Draft do not cite George Washington University Dirgha Ghimire - PDF document

Women’s Labor Force Participation and Child Health in Nepal: Not all work is the same By Sarah Brauner-Otto 1 McGill University Sarah Baird Draft do not cite George Washington University Dirgha Ghimire University of Michigan 1 Corresponding author: sarah.brauner‐otto@mcgill.ca; Subsequent authors are listed alphabetically.

Women’s Labor Force Participation and Child Health in Nepal ABSTRACT The increase in female labor force participation in the paid labor market since the mid-1900s is one of the most pronounced family transitions of the past century and is increasingly a global phenomenon. While this transition may improve income and bargaining power of the women, it may also increase stress and decrease time with children. We explore the consequences of this transition for children’s health in rural Chitwan, Nepal using newly collected data on child health Draft do not cite outcomes combined with 20 years of longitudinal data (the Chitwan Valley Family Study, CVFS). We model the selection of women into the formal labor market and account for other, dramatic social changes occurring at the same time as women increasingly entered the work force. Results show that the type of employment mother’s are engaged in is a crucial component of the story. Different individual, household, and community factors predict different types of mother’s employment, specifically salaried employment vs wage labor. Furthermore, mother’s employment is inversely related to child health but that is only true for salaried employment, not wage labor.

Women’s Labor Force Participation and Child Health in Nepal Many countries prioritize issues surrounding women’s increasing participation in the work force and the subsequent effects this has on families. Dramatic changes in world economies have brought women out of the household into formal work across the globe. 1 This increase in formal female labor force participation (FLFP) since the mid-1900s is one of the most pronounced transitions the family has seen and is increasingly a global phenomenon. While this transition took place much earlier in Western Europe and North America, FLFP rates are now at least 40- Draft do not cite 50% in Southern Asia and Central America. 2 This shifts the dynamic within the household and likely has profound implications for the health and educational outcomes of the women themselves as well as their children. This study focuses on the consequences of this change for children in rural Nepal. We investigate the relationship between FLFP and child health in part because existing theoretical frameworks and empirical evidence yield contrasting hypotheses. Increased household financial resources may enable families to purchase more/better food, use more preventative health services, and obtain treatment for sick children. This may result in better nutrition and physical health. On the other hand, women’s increased time out of the household may have negative effects on children’s health outcomes. If employment increases time constraints, employed mothers may have less time available for food preparation, home health care, or visits to health care providers. The vast majority of research on the consequences of FLFP for people other than the women themselves uses data on wealthy countries like the U.S. where FLFP has been over 40% since at least the late 1960s/early 1970s. 41 Furthermore, the context in which women are engaged in the labor force in high-income countries is very different from that in low-income countries in 1

particular in terms of childcare infrastructures, family and gender norms, and divisions of household labor. By focusing on a lower-income setting where female participation in non- family labor has only recently begun to be widespread we can learn more about the processes through which the current transformation of women’s labor experiences influences children’s health. Using the rich longitudinal data from Chitwan, we focus on identifying the total effect of FLFP that is separate from the concomitant individual, household, and community- level changes Draft do not cite that are occurring. Household composition may condition whether women engage in non-family labor and most factors that would make labor force participation more likely (e.g. increasing women’s education and increasing access to employers) are also related to child outcomes. Using multilevel longitudinal data, we estimate models of FLFP and child outcomes accounting for prior individual, household, and neighborhood-level characteristics and assess the degree to which the observed relationship is independent of them. While this does not allow us to control for unobservables, the richness of the longitudinal data allows us to control for confounders that are often not available to the researcher. That said, we are careful in our discussion of results and make clear that these are well-identified associations. Background Women have been and continue to perform unpaid labor in the household and on family farms. This paper focuses on the transformative shift of women working for pay, an activity that is often done in addition to their unpaid, domestic work. We use the phrase “female labor force participation (FLFP)” to include women’s paid work, regardless of whether it occurs in or outside of the home. When discussing the specific connections between FLFP and child 2

outcomes we are referring to mother’s labor force participation. We continue to use the abbreviation FLFP both for ease to the reader and to highlight the connection to existing literature. We consider several competing, theoretically motivated hypotheses regarding the relationship between FLFP and child outcomes. First, consider household economics. Following from a rational choice framework, net of household assets and wealth, increasing FLFP leads to increases in household income (assuming the return to women’s labor is greater outside the home Draft do not cite than inside), which should lead to an increase in resources devoted to children and better child outcomes. Specifically, purchasing better quality food and spending more money on medical expenses leads to better nutrition and health. Empirical findings demonstrate that when women work more household money is spent on food, 14-17 which should mean a decrease in malnutrition and stunting. Also, to the extent that medical care is costly, children are more likely to receive that care when mothers are working for pay and have more autonomy. 18; 19 Mother’s employment may also be important because as women engage in non-family activities such as work they are exposed to new ideas including the importance of education, information on the benefits of health services, and childhood as a period of investment. 25-27 This theoretical perspective leads us to expect that children whose mothers engage in paid labor will have better physical health . The second theoretical approach centers on time investments and constraints and yields a contrasting hypothesis, namely that mother’s employment will be associated with poorer child outcomes. At the core of this argument is the acknowledgement that time is limited and when mothers spend more time in paid labor they are spending less time devoted to their children leading to worse child outcomes. 28-30 This time shortage manifests itself in several ways. Most directly, we would expect less time to take care of important household tasks, such as food 3

preparation, and less parental supervision and monitoring. 31 In the U.S., children whose mothers work are more likely to be participating in school lunch programs, implying that mothers are investing less of their own time in meal preparation and nutrition. 32 In Nepal where meal programs are not typically available we would expect to see an increase in child malnutrition and stunting. Less time may also mean parents are not able to seek out medical care when children are sick or for regular visits leading to worse health outcomes. 33 Aside from the time constraint theory, there are other reasons to expect a negative Draft do not cite relationship between mother’s employment and child health outcomes. Work is often stressful for the worker and that stress may have consequences for other family members. Research on intergenerational relationships more broadly has identified such spillover effects. This stress effect may also have a biological link to child health, particularly when we focus on the prenatal period. Factors that contribute to stress are key predictors of low birth weight. Another possible pathway through which women’s employment may have negative consequences for children is childcare. When women are working someone still needs to tend to household tasks such as caring for younger children. This is of particular concern for low-income countries because even though there is increasing pressure and availability for mothers to work there has not been a similar increase in childcare options. Most research in wealthier settings has found that when mothers return to work children typical spend more time in non-family care (e.g. formal child care settings). Without this option, it is possible that young children will be left in the care of older children or other, less qualified caregivers, which may lead to poorer health outcomes. In sum, our competing hypothesis is that children whose mothers engage in paid labor will have worse physical health . Note that some empirical research has found that mother’s employment has no effect on 4