistics • Detailed information on households and individuals, including socio-economic characteristics

  18. 3. Household and Individual Data • Anthropometric measures for children ages 0-5 years (0- 60 months) at the time of the survey • Height • Weight • Focus on height: • a long-term measure of health

  19. WHO Multicentre Growth Reference Study • Height for age (HAZ): • the study population lived in the favorable socio-economic conditions and where the mobility was low; • 80+% followed WHO feeding guidelines • Cross-sectional and longitudinal component • New dataset • Brazil • Ghana • India • Norway • Oman • USA

  20. 3. The key dependent variable • Height for Age Z-score (deviation from the mean score based on WHO standards): • (Measured Value - Average Value in the reference population)/ Standard Deviation of the reference population • Ranges • HAZ> - 2 s.d.– not malnourished • -3 s.d. <HAZ < -2 s.d. – moderately malnourished • HAZ< - 3 s.d. – severely malnourished • -2< HAZ < 2 – 95% of reference population

  21. 3. WHO guidelines • The use of -2 Z-scores as a cut-off implies that 2.3% of the reference population will be classified as malnourished even if they are truly "healthy" individuals with no growth impairment. Hence, 2.3% can be regarded as the baseline or expected prevalence. • % of population with HAZ < -2 SD: • <20% - low prevalence of malnourishment • 20-29 – medium • 30-39 – high • 40+ - severe

  22. Descriptive data • HAZ by province of residence and age group • Historical HAZ by gender and year • HAZ by gender, year and conflict exposure

  23. Table 1 - Overview of nutritional status and poverty in CIV, by region

  24. Table 1 - Overview of nutritional status and poverty in CIV, by region

  25. Table 1 - Overview of nutritional status and poverty in CIV, by region

  26. Table 1 - Overview of nutritional status and poverty in CIV, by region Failure to improve as much

  27. Figure 4 – Long-term perspective on child health in CIV: Percentage of children with HAZ < - 2 s.d. Years 1994, 1998, 2002, 2006, and 2008. Sharp increase in malnourishment rates in 2002

  28. Figure 5 – Long-term perspective on child health in CIV: Percentage of children with HAZ < - 3 s.d. Years 1994, 1998, 2002, 2006, and 2008.

  29. Figure 6 - War vs. non-war affected areas: Percentage of children with HAZ < - 2 s.d.

  30. Figure 6 - War vs. non-war affected areas: Percentage of children with HAZ < -2 s.d.

  31. Figure 6 - War vs. non-war affected areas: Percentage of children with HAZ < -2 s.d.

  32. Figure 6 - War vs. non-war affected areas: Percentage of children with HAZ < -2 s.d. Failure to lower as much malnour. rates in conflict areas by 2008

  33. Figure 6 - War vs. non-war affected areas: Percentage of children with HAZ < -2 s.d. Failure to improve for males in conflict ares Worse rates for females in 2008 in conflict areas

  34. Figure 7 – War vs. non-war affected areas: Percentage of children with HAZ < -3 s.d.

  35. Figure 7 – War vs. non-war affected areas: Percentage of children with HAZ < 3 s.d. Worsening of extreme malnourishment for men and women

  36. Regression Results

  37. 4. Regression framework • Dependent variable: • HAZ score of a child • Independent: • Residence in the conflict affected area • Gender • Controls: • Birth cohort dummies • Province dummies

  38. Table 2 – Determinants of anthropometric outcomes in Cote d’Ivoire (children born b/w)

  39. Table 2 (cont-ed)– Determinants of anthropometric outcomes in Cote d’Ivoire

  40. Table 3 - Determinants of anthropometric outcomes in Cote d’Ivoire. OLS Regressions. Dependent Variable: Children’s Height for Age Z-Score.

  41. Table 3 (cont’ed)- Determinants of anthropometric outcomes in Cote d’Ivoire. OLS Regressions. Dependent Variable: Children’s Height for Age Z-Score.

  42. 5. Discussion

  43. 5. Main findings • Lower HAZ rates in the rebel-controlled North • Greater impact on children who were born when the conflict started • No significant negative impact on female HAZ once we control for the year of birth and province of residence

  44. 5. Limitations and Future Work • Potential selection: • Only children who were alive at the time of the survey • Results do not account for migration • Future work: • Account for the selection issues • Add household characteristics • Exploit individual variables of exposure to conflict

  45. Policy implications • Early intervention is important • School feeding programs? • Support for families with young children • Loss in child health is cumulative, children stagnate and follow on a different growth path • Research shows that: • Shorter individuals complete fewer years of schooling • Earn lower wages in the developing countries, especially this is true for males

  46. Thank you!!!

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