Impact of Prenatal Exposure to Fasting on Child Health Outcomes

Abstract

Early life factors play an important role in the foetal development as stated by Barker’s “womb with a view” hypothesis. This study explores how prenatal exposure to Ramadan, the month of fasting, has an impact on the child’s health outcomes in terms of height-for-age and weight-for-age Z-scores. In order to explore the relationship between prenatal exposure to the month fasting and child health outcomes, in the absence of actual reported fasting behaviours, the “Intent to Treat” (ITT) approach is used as in Randomized Control Trial (RCT) evaluations, as it allows for the unbiased impact of an intervention to still be measured, even when there is imperfect compliance with random assignment into control and treatment groups. It does not require or assume all women who are pregnant during Ramadan are fasting. What is critical, however, is that Ramadan is exogenous to the timing of pregnancy; in other words, women do not intentionally time their pregnancies to fall outside of Ramadan. In our study, the ITT framework is used to compare the health outcomes of children whose time period in the utero happened to coincide with the month of Ramadan (treatment group) to those who were not exposed (control group), without using any information on actual fasting behaviour. The date of birth of children under age of five has been used to identify whether pregnancy overlapped with the month of Ramadan and gestational month of exposure variables were constructed using this information. The data for our analysis is provided by the Punjab Multiple Indicator Cluster Survey for 2008 and 2011 gathered by the Punjab Bureau of Statistics. The results of this study indicate that exposure to the month fasting during the first two trimesters has negative implications in terms of height of children. In addition, children who were prenatally exposed to fasting in second and third trimester were on average thinner compared to unexposed children. We did not find evidence of selection bias arising due to parents selectively timing their pregnancy to avoid Ramadan; which was one of the major concerns of our study.