Abstract:
This study aims to estimate the impact of fertility on child health outcomes in Pakistan.
Fertility can affect family size and hence the resources available for the welfare of each
family member: a larger family size may result in fewer resources for children and
adversely affect child health. The existing literature provides suggestive evidence on the
likely impact of family size on child health but causal evidence is rare: while fertility
decision can affect child health, health of existing children can also influence the decision
to have another child. This study uses the incidence of ‘twin birth’ as an instrument for
family size and is the first study for Pakistan that attempts to provide causal evidence on
the impact of family size on child health. I use household - level data and child health data
(height and weight-for-age, child mortality) from a sample of children under the age of 5
years from the Punjab (Pakistan) MICS rounds. Results show that each additional member
of the family reduces height- and weight-for-age z scores by 0.2 – 0.3 standard deviations
and increases the likelihood of child death by 8 – 9 percentage points. The results of this
study can help policy makers in establishing policies that address the large family size
issues and its importance for better child health outcomes.
