Son-biased fertility stopping, birth spacing, and child nutritional status in Pakistan

In this article, we append information from four cross-sectional household surveys (Multiple Indictors Cluster Survey of the United Nations International Children's Emergency Fund) in Punjab, Pakistan, collected between 2007 and 2018 to create a data set of 140,000-150,000 child-level observations. Using linear regression, we document a strongly negative birth-order gradient in the nutritional status (measured as height-for-age z-scores) of children below age 5, indicating a pattern of disinvestment in later-born children that is even greater than that documented for poorer countries in sub-Saharan Africa in an earlier study. Consistent with other empirical work in developing-country contexts, girls have on average higher z-scores than boys, but their advantage is lower in Pakistan than other countries outside of the South Asian region, and worryingly, the negative birth-order gradient is steeper for girls than boys. Son-biased fertility stopping rules and close-birth spacing appear to play key roles in Pakistan; following the birth of daughters, parents reduce contraceptive use and breastfeeding (a natural birth control). Using an IV strategy based on the genders of the previously born children, we find that shortened intervals between births harm children's nutritional status, especially that of boys.