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Why Does Mother's Schooling Raise Child Health in Developing Countries? Evidence from Morocco Author(s): Paul Glewwe Source: The Journal of Human Resources, Vol. 34, No. 1 (Winter, 1999), pp. 124-159 Published by: University of Wisconsin Press Stable URL: http://www.jstor.org/stable/146305 . Accessed: 20/05/2011 02:27
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Why Does Mother's Schooling Raise Child Health in Developing Countries?

Evidence from Morocco

Paul Glewwe
ABSTRACT Mother's education is often found to be positively correlated with child health and nutrition in developing countries, yet the causal mechanisms are poorly understood. Three possible mechanisms are: (1) Formal education directly teaches health knowledge to future mothers; (2) Literacy and numeracy skills acquired in school assist future mothers in diagnosing and treating child health problems; and (3) Exposure to modern society from formal schooling makes women more receptive to modern medical treatments. This paper uses data from Morocco to assess the role played by these different mechanisms. Mother's health knowledge alone appears to be the crucial skill for raising child health. In Morocco, such knowledge is primarily obtained outside the classroom, although it is obtained using literacy and numeracy skills learned in school; there is no evidence that health knowledge is directly taught in schools. This suggests that teaching of health knowledge skills in Moroccan schools could substantially raise child health and nutrition in Morocco.

I. Introduction
Child healthis a key indicatorof the qualityof life in developing countries.Mother'syearsof educationis often positivelyassociatedwith improved status(see Behrman, childhealthandnutritional 1990).Therearea varietyof mechaPaul Glewwe is a Senior Economist in the Development Research Group at the The World Bank. He would like to thank Hanan Jacoby, Martin Ravallion, and two anonymous reviewers for helpful comments on previous drafts, and Nauman Ilias for excellent computational assistance. This research was supported by a grant from the World Bank Research Committee (RPO 679-84). The findings, interpretations and conclusions expressed in this paper are entirely those of the author. They do not necessarily represent the views of the World Bank, its Executive Directors, or the countries they represent. The data used in this article can be obtained beginning May, 1999, through April, 2002, from Paul Glewwe, The World Bank, 1818 H Street NW, Washington, DC 20433.

October1996; acceptedFebruary 1998] [Submitted THE JOURNAL OF HUMAN RESOURCES * XXXIV * 1

Glewwe nisms throughwhich mother'seducationcould raise child health:(1) Direct acquisition of basic healthknowledgein school may providefuturemotherswith informationuseful for diagnosingand treatingchild health problems;(2) Literacyand numeracyskills learnedin school may enhancemothers'abilitiesto treatchild illon nesses, conditional healthknowledge,andalso shouldhelp mothersincreasetheir stockof healthknowledgeafterleaving school;and (3) Exposureto modem society in generalvia schoolingmay changewomen's attitudes towardtraditional methods of raisingchildrenand treatingtheirhealthproblems. This paperattempts assess the relativeimportance these threemechanisms, to of using the 1990-91 MoroccanEnqueteNationaledes Niveaux de Vie des Menages of (ENNVM). Knowledgeof the relative importance these mechanismscan have For important policy implications. example,if the mainimpactof educationcomes from directlyraisingmothers'basic healthknowledge,such knowledgeshouldbe taughtin schools as early as possible (that is, before girls drop out) and perhaps shouldalso be taughtin special educationcoursesfor women of child-bearing age who have alreadyleft school. The paperis organizedas follows. SectionII reviews, in broadterms,the impact of mother'seducationon child healthandbrieflyreviews the recentliterature. Section IIIdiscussesthe dataandthe estimation SectionIV presentsthe empiristrategy. cal results.Section V decomposesthe total impactof mother'sschooling on child health.Section VI summarizes results. the

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II. Mother's Education and Child Health A. GeneralDiscussion of Figure 1 provides a schematicframeworkfor thinkingabout the determinants child healthand nutritional status.As seen at the bottomof thatfigure,child health is ultimatelydetermined three distinctsets of factors:1. Healthand nutritional by inputsprovidedby the household(arrowi); 2. The local healthenvironment (arrow f); and 3. The child's health endowment(arrowh). Health and nutritional inputs breastmilk substitutes care, breastmilk, providedby the householdincludeprenatal such as infantformula,caloriesfrom adultfoods (for weanedchildren),medicines, and medicalcare. The qualityof householddrinkingwatersources,toilet facilities, andotherhygienicconditionscan also be considered healthandnutritional as inputs consistsof all community providedby the household.The local healthenvironment characteristics directlyaffect child healthand are generallybeyondthe control that of theparents, suchas prevalence parasites the incidenceof contagiousdisease of and among the generalpopulation.Finally, the child healthendowmentconsists of all that componentsof the child's genetic inheritance have implicationsfor his or her health. Householdhealth and nutritional inputs are determined householddecisions by thatreflectthe characteristics the household,the local community,andthe child, of such as (initial) household assets, parentalschooling, communityeconomic and health-related characteristics and (suchas the availability pricesof medicalservices), andeachchild'shealthendowment. Thispaperfocuseson parental schooling,partic-

Exogenous Variables

Parental Schooling

Household Assets

Education Outcomes and Endogenous Variables ParentalHealth Knowledge abc \

v

a' \a

ca c'

Household Income I/ c acd 4--

Household Health and NutritionalInputs Health Outcome Child Health

Figure 1
The Determinants of Child Health

Glewwe ularlymother'sschooling;father'sschooling, apartfrom its income effect, is less for children'shealth. likely to be important maintaining Schultz (1984) arguesthat mother'seducationcan influencechild healthin five may lead to a more efficientmix of healthgoods used to proways:1(1) Education duce child health;(2) Bettereducatedmothersmay be more effective at producing child healthfor a given amountand mix of healthgoods; (3) Schoolingcan affect in motherstendto opt parents'preferences systematicways-for example,educated for fewer but healthierchildren;(4) More schooling should raise family incomes, in either throughhigher wages or increasedproductivity self-employment, which shouldimprovechild health status;and (5) Educationraises the opportunity costs of time, which tends to increasethe time mothersspendworkingoutsidethe home and thus reduce time for child care-this effect of schooling could reduce child health by reducing both maternaltime devoted to child care and durationof In breastfeeding. Figure 1, the third and fourthpathwaysare represented the by arrowsa-a' (and also by a-a") and acd (via a-a"'and c-c"'), respectively.2 first The two pathways,which reflectthe directeffect of the healthknowledgeand cognitive skills thateducationimparts,have receivedlittle attentionin the literature. Whatis it aboutschoolingthatmakes mothersmore efficientin producingchild health? Figure 1 presentstwo mechanismsthroughwhich schoolingcould influencethe choice of health and nutritional inputs via the knowledge and skills it provides.3 First, schools may directlyteach effective health care practicesto students.This on pathwayis denotedby b-abc. For example,the impactof diarrhea child health can be reducedby oral rehydration therapy(ORT), which can be taughteven in schools(see Cash 1983).Second,schoolingcaninfluencechildhealthinputs primary such as literacyandnumeracy. Literate moththroughthe cognitiveskills imparted, ers arebetterable to readwritteninstructions treatingof childhooddiseases,and for This numeracyenables mothersto bettermonitorillnesses and apply treatments. directeffect is shownby c-c" in Figure1. Literacy numeracy enablemothers and also to increase their health knowledge by enabling them to gatherinformationfrom writtensources.This indirecteffect is path c-c'-abc in Figure 1. Figure 1 also depicts how factors other than schooling influence child health. Householdphysical assets raise householdincomes (arrowd), which should have a positiveeffect on bothnutritional coninputs(such as calories)andenvironmental ditions aroundthe home. The choice of health and nutritional inputs will also be affected by factors associatedwith the supply of these inputs in the community and commu(arrowe). Forexample,the availability qualityof healthandnon-health healthandnutritional nity facilitiesaffectsthe decisionshouseholdsmakeregarding
1. Schultz'sframework primarily is concernedwith child mortality. broadening to includeother, Yet it less severe, aspectsof child healthdoes not requiresignificantmodification. 2. The fifth pathway,via mother'stime, could be added to Figure 1 but is omittedto reduce clutter. Similarly,the impactof the thirdpathwayvia reducedfamily size could also be made more explicit (as a box labeled "family size," another but endogenousvariable), this is also omittedto reduceclutter. 3. The distinctionbetweenpathways(1) and (2) in the previousparagraph that the first concernsan is efficient mix of physicalhealthinputs (for example,medicines)while the second adds efficientuse of betweenphysical non-physical inputs(such as care given to the sick child). In this paper,the distinction andnonphysical rather emphasis on the different the is interest, inputsis not of primary typesof knowledge and skills learnedin school, and how they affect efficientuse of both types of inputs.

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The Journalof HumanResources inputs.Finally,the child's healthendowmentwill also affect householdhealthand nutritional inputs (via arrowg), since more sickly childrenusually receive larger amountsof healthand nutritional inputs. B. Recent EmpiricalEvidence Manyrecentstudieshave examinedthe impactof mother's(andfather's)education on child health.For comprehensive reviews of the literature Behrman Deosee and lalikar(1988), Behrman(1990), and Straussand Thomas (1995). The discussion here will be limitedto an overviewof a few recentstudies,focusing on the impact of mother'seducationon height-for-age weight-for-height. and of Studies of the determinants child height and weight in many countrieshave Mostof thesestudiespresented foundpositiveeffectsof mother'seducation. reduced formestimates,but a few went further, examiningthe pathwaysby which mother's Barrera education (1990) foundthatbetter improveschild health.In the Philippines, for mothers educated tendedto weantheirchildren sooner,buttheycompensated this werehealthier as timewithbettercare;overall,theirchildren shortened breastfeeding The only publishedstudythatfocuses measured higherheight-for-age z-scores.4 by of on the "information processing"attributes schoolingis by Thomas,Strauss,and Henriques(1991), which used Braziliandatathat includedvariablesfor whethera woman reads a newspaper,listens to the radio, or watches television. Mother's wereincludedfor these "inforwhendummyvariables schoolingwas not significant in and mationprocessing"activities;the newspaper radiovariableswere significant ruralareasbut only the television variablewas significantin urbanareas. Among the most interestingstudies are those based on the Cebu Longitudinal HealthandNutrition Survey.Severalstudieshaveusedthesedatato modelthe pathstatusandmorbidity. influencechild nutritional ways by whichexogenousvariables leadsto improved The CebuStudyTeam(1991, 1992)foundthatmother'seducation calorieintake,both of which reducethe waste disposaland highernon-breastmilk Maternal educationalso leads to earlierweaning,which can incidenceof diarrhea. educationis to reduce but increaseepisodes of diarrhea, the net effect of maternal the incidenceof diarrhea. An important critiqueof findingsthatmother'seducationimproveschild health characteristics. maternal is the hypothesisthateducationsimplyreflectsunobserved data on mothers'siblings to control Wolfe and Behrman(1987) used Nicaraguan for unobserved family fixed effects. They foundthatapplyingthese controlsleaves status.However, on effect of mother'seducation child anthropometric no significant Strauss(1990) found in Cote d'Ivoirethat mother'seducationraises child heighteven afterusing family fixed effects estimators. for-age and weight-for-height, education evidencethatmother's In summary, thereis considerable improveschild health,and some evidenceon how this occurs.Still, thereareno studiesthatdistinworkbelow, arebasedon fittinga standard 4. Heightfor age z-scores,whichwill be used in the empirical of to normaldistribution the growthcurves of a healthypopulation children.A child with a z-score of zero is exactly at the medianin termsof heightfor age, while childrenwith positive (negative)z-scores than average.Low height for age z-scoresindicatestuntingdue to repeatedepisodes are taller (shorter) over the life of the child, while low weight for heightz-scoresindicatewasting(weight of malnutrition (see loss) due to a current episodeof malnutrition Gibson 1990).

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guish between the literacy and numeracy impacts of schooling and other, more general, impacts. Also, there are no studies that attempt to assess directly the impact of mother's health knowledge on child health.

III. Analytical Framework, Data and Estimation Strategy

A. Analytical Framework Estimation of the pathways by which mothers' schooling affects child health is not necessarily straightforward.This subsection provides a framework for thinking about how to estimate these relationships. Recall Figure 1. The bottom of that figure shows how health and nutritional inputs, the environment and a child's health endowment jointly determine child health. This can be expressed in terms of a production function for child health: (1) Hi = f(HIi, Ei, Ei)

where Hi is the health of child i, HIi is a vector of health inputs chosen by child i's household, Ei is a vector summarizing the environmental conditions surrounding child i, and Eiis the child's genetic health endowment. Parents take this technological relationship into account as best they can when making decisions that affect their children's health. Although Ei and Eiare outside the household's control,5 health and nutritional input choices are chosen by the household. Estimation of Equation 1 would require detailed information on a large number of health inputs, which is not feasible with the 1990-91 ENNVM data. However, as seen in Figure 1, one can substitute out these health inputs and obtain a reduced form relationship that shows how exogenous variables (those shown at the top of Figure 1) determine child health:6 (2) Hi = g(FSi, MSi, HAi, Ei,
Ei)

where FSi and MSi are father's and mother's schooling, respectively, and HAi is the initial assets of child i's household. Although Equation 2 is much easier to estimate, and often has been estimated, it does not indicate what aspects of mother's schooling lead to improved child health. Referring again to Figure 1, one can obtain a better understanding of the impact of mother's schooling by replacing it in Equation 2 with the educational outcomes it directly affects, namely cognitive skills, parental values and health knowledge:
is 5. The local healthenvironment not chosenby parents a) migration purposesof findinga better if: for healthenvironment rare;andb) householdscannotpressure is local authorities improvethe local health to environment. The formerassumption supported migrationdata from the 1990-91 ENNVM;only is by 0.5 percentof respondents reportthat "healthreasons"were the mainreasonfor theirmost recentmove. The latterassumption, while harderto check, is plausiblefor Moroccobecausehealthcare provisionis with few fundsunderthe controlof local governments highly centralized, (see WorldBank 1994). 6. The assumption that parentaleducationis exogenous seems reasonable Morocco,where average for Even schoolingfor men andwomanbetweenthe ages of 18 and65 is only 4.7 and2.3 years,respectively. will be checkedin Section IV. so, this assumption

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The Journalof HumanResources

(3) Hi = h(FSi, Li, Ni, Vi, HKi, HAi, Ei, ?i)

where Li, Ni, Vi and HKi standfor mother'sliteracy,numeracy,values and health is Thisequation a conditional demand relationship because, knowledge,respectively. as explainedbelow, healthknowledge,and perhapsliteracyand numeracy, may be endogenous. of 3 Estimation Equation wouldclarifythe pathways whichmother'sschooling by affects child health,but such estimationis complicatedby severalproblems.First, it is difficultto observemother'svalues(Vi),andindeedthereareno suchdatain the 1990-91 ENNVMsurvey.Second,a child's healthendowment is also virtually (?i) of impossibleto observe.Third,becauseparents'treatment their children'shealth healthknowledge,healthknowlproblemsoften causes them to acquireadditional healthknowledgeis likely variable.In particular, is likely to be an endogenous edge with a child's (unobserved) to be negativelycorrelated genetic healthendowment as neednot acquire muchhealthknowledge with "healthy"children becauseparents as parentswith "sickly" children,ceteris paribus.7 Fourth,it is also possible that health are literacyand numeracy endogenousbecause actionsto acquireadditional knowledgemay lead to greateruse of those skills, thoughthe impactof a child's genetic health endowmenton these variablesis likely to be considerablysmaller takento deal with these probthanits impacton healthknowledge.The approaches lems will be discussedin detail in SubsectionIIICbelow. to of Anotherrelationship interestis a variationof Equation3; when attempting assess the pathwaysby whichmother'seducationaffectschild healthone may wish income income.8 thiscase one canaddhousehold In to isolateits impacton household (Yi)to Equation3 and removehouseholdassets (since theirimpacton child health theirimpacton householdincome).This yields the folwould operateonly through for lowing conditionaldemandrelationship estimation: (4) Hi = h'(FSi,Li, Ni, Vi, HKi, Yi,Ei, ?i). interestin this paperare Equations3 and 4. of The relationships primary A finalissue to consideris the possibilitythatmother'seducation improveschild healthby reducingthe numberof childrenwomen bear-with fewer children,the mothershouldbe able to allocatemore time and healthinputsper child. As mentioned in Section II, the desire for fewer childrencan be depictedas the impactof 3 values.Thus,one couldmodifyEquations and4 by replacing schoolingon parental of Viwith the number childrenbornor, moregenerally,by addingthe lattervariable while retainingVi (since values may affect child healthin otherways). Of course, since the numberof childrenbornis clearlyan endogenousvariable,estimationreto 7. This could be shown in Figure 1 by an arrowleadingfrom the child's healthendowment parental healthknowledge. 8. One could go even further.Increasededucationcan raise householdincome not only by increasing wage rates but also by increasingthe amountof time the motherworks outsidethe home. Moreover, increasedtime of the motheraway from home may have a direct,negativeimpacton child health.Thus 4. one could add both householdincome andmother'stime spentworkingto Equation This was triedin variables an earlierversionof this paper(see Glewwe 1997),but it provedimpossibleto findinstrumental of 4 thatcould plausiblybe excludedfrom Equation and were also good predictors mother'stime spent 4. out working.In this papermother'stime spentworkinghas been substituted of Equation

Glewwe variables;this will be discussedfurtherin Subsection quiresplausibleinstrumental IIIC. B. The Data This paperuses data from the 1990-91 EnqueteNationalesur le Niveau de Vie des Menages (ENNVM), which was implementedby Morocco's Direction de la The Statistique. survey,whichis basedon the WorldBank'sLSMSsurveys,covered 3,323 householdsfromall areasof Morocco.The surveycollecteda varietyof informationfromeachhousehold, householdexpenditures income,employand including assets,agricultural activities,andmuchmore.A key aspectof these ment,education, datafor this paperis thatthey containthe height andweight of all householdmemis bers.Even moreimportant thata batteryof tests was given to householdmembers in two thirds(2,171) of the sampledhouseholds. testsincluded:1. Five questions The on health knowledge;2. Twelve questionson generalknowledge (how to mail a test letter,how to readan electricitybill, and so on); 3. An oral mathematics of ten tests of varying degrees of difficulty; questions;4. A set of writtenmathematics 5. A set of Arabicreadingand writingtests; and 6. A set of Frenchreadingand writingtests. The tests are describedin detailin Glewwe (1997). The healthknowlinterest,since it is rarelya partof any householdsurvey. edge test is of particular It consists of five questionson vaccinations, and treatinginfections,polio, diarrhea safe drinkingwater.The test is fully describedin AppendixI. All personsin the 2,171 selectedhouseholdsbetweenthe ages of 9 and 69 were to be tested except: 1. Individualswith a baccalaureate degree9or higher level of educationtook only the healthknowledgetest since it was assumedthatthey could obtainnearlyperfectscoreson all othertests; and2. The healthknowledgetest was takenonly by individuals betweenthe ages of 20 and50. The 2,171 householdswho contained1,612 childrenage 5 or younger,of which 81 had mothers participated who did not participate the tests for one reasonor another,leaving a sampleof in 1,531 children.It is assumedthatthe 39 motherswith a baccalaureate degreewould have receivedperfectscores on all the tests (exceptthe healthtest, which they did with missing take), which boosts the sample size to 1,570. Droppingobservations values leaves a sampleof 1,495 children. Table 1 providesdescriptivestatisticson all variablesused in the analysis. Of interestare the test score variables,which are definedas the numberof particular questionscorrectlyansweredby the respondent. variation, They show substantial which is necessaryto assess the underlying pathwaysby which mothers'schooling raises child health. In addition,these scores should not be highly correlatedwith years of schooling,or with each other;if they are, regressionanalysisis less likely to identifythe underlying mechanisms. Table2 shows correlation yearsin school of with the test scores (the table also includesa test on readinga medicinebox-this will be discussed in Section IV). Mathematics, Frenchand Arabic scores are all with each otherand with years in school (correlation coefficients highly correlated
9. Roughly speaking,a baccalaureate degree lies somewherebetweena U.S. high school degree and a college degree.It is only awardedafterpassinga rigorousset of examinations.

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The Journalof HumanResources Table 1 DescriptiveStatisticsof VariablesUsed Variable Heightfor age Z-score Per capitaexpenditure Sex of child (female) Age of child (in months) Mother'sheight Father'sheight Father'sheight missing Mother'syears schooling Father'syears schooling Healthknowledge Generalknowledge Oralmathematics Readingand writingmathematics Arabicreading Arabicwriting Frenchreading Frenchwriting Rentalincome Childrenoverseas Irrigated crop land (hectares) crop land (hectares) Unirrigated Tree crop land (hectares) Mother'smarriedsisters Father'smarriedsisters Father'smarriedsistersmissing Fatherbornhere Numberof televisions Numberof radios Availabilityof newspapers Mother'sfather'sschooling Mother'smother'sschooling
SampleSize: 1,495.

Mean -0.94 5,398.82 0.53 35.86 157.02 168.49 0.31 1.98 3.14 2.89 1.53 1.71 1.18 2.33 0.57 1.48 0.26 1,460.79 0.01 2.36 30.88 0.32 1.88 1.51 0.22 0.64 0.55 0.89 0.21 0.03 0.01

Standard Deviation 1.86 5,081.68 0.50 20.00 6.20 5.95 0.46 2.97 4.10 1.57 3.18 1.90 2.62 4.98 1.54 4.44 1.06 13,920.17 0.09 12.62 94.59 1.42 1.56 1.56 0.41 0.48 0.58 0.55 0.41 0.16 0.10

Glewwe Table 2 Correlation AmongSchoolingand Test Score Variablesof Mothers

Years Schooling Yearsschooling Arabicliteracy Frenchliteracy Numeracy Healthknowledge Readingbox of medicine 1.0000 0.8938 0.8869 0.8665 0.3343 0.8152 Arabic Literacy Reading Health Box of French Literacy Numeracy Knowledge Medicine

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1.0000 0.8681 0.8695 0.3867 0.8553

1.0000 0.8383 0.3138 0.7775

1.0000 0.4356 0.8198

1.0000 0.4387

1.0000

Note: All variablesare in logarithms.

from 0.84 to 0.89).10Healthknowledgeis less highly correlatedwith these other variables(correlation coefficientsfrom 0.31 to 0.44). Whetherregressionanalysis betweenthe impactsof the most highly correlated skills is uncertain can distinguish and will become clear only by examiningestimationresults. C. EstimationStrategy:General Considerestimationof equation(4) using the 1990-91 ENNVM.1 Child health can be measured the Z-scoreof child heightfor age (see endnote4), which indiby cates chronic malnutritionover a child's lifetime (stunting). In principle, one could also use weight for height, but the 1990-91 ENNVM weight data suffer from seriousmeasurement errorbecause weight was recordedonly to the nearest kilogram. Severalestimationproblemsarise concerningthe explanatory variablesin Equation 4. Begin with the child's local health environment, Althoughthe 1990Ei. 91 ENNVM datacontaininformation aboutlocal healthclinics and otherpertinent is variables,some of the dataaremissing andcomparability a problem.In addition, the samplingprocedure used for choosingthe healthfacilitiescoveredby the survey is unclear.Becausethe main interestof this paperfocuses on householdlevel variables (the skills and educationlevels of mothers),a simple communityfixed effects is level healthenvironprocedure used to avoid bias causedby omittedcommunity ment variables.This is possible becausethe sampledhouseholdswere drawnfrom 140 primarysamplingareas. Of the remaining variablesin Equation two areunobserved: mater4, explanatory nal valuesacquired school (Vi)andthe child's healthendowment in (e6).If the effect
10. For simplicity,in the remainder this paper(the logarithmsof) the two mathematics of scores are summed createa singlemathematics to and and for variable, the reading writingscoresaresummed French and Arabic.For an analysisof the moredisaggregated scores, see Glewwe (1997), the findingsof which are basicallythe same as those in this paper. 11. The following paragraphs applyto Equation3, except the discussionon choosinginstrumental also variablesfor householdincome is irrelevant out (householdincome has been substituted of Equation3).

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of The Journal HumanResources of schoolingon maternal one values is important, could detectthis by addingyears 4. of schoolingto Equation A positiveeffect of yearsof schoolingon heightfor age would indicatethat values (or perhapssome other aspect of schooling other than of literacy, numeracy,and health knowledge) is an importantdeterminant child health. If the years of schooling variablehas no perceptibleeffect, it is unlikely that values acquired mothersfrom schoolingis an important by pathwayby which schooling affects child health. The inabilityto directlyobserve a child's health endowment(E?)could lead to biasedparameter estimatesdue to its correlation with observedvariables.One way to reducesuch bias is to enterthe heightsof both parentsas explanatory variables, since tallerparentsare likely to have betterhealthendowments, which in turnare inherited theirchildren.In addition, by parents(andtheirchildren) displayvariation in height that is not relatedto health status-healthy people can vary in height. Enteringparentalheight in the regressionscontrolsfor this as well, purgingthe dependentvariableof variationin height that is not indicative of health status. Note that father'sheight is missing for aboutone thirdof the children,eitherbefor cause the fatherdid not live with the childrenor was unavailable measurement at the time of the interview.To avoid losing this portion of the sample, which could lead to sample selectivity biases, a dummy variableis createdindicating that father'sheight was missing;in such cases father'sheight variableis set equal to the mean. childhealth Evenafteraddingparental heightto reducebiascausedby unobserved it endowments, is still possiblethatthe inabilityto observechildren'shealthendowHealthknowledge,housementscouldbias estimated impactsof observedvariables. Particuhold income,andperhaps literacyandnumeracy, may well be endogenous. with is larlyworrisome the fact thathealthknowledgemay be negativelycorrelated In variable the child's unobserved healthendowment. principle,using instrumental Householdassets methodscan removebias, but this requires plausibleinstruments. currentincome.12 The 1990-91 ENNVM containsdata can be used to instrument that can be used to constructseveralhouseholdasset variables.The following are land (in hectares)owned by used in this paper:1. Threevariableson agricultural 2. rentalincome(fromland,buildingsanddurable the household; Household goods); and 3. The numberof adultchildrenof householdmembersliving overseas (who may send sizable remittances). variablesfor mother'shealthknowledgeis more difficult. Findinginstrumental Threedifferenttypes seem plausible:indicatorsof the existence of close relatives who could be sourcesof healthknowledge;exposureto mass media;and mother's 4 education(whichcan be excludedfromEquation if one findsthatit is not needed as a proxyof the impactof valueson childhealth).Oneway thatmotherscan acquire healthknowledgeis from close relatives,especiallythose who have had children. theirchildren's The idea hereis thatmothersconsultwith otherrelativesconcerning health,and by doing so they add to theirstock of healthknowledge.Most of these relativesdo not directlycare for the mother'syoung children,except perhapsthe so paternalgrandmother, their impact on the child's health comes about only by
is 12. In the estimatesgiven in latersections,householdexpenditure used insteadof householdincome incomes. becauseit is likely to be moreaccurateand more closely relatedto households'permanent

Glewwe raisingthe mother'shealthknowledge(thus they can be excludedfrom Equations 3 and 4).13 The 1990-91 ENNVM containsdata on the numberof marriedsisters of the motherand of her husband.It can also be used to add a dummy variable was if whetherthe husband bornin the current place of residence; he was, indicating thereshouldbe severalmembersof his family in the areafrom whom his wife can obtainhealthknowledge.Finally,the educationof the mother'sown parentscould also affect her healthknowledge(and her cognitive skills as well), but can be excludedfromEquations and4 becausethe motherno longerlives with her parents. 3 Mass mediais also a useful sourceof healthknowledgeinformation Thomas, (see Straussand Henriques,1991). It is unlikelythatthese variableshave any effect on child healthapartfromtheirimpacton mother'shealthknowledge;in particular, it would be rarefor parentsto purchasetelevisionsor radiosin responseto having a sick child. The ENNVM data collect data on the numberof radiosand televisions in the householdand on the availabilityof local newspapers.These mass media for variablescould also be used as instruments numeracyand literacy. Finally, this paperwill also investigatewhetherpart of the impact of mother's education childhealthworksby reducing on familysize, andsince familysize is also one variables childreneverborn.It is particularly for endogenous needsinstrumental difficultto find plausibleinstruments this variable.Some possibilities are the for numberof married sistersof both the womanand her husband,which could reflect preferencesfor childrenon both sides of the family, the educationlevels of the woman'sparents, whichagainmayreflectfamilypreferences children, finally for and the age of the woman,since olderwomenwill have had moretime to bearchildren. Of course,one can imagineplausiblereasonsfor why these variablesmay directly affect child health,but thereare no betterinstrumental variablesavailablefromthis data set. The instrumental variablesdescribedin the previousparagraphs generallyappear but 4. reasonable, one cannotprovethatthey do notbelongin Equation Thisproblem variables.Thus one plagues most, if not nearly all, applicationsof instrumental shouldapplya specification to checkthe plausibility the underlying test of exclusion restrictions. This is done using standard overidentification tests (see Davidson and MacKinnon1993). D. EstimationStrategy:Decomposingthe SeparateImpactsof Mother's Education Finally, considerhow estimatesof Equations3 and 4 can be used to assess the mechanisms which mother'sschoolingleads to improvedchild health.As seen by in Equation andFigure1, the overallimpactof mother'sschoolingon childhealth 4, can be decomposedas follows:
) (5) HH aHi
aMSi

135

aHi aLi -- aLi aMSi

a
aNi aMSi

+ aHi avi
av,i MSi

13. In Moroccan whenwomenmarry household. Thusthe mother moves culture, theyjoin theirhusband's and married sistershave movedawayfromhis family. away fromher parents siblings,andherhusband's brothershe may have sisters,and the wives of any married Only the husband'smother,his unmarried belong to his (and thus to his wife's) household.

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+ Hji (3HKi aHK,i aMSi

aHKi a3L aLi aMSi

aHKiaNi aN Si

aHi 3Yi aYi MSi

The first, second, third,fourth,and fifth termsto the right of the equal sign show the impactof mother'sschoolingvia its impacton literacy,numeracy, values,health knowledge,andincome,respectively.Note thatthe impactsvia literacyandnumeracy (the first and second terms) are directeffects only (arrowc" in Figure 1); the indirecteffects via the impacton healthknowledge(arrowc' in Figure1) arerepreof sentedby the second and thirdtermsinside the parentheses the fourthterm.A similardecomposition basedon Equation3 is identicalexceptthatthe incometerm is dropped; remainingpartialderivativesmay differ from those in Equation5 the terms(forexample, becausethe incomeeffect is "dividedup" amongthe remaining both a directeffect and the indirecteffect the impactof literacynow incorporates of literacythroughits effect on householdincome). Assume simple linearfunctionalforms for Equations2, 3, and 4:
(2') (3')
(4')

Hi = Po + FFSi + P2MSi + P3HAi + Ul Hi = Yo + ylFSi + y2Li + y3Ni + Y4Vi+ y5HKi + y6HAi + u2

Hi = 80 + 8lFSi + 82Li + 63Ni + 64Vi + 65HKi + 66Yi +
U3.

In each specification,an errorterm is addedto accountfor randommeasurement healthendowment errorin child heightandthe child's unobserved (recallthatcomIn munityfixed effects estimationallows one to dropEi fromeach equation). Equation 2', P2 estimates the overall impact of mother's schooling on child health, aHil/MSi, which is the left hand side of Equation5. Estimatesof all the partial 5 on derivatives the righthandside of Equation come from:1. Equation or Equa4, tion 3 if the income term is droppedfrom Equation5; 2. Reducedform estimates healthknowledge(HKi),and householdincome (Yi),which can be denotedas oL,
of the impact of mother's schooling on literacy (Li), numeracy (Ni), values (Vi), o, (HK, and oty, respectively; and 3. Estimates of the impact of literacy aN, a and numeracy on health knowledge, which can be denoted as rL and TH, respectively.14

Thus Equation5 becomes:

(5')
12
=
620L

63(aN

64aV

S5(OHK

LaL

rTNO(N) +

66aY.

This decompositionis based on Equation4' and thus explicitly accountsfor the on out, impactof mother'seducation income.If incomeis substituted as in Equation becomes: 3', the last termis droppedfrom Equation5 and the decomposition
(5") 32 = Y2a2L + Y3aN + Y40v + Y_5(OHK + I1LaL + T_NAN).

can 14. Theseimpacts(rL and1nH)areshownas arrowc' in Figure1. If literacyandnumeracy be consideredexogenouswith respectto healthknowledge,namely,literacyandnumeracy changevery little after is one leaves schoolbut healthknowledgecan change,thenthis relationship a reducedform.On the other demandfunction.This will be hand,if literacyand numeracyare endogenousthen this is a conditional is further discussedwhen this relationship estimatedin SectionIV.

Glewwe of Estimation the differentparameters Equations and5" allows one to examine of 5' not only whichpathwaysareimportant, also to assess theirrelativecontributions. but IV. Estimation Results A. ReducedForm Estimatesof the Determinantsof Child Height Table 3 presentsordinaryleast squares(OLS) and communityfixed effects (FE) estimatesof Equation2, thatis reducedformestimatesof the determinants child of The heightfor age.15 OLS andFE estimatesin Table 3 are similar,but specification tests favor the fixed effects specification.16 Because of this, all remainingestimates in this paperwill incorporate communityfixed effects. Table 3 shows thatmother'syearsof schoolinghas a significantly positive effect on child height, which is consistentwith evidence from other countriesdiscussed in SectionII.17 is the mainfindingof interest Table3; the restof thisparagraph This in discussesthe otherexplanatory A variables. dummyvariablefor female chilbriefly drenis negativebut insignificant, yieldingno strongevidenceof genderdiscrimination in child health. Child height for age varies substantially with child age (in rises with age in the months);this reflectscommonpatternswherebymalnutrition firsttwo yearsof life (untilweaningends)butthenlevels off (andmay even decline). Both mother'sandfather'sheightarepositivelycorrelated withheightfor age, which in healthendowment(?i) andnatural picks up both variation the child's unobserved variationin height amonghealthychildren.Father'syears of schoolingis positive but insignificant, which suggestslittle directeffect on child height.Perhapsa weak indirecteffect exists via householdincome;this will be checkedbelow. The household asset variablesare all insignificant, thoughthreeof the five have the expected
signs.

137

Before moving to conditionaldemandestimates,it is useful to check whether mother'syears of schoolingcan reallybe specifiedas exogenous,and whetherpart of the effect of mother'sschooling on child health works throughreducedfamily size. To investigatethe former,mother'syearsof educationwas instrumented using the educational levels of both her parents,as well as the numberof marriedsisters she has. These instruments were good predictorsof mother's schooling (joint Fstatisticsover 20 for both OLS and fixed effects estimates,with p-valuesof 0.000).
15. All yearsof schoolingandtest score variablesare specifiedin logarithmic formbecause:1. It seems reasonable assumethatattainment the most basic skills wouldhave largerimpactthanwould attainto of mentof additional skills amongpersonswho alreadyhave basic skills; and 2. In general,takingthe logs of these variablesalmostalwaysfit the databetter(as measured R2statistics).If yearsof schoolingor by any test score is zero, the log of it is set to zero, and the same appliesto rentalincome. 16. A Hausman of fixedeffectsversusthenullhypothesis random test of effectsyields a X2(d.f. statistic 13) of 20.29, which is statisticallysignificantat the 10 percentlevel. Since Hausmantests often have low to In powerto rejectthe null, it is prudent rejectthe randomeffects specification. turn,thatspecification (not shownin Table3, but similarto the OLS results)is favoredover OLS;the Breusch-Pagan Lagrange test multiplier has a X2(d.f.1) statisticof 46.70, clearlyrejectingthe null hypothesisof homoscedasticity. 17. In regressions shownhere,a squared not termof (the logarithm mother'syears of schoolingwas of) addedto both specificationsin Table 3 to allow for a more flexible functionalform. The linear term remainedsignificant(at the 10 percentlevel), but the squaredtermwas completelyinsignificant. the In rest of this paperonly the lineartermis used.

138

The Journalof HumanResources Table 3 ReducedForm Estimatesof Determinants Heightfor Age Z-Scores of OLS Variable Constant Sex (female) Age (months) Age2 (months) Mother'sheight Father'sheight Father'sheight missing Log mother'sschooling Log father'sschooling Log rentalincome Childrenoverseas Irrigated crop land Unirrigated crop land Tree crop land
R2

Community Fixed Effects t-Statistic -10.83 -1.69 -9.14 7.70 8.95 5.39 1.61 3.17 1.43 1.03 0.99 -0.28 1.21 -1.23 Coefficient t-Statistic

Coefficient -16.931 -0.149 -0.081 0.001 0.066 0.041 0.155 0.226 0.076 0.020 0.517 -0.001 0.001 -0.038
0.170

-0.116 -0.076 0.001 0.052 0.041 0.167 0.165 0.050 -0.016 0.659 0.001 0.000 -0.014
0.299

-1.31 -8.55 7.11 6.39 4.96 1.60 1.97 0.82 -0.74 1.21 0.14 0.61 -0.39

test effects),X2(l) = 46.70,p-value = 0.000 multiplier (OLSvs. random Lagrange Hausmantest (randomeffects vs. fixed effects), X2(13) = 20.29, p-value = 0.088
Samplesize: 1,495.

The impactof mother'sschoolingon child healthwas substantially lower, and not differentfromzero for both OLS andfixed effects estimates.However, significantly errorswere much larger(0.256 for OLS and 0.374 for fixed effects), the standard tests could not rejectthe hypothesisthatthe instrumental so thatstandard Hausman variableestimateswere equal to those given in Table 3. the on Regarding impactof education family size, simplereducedformOLS estimates (not shown here) confirmthat mother'syears of schoolinghas a strongand the significantlynegative impact on family size. Unfortunately, only instrumental variablethat had a significantimpacton fertilitywas mother'sage. This was true for two distinctfertilityvariablestried, numberof childrenand age of motherat first birth.The fixed effects specificationin Table 3 was reestimated addingeach and versionswere tried. and variableseparately, both instrumented uninstrumented and In each case, the fertilityvariablewas not statistically significant the parameter estimatefor mother'syears of school showed little change. Thus it appearsthat althoughmother'seducationdoes reducefamily size, thereis no strongimpactof family size on child healthaftercontrollingfor mother'seducation.

Glewwe B. ConditionalDemand Estimatesof Child Height (not Conditioning on Income) Table 4 presentsestimatesof Equation3, the conditionaldemanddeterminants of child height whereincome is not one of the conditioning variables.Threekinds of estimatesare shown: communityfixed effects (FE); two stage least squareswith fixed effects (2SLSFE)with only healthknowledgespecifiedas endogecommunity nous;and2SLSFEwith all four skills test (mathematics, Arabic,French,andhealth knowledge)specifiedas endogenous.The last two kindswere estimatedtwice, once with mother'seducationand once withoutit, for reasonsexplainedbelow. The FE estimatesshown in Table 4 are identicalto the FE estimatesin Table 3, have been addedas (exogenous)explanatory exceptthatthe fourtest scorevariables variables. Mother'sschoolingis now completelyinsignificant, even slightlynegand ative, which suggests that the four test score variablesfully capturethe impactof mother'seducationon child health.However,althoughall four test score variables show positiveeffects none is even close to being statistically and significant, neither are theyjointly significant. These resultsare quitepuzzling.One problemwith this is the specification thathealthknowledge,andperhaps othertest scorevariables, may be endogenous. remaining The in to specifications Table4 use 2SLSFEspecifications addressthis problem. The secondandthirdcolumnsof Table4 areidenticalto the firstexceptthathealth variablesdescribedin knowledgeis specifiedas endogenous,using the instrumental subsectionIIIB. The one differencebetween the second and thirdcolumns is that the formerincludesmother'sschooling(to accountfor the impactof values) while the latterexcludesit (to providean additional instrumental variablefor healthknowledge). The main findingwhen healthknowledgeis specifiedas endogenousis that such knowledge has a strong and statisticallysignificantimpact on child health. thatincludesmother'seducationthe point estimateinIndeed,in the specification creases50-fold and is significantat the 1 percentlevel."8 When mother'seducation is excluded from the specificationthe impact of health knowledge is somewhat smaller,but still highly significant(t-value of 2.48). None of the other test score variables(mathematics, Arabic,andFrench)have significantly positive effects, and in fact both Arabicand mathematics have negativeeffects. One issue thatarisesat this pointis whatis meantby healthknowledge.The five questionsthatcomprisethe healthknowledgetest are shown in AppendixI. Could it be thatwhatreallymatters only a subsetof thesequestions? the five questions, is Of the one concerning vaccinations because95 percent providedvery little information of the women answeredit correctly.The percentage women answeringthe other of four questionscorrectlyvariedbetween44 percentand54 percent.These fourquestions were also fairlyhighly correlated with each other,with correlation coefficients between0.40 and0.50. To checkwhethersome questionsmattered morethanothers, the regressionin the second column of Table 4 was reestimatedfive times, each time with the responseto a single questionreplacingthe healthknowledgevariable.
18. At the suggestion one reviewer,separate of wererunby sex andage (thetwo age categories regressions being 0-35 monthsand 36-71 months)to see whetherthe impactof healthknowledgevariedby sex or age. Althoughtherewere some differences(the impactwas largerfor girls thanfor boys, and largerfor youngerchildren),they were not statisticallysignificant.

139

Table 4
Conditional Demand Estimates of Determinants of Height for Age Z-Scores Two Stage Least (Including Community Community Fixed Effects Father's schooling Arabic French Math Mother's schooling Mother's health knowledge Sex (female) Age (months) Age2 (months) Mother's height Father's height 0.012 (0.20) 0.048 Only Health Knowledge Endogenous -0.114 (-1.32) -0.129 (-1.04) -0.073

(-0.96)
-0.033 (-0.34) 0.216

(0.63) 0.046
(0.45)

0.199
(1.37) -0.370 (-1.97) 0.357 (1.40) 2.020 (2.71) -0.076 (-0.72) -0.072 (-6.84) 0.001 (5.73) 0.040 (3.70) 0.040 (4.01)

(1.60)
-0.221 (-1.52)

0.024
(0.27) -0.012 (-0.08) 0.037 (0.41) -0.109 (-1.25) -0.075

(-8.06) 0.001
(6.92) 0.052

(6.69)
0.041 (5.33)

1.452 (2.48) -0.084 (-0.85) -0.073 (-7.43) 0.001 (6.19) 0.043 (4.46) 0.040 (4.33)

Father'sheight missing Rentalincome Childrenoverseas Irrigated crop land (hectares) Unirrigated crop land (hectares) Tree crop land (hectares) Overidentification (d.f.) test F-tests of identifyinginstruments Mother'shealthknowledge Arabic French Math Hausmantests (d.f.) (Endogenous parameters only)

0.136 (1.34) -0.017 (-0.66) 0.224 (0.39) -0.001 (-0.13) 0.000 (0.70) -0.019 (-0.51)

0.262 (1.96) -0.030 (-1.13) 0.354 (0.53) -0.002 (-0.38) 0.001 (1.29) 0.048 (0.96) 10.16(8) [0.254] 4.42 [0.000]

0.220 (1.81) -0.026 (-1.06) 0.290 (0.46) -0.002 (-0.34) 0.001 (1.16) 0.029 (0.65) 14.07(9) [0.120] 5.76 [0.000]

7.16(1) [0.007]

5.95(1) [0.015]

Notes: 1. Samplesize is 1,451. This is lower thanin Table3 becausescores on the healthknowledgetest were missing for 22 observa Arabicand Frenchtests. missingat least one test scorefor the mathematics, 2. Asymptotict-statistics shownin parentheses. 3. P-valuesof specification tests shownin brackets.

142

The Journalof HumanResources As one wouldexpectgiven its lack of variation, answerto the vaccination the question had no significanteffect on child health. In contrast,each of the four other questionshad a significantly positive effect on child health,with t-statistics ranging from 1.71 to 1.99 andparameter estimatesrangingfrom 1.24 to 1.79. This suggests that the healthknowledgeembeddedin each of these questionsis important, and because the differenttypes of health knowledge are fairly highly correlatedwith each otherthey may well reflectthe impactof othertypes of basichealthknowledge not measuredin this test. In addition,these resultsalso suggest that specifyingthe overallimpactof healthknowledgeas the sum of the scoreson this test is a reasonable way to aggregatehealthknowledgeinto a single variable. Givenhow the resultschangewhenhealthknowledgeis specifiedas endogenous in the secondandthirdcolumnsof Table4, it is worthwhile applysome specificato tion tests to these regressions.In general,instrumental variablesmustnot be correlated with the errorterm of the equationof interest(u2 in equation3'), and they must provide strong explanatory power for the endogenousvariable(s).The first can test. requirement be checkedby an overidentification In bothcolumnsthe exclusion restrictions not rejected(thep-values being 0.254 and 0.120 in the second are and thirdcolumns,respectively).The second requirement verifiedby F-tests on is the explanatory of the identifyinginstruments, null hypothesisof no exthe power poweris resoundingly rejected(see AppendixII for the firststageregresplanatory R2 sions andpartial statistics, latterof whicharerecommended Bound,Jaeger, the by test and Baker 1993). Finally,a Hausman is used to examinewhetherthe 2SLSFE to This test rejectsthe FE specificais specification preferred the FE specification. tion.19 testsindicatethathealthknowledgeshouldbe treated Overall,the specification variablesused satisfy both requirements. as endogenousand that the instrumental Thereis one moreset of regressions checkbeforeconcluding healthknowlto that leads to improved edge is the mostimportant pathwayby which mother'seducation child health. Perhapsthe mathematics, Arabic and Frenchtest score variablesin Equation3 are also endogenous,so that when they are specified as such during estimationthey will also yield significant impactson child health.This is examined variablesused for in the last two columnsof Table 4, using the same instrumental healthknowledge.The basic resultsare unchanged-health knowledgehas a large, positive and statisticallysignificantimpacton child health,and none of the other of variablesdoes. This is trueregardless whethermother'seducationis includedas variable. an explanatory More specifically,when mother'seducationis includedas a regressor(Column 4) Arabichas a small (relativeto the impactof healthknowledge)positive effect, but it is completelyinsignificant(t-statisticof 0.16); when mother'seducationis excluded (Column 5) the impact is slightly negative and even less significant (t-statisticof -0.00). Frenchlanguageskills have implausiblenegative effects in 4 bothColumns and5, andarecompletelyinsignificant. Finally,theimpactof mathematicsis stronger termsof the size of the coefficient)thanArabicor French,but (in
test 19. This Hausman examinedonly the coefficienton healthknowledgein orderto increasethe power of tests in the remainder this paperareappliedonly of the test to rejectthe null hypothesis.All Hausman tests associatedwith potentiallyendogenousvariables,for the same reason.Hausman to the parameters in werealso runon the entireset of explanatory variables; everycase theyfailedto rejectthe nullhypotheof reflectstheirlow powerwhenjointly testinga largenumber parameters. sis, which probably

Glewwe it is still statistically (t-statisticsof 0.92 and 0.57 in Columns4 and 5, insignificant To see whetherthe statisticalsignificanceof mathematics skills might respectively). the in improveif only it andhealthknowledgewereinstrumented, regression Column 4 was reestimated shownhere)withonly thesetwo test scorevariablesas endog(not skills dropsto half its value (0.402) and the enous. The coefficienton mathematics muchlower (0.55). Thusspecifyingmathematics, Arat-statisticis correspondingly bic, and Frenchas endogenousdoes not changethe basic resultsfound when only healthknowledgeis treatedas endogenous. testsdonefor Columns2 and3 werealso donefor Columns4 and The specification 5. Both specifications that test, passedthe overidentification indicating the exclusion restrictions reasonable the explanatory are and powerof the identifyinginstruments is is quitegood (especiallywhenmother'seducation not used as a regressor). Unlike the specifications when only healthknowledgeis endogenous,Hausman tests of the of joint endogeneity the fourtest scorevariablesonly weaklyrejectthe FE specification (p-values of 0.065 and 0.073 for Columns4 and 5, respectively).In fact, a Hausman of the joint endogeneityof the mathematics, test Arabic,and Frenchtest scoresdoes notrejectthenullhypothesis exogeneity(thex2 statisticwith 3 degrees of of freedomis 3.83, whichhas a p-valueof 0.280). Thusit is not clearthatthe specifito cationwith all test scores endogenousis preferable that with only healthknowledge endogenous. A finalissue to considerregarding Table4 is whether of the effect of mother's part educationworks throughreductionsin the numberof childrenborn. Using age of the mother,andits square,as additional identifyingvariables,the regressionsin the last four columns of Table 4 were reestimated twice, once addingthe numberof childrenandagaintryingage of motherat firstbirth.Neithervariablewas significant at the 5 percentlevel, and the impactof mother'shealthknowledgedid not change (thoughin one of the eight cases it lost statisticalsignificance).Moreappreciably over, the sameresultshold whenthese two variablesaretreatedas exogenous.Thus there is no evidence that most, or even some, of the effect of mother'seducation on child healthoperatesthroughreductionsin family size. To summarize resultsof Table4, it appears healthknowledgeis the main that the pathwayby which mother'seducationleads to healthierchildren.This was seen only when mother'shealthknowledgewas specifiedas endogenous;treatingit as its exogenousgreatlyunderestimated impacton child health.Numeracyandliteracy skills never showed any significantlypositive impact,whetherthey were specified as endogenousor exogenous. In the three specificationsthat included mother's schoolingas a regressor,its coefficientwas never significant,which casts doubton the hypothesisthatan important pathwayby which mother'sschoolingaffectschild healthis by changingthe values of the mother. C. ConditionalDemand Estimatesof Child Height (Conditioningon Income) Turnnow to the final pathwayto investigate,that via householdincome. Table 5 shows threeregressionsthat estimateEquation4, the conditionaldemandfor child healththatincludesincome as a conditioning variable.The FE estimatesin the first columnarein manyways similarto those in Table4; in particular, althoughall four test score variablesshow positive effects none is close to being statisticallysignifi-

143

Table 5
Conditional Demand Estimates, Conditioning on Income, of Height for Age Z-Scores

Two-StageLe (IncludingCommun Community Fixed Effects Father'sschooling Arabic French Math Mother'sschooling Mother'shealthknowledge per Expenditures capita Sex (female) Age (months) -0.009
(-0.15)

and Expenditures Health KnowledgeEndogenous -0.134

(-1.59)

0.071 (0.93) 0.025

(0.25)

-0.027 (-0.23) 0.113 (0.84)

-0.295

0.013 (0.15) -0.051 (-0.32) 0.025 (0.28) 0.224 (2.14) -0.105 (-1.21) -0.074 (-8.03)

(-1.84) 0.159 (0.68) 1.443 (2.47)

0.587

(1.79) -0.070 (-0.71) -0.071 (-7.28)

Age2(months) Mother'sheight Father'sheight Father'sheight missing Overidentification (d.f.) test F-tests of identifyinginstruments Mother'shealthknowledge Income Arabic French Math tests (d.f.) Hausman (Endogenous parameters only)
Notes: 1. Sample size is 1,451. 2. Asymptotic t-statistics shown in parentheses. 3. P-values of specification tests shown in brackets.

0.001 (6.89) 0.050 (6.31) 0.040 (5.27) 0.140 (1.39)

0.001 (6.05) 0.037 (3.55) 0.038 (4.10) 0.218 (1.79) 11.46(12) [0.490] 3.74 [0.000] 14.89 [0.000]

7.32(2) [0.026]

146

The Journalof HumanResources cant,andmother'sschoolinghas no explanatory power.Household expenditures per positive effect, as expected.Of course,householdincome, capitahas a significantly Arabicand French,may be endogehealthknowledge,and possibly mathematics, in nous. The second and thirdspecifications Table 5 allow for this.20 The second column of Table 5 treatsboth healthknowledgeand householdper variablesdescribedin capita expendituresas endogenous,using the instrumental SubsectionIIIB.As in Table4, healthknowledgehas a significantly positive effect and/ornegative.Household on childhealth,butthe othertest scoresareinsignificant at incomehas a positiveeffect thatis significant the 10 percentlevel, andmorethan The same twice as large as the effect shown in the FE estimatesof Column 1.21 test tests shownin Table4 are also shownhere.The overidentification specification and does not rejectthe exclusionrestrictions impliedby the choice of instruments, test those instruments have strongexplanatory power.Finally,the Hausman shows that the 2SLSFEresults are significantlydifferentfrom the FE results(p-value of 0.026). Thus,assumingthatmother'seducationaffectshouseholdincome (whichis verifiedbelow), thereis a pathwayotherthanhealthknowledgeby which mother's educationaffects child health. The thirdcolumn of Table 5 treatsall test score variables,as well as per capita As as expenditures, endogenous. in Table4, this does not changethe generalfinding motherspossess thatraisestheir thathealthknowledgeis the key skill thateducated variablesappear tests show thatthe instrumental children'shealth.The specification the test and reasonable, the Hausman does not support hypothesisthatall five endogenousvariablesareindeedendogenous. Arabic, Indeed,whenonly the mathematics, test and Frenchtest scores are specifiedas endogenous,the Hausman cannotreject the null hypothesisof exogeneity(the x2 statisticwith 3 degreesof freedomis 2.57, whichhas ap-valueof 0.463). Note finallythatthe coefficienton per capitaexpendituresis almostthe same in Column3 as in Column2, thoughno longersignificant at the 10 percentlevel (the t-statisticis 1.45). Overall,the resultsin Table 5 show thathouseholdincome is anotherpathwayby which mother'seducationcan affect child health(andthe only pathwayby which father'sschoolingaffectschild health, in since the firststageregressions TableAl of AppendixII show a significant impact The relative magnitudesof the of father's schooling on householdexpenditures). differentimpactsof mother'sschoolingwill be examinedin Section V. D. Health Knowledgeor the Abilityto Read a MedicineBox?: A Brief Digression As mentionedin Section III, anothertest given to respondentsin the 1990-91 ENNVM was one on "general knowledge." This test consisted of 12 questions
educawererunin whichmother's to 20. In addition the threespecifications shown,analogous regressions variable.They were very similarto the resultsshownhere and thus tion was omittedas an explanatory to are not presented reduceclutterin this table. term added this 21. To check for nonlinearities, regressionwas repeatedwith a squaredexpenditures termhas the Becauseaddinga squared termwas completelyinsignificant. (not shownhere).The squared termwas not used in of disadvantage addinganotherendogenousvariableto the regression,the squared here. resultsreported the estimation

Glewwe and everydaylife in which a commonobjectis handedto the respondent concerning two or threequestionsare askedaboutit. The objectswere a nationalidentitycard, interest and a letter,a box of medicine,a newspaper an electricitybill. Of particular for this study are the questionsconcerninga box of medicine.The threequestions askedwere: 1. Wheredoes it show how manypills arein the box?;2. Wherearethe and indicated? for instructions usingthe medicine?; 3. Whereis the dateof expiration motherswho are more able to answerthese questionscorrectlycan Presumably, providebetterhealthcare for theirchildren. For purposesof this paper,two questionsarise. Do the medicinebox questions measuresomethingthatthe othertests do not?And if they do, whatarethe implicabetweenmothers'healthknowledgeandchildhealth? tionsregarding relationship the A mother'sability to read a medicine box may simply reflect her ability to read Arabic (all writing on the medicinebox was in Arabic), the impact of which on it child healthhas alreadybeen examined.Alternatively, may be that the abilityto reada medicinebox is a formof healthknowledge.In this case, it wouldbe interesting to examine whetherreadinga medicinebox is the "most important"kind of healthknowledge(in which case thatabilitywould "displace"most of the explanatory power of health knowledge) or whetherit plays only a small role (and thus wouldnot "displace"the explanatory powerof healthknowledge).The correlations shown in Table2 suggestthatthe abilityto reada medicinebox may be little more coefficient thananotherversionof the test for Arabicliteracy,since the correlation with betweenthesetwo variablesis 0.85. However,it is also fairlyhighly correlated recoefficientof 0.44). Further healthknowledge(correlation investigation requires gressionanalysis. The role of the abilityto reada medicinebox is examinedin Table6. In orderto betweenthatabilityandhealthknowledge,the mathematics, focus on therelationship Frenchand Arabictest score variableshave been omitted(recall that they had no power in Tables 4 and 5). The first two columns show FE estimates, explanatory with (Column 1) and without (Column2) mother'sschooling. As usual with FE mother'shealthknowledgeis completelyinsignificant. However,mothestimation, at er's abilityto reada medicinebox is significant the 10 percentlevel whenmother's and schoolingis includedas a regressor nearlyat the 1 percentlevel when mother's morethanjust the is excluded.Thusthis variableappears be capturing to schooling in abilityto readArabic,whichwas neversignificant anyof the previousregressions. Becausethe previousregressions fairlyconvincingevidencethatmothpresented In er's healthknowledgeis endogenous,thatvariableshouldbe instrumented. addiwith sickly childrenhave more and tion, it is prudent, intuitivelyplausible(parents experiencereadingmedicineboxes), to specify the ability to read a medicinebox as endogenous.These regressionsare shown in Columns3 and4 of Table 6. When mother'seducationis includedin the regression,both mother'shealth knowledge While neitheris and the abilityto read a medicinebox have much largereffects.22 significantat the 5 percentlevel, healthknowledgeis significantat the 10 percent
into because 22. Note thatmother'sabilityto reada medicinebottlehas not been transformed logarithms the originalvariablerangesonly from 0 to 3. Moreover,transforming to logs would have equatedreit sponsesof 0 and 1, which togetheraccountedfor 85 percentof the responses.

147

148

The Journalof HumanResources Table 6

Conditional Demand Estimates of Height for Age Z-Scores, Health Knowledge and Ability to Read a Medicine Box
Two Stage LeastSquares (Including Community Fixed Effects) HealthKnowledge and Abilityto ReadMedicine Box Endogenous -0.205 (-1.82) 1.563 (1.69) 1.670 (1.40) -1.743 (-1.51) -0.088 (-0.79) -0.071 (-6.30) 0.001 (5.15) 0.036 (3.15) 0.038 (3.65) 0.202 (1.37) -0.017 (-0.59) 0.968 (1.25) -0.001 (-0.18)
0.001

Community F s 'ixedEffect Father'sschooling Mother'shealthknowledge Mother'sabilityto reada medicinebox Mother'sschooling Sex (female) Age (months) Age2 (months) Mother'sheight Father'sheight Father'sheightmissing Rentalincome overseas Children Irrigated crop land (hectares) crop land (hectares) Unirrigated Tree crop land (hectares) tests Overidentification (d.f.) F-tests of identifyinginstruments Mother'shealthknowledge Ability to reada medicinebottle Hausman tests (d.f.) only) (Endogenous parameters Notes: 1. Samplesize is 1,473. 2. Asymptotict-statisticsshown in parentheses. tests shown in brackets. 3. P-valuesof specification -4.41 -2.37 0.01 28 (0.41) 0.01 34 9) (0.3C 0.1 54 (1.82 7) -0.0127 (-0.2, 2) -0.1] 14 (-1.3: 3) -0.0, 76 (-8.2 5) 0.0( 01 )I (7.1 3) 0.0'51 (6.6,7) 0.0'41 (5.5'i) 0.1' 55 5) (1.5' -0.0] 15 (-0.518) 0.6& (1.1I 2) -0.0( 0 (-0.043) 0.0( )0 (0.7: 7) -0.0114 (-0.4 1) 0.027 (0.47) 0.036 (0.41) 0.149 (2.53) -0.114 (- -1.33) 0.076 -8.26) 0.001 (7.14) 0.051 (6.68) 0.041 (5.55) 0.156 (1.57) 0.014 (- -0.58) 0.688 (1.11) -0.000 -0.00)
0.000
4 (0.77)

-0.105 (-1.19) 2.223 (2.82) -0.120 (-0.83) -0.084 (-0.78) -0.074 (-6.96) 0.001 (5.90) 0.037 (3.33) 0.040 (3.97) 0.278 (2.07) -0.022 (-0.83) 0.414 (0.63) -0.002 (-0.36)
0.001

-0.014 (- -0.41)

(1.48) 0.013 (0.22) 5.89(7) [0.553] [0.000] [0.012] 9.59(2) [0.008]

(1.39) 0.059 (1.18) 8.99(8) [0.343] 7.66 [0.000] 100.08 [0.000] 7.83(2) [0.020]

Glewwe level, and the estimatedcoefficientis about the same magnitudeas it was in the regressionsin Tables 4 and 5. Note, however,that mother'seducationhas a very large negative coefficient,with a t-statisticof -1.51. This suggests possible colinearityproblems.When mother's educationis droppedfrom the regressionthe impact of the ability to read a medicine box becomes completely insignificant, and even becomes slightly negative, while health knowledge remains strongly significant. Overall,the resultsshown in Table 6 do not alterthe conclusionreachedabove thathealthknowledgeis the key aspectof motherseducationthatleads to improved the to childhealth.Although abilityof mothers reada medicinebox initiallyappeared not to containinformation pickedup in healthknowledge,2SLSFEestimationcasts as seriousdoubton thisproposition. contrast, long as healthknowledgeis specified In as endogenous yields statistically it results(atleast at the 10 percentlevel) significant and the parameter estimatesare fairly stable. To summarize Section IV, the fundamental resultis thatmother'shealthknowledge is the key mechanismby which mother'seducationleads to improvedchild nature: health.A secondfindingis of a moremethodological ignoringthe endogeneits of mother'shealthknowledgemay seriouslyunderestimate role in promoting ity child health. V. Decomposing the Impact of Mother's Schooling on Child Health The findingin the previoussection that mother'shealthknowledge role child healthdoes not necessarily playsby farthe most important in determining As do implythatliteracyandnumeracy not matter. explainedin SectionII, mother's healthknowledgemay develop afterleaving school, and in a way that will depend on mother'sliteracy, and perhapson numeracyas well. This section attemptsto decomposethe overallimpactof mother'sschoolingon childhealthby decomposing the parameter given in Equation2' in Section III. [2 RecallfromSectionIIIthatthe overalleffect of mother'seducation childhealth on in (2'), 32,can be decomposedin two ways. If one explicitlyincludesthe pathway thatoperatesvia householdincome, the decomposition that given in Equation5' is of Section III. If income effects are substituted out, the decompositionis that in Equation5". The results in Section IV indicate that the direct effect of literacy, and numeracy values on child health(thatis the coefficients82, 63 and 84) on child healthwere not statisticallysignificantfrom zero. The 2SLSFEestimatesin Table 5 indicatethat the impact of householdincome on child health (measuredby 66) was approximately equal to 0.59.23 Finally, the best point estimatesfor the impact

149

23. Tables 4, 5, and Al presentseveralspecifications. Based on the resultsof the previoussection,the used in this sectionarethose where:1. Heathknowledgeis endogenous Arabic,French, but specifications and mathematics skills are exogenous;and 2. The directeffect of years of schoolingon child healthis to constrained equalzero.An alternative to be moreagnostic,takingaveragesacrossdifferentspecificais resultsvery similarto those given here. tions, yet doing so produced

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The Journalof HumanResources of healthknowledgeon child health(65) are 1.44 when income effects are explicit out. and 1.45 when income effects are substituted of To completethe decomposition 32one needsestimatesof the impactof schooland ing on health knowledge (either directly via aHK or indirectly via TrLacL rlNtN)

and the impactof mother'sschoolingon householdincome (cay).Table Al in the estiparameter Appendixprovidesa point estimateof 0.153 for ay. The remaining matesare shownin Table7. The firstthreecolumnspresentreducedformestimates of the determinants healthknowledgeunderthe assumption Arabic,French, of that as in andmathematics scorescan be considered exogenous.24 regression column The skills have significantly 1 shows that Arabicand mathematics positive impactson healthknowledge.Frenchskills have an unexpected negativeeffect, but this is significantlydifferentfrom zero only at the 10 percentlevel. Finally,aftercontrolling for these effects years in school has a significantlynegative effect. Takingthese
estimates at face value implies that cHK = -0.185, rN = 0.184 and the two parts of TrL 0.088 and -0.052 for Arabicand French,respectively.Estimatesof the are impact of years of schooling on literacy (otL) and numeracy (aN) skills are shown

in columns4-6 of Table 7. Briefly,aN = 1.268 and the two partsof aL are 1.734 and 1.266 for Arabicand French,respectively. Using the estimatesof aHK, TL and aN given in the firstcolumnof Table7 yields an estimateof 32 of 0.196, as shownin the firstrow of the last columnof Table 8. Given the simple functionalforms used and the imprecisionof the estimates,this similarto the estimatedfigureof 0.165 from the FE reducedform is surprisingly estimatein Table 3. The othercolumnsin Table 8 show how this is decomposed accordingto Equation5". Perhapsthe most unusualfindingis thatyears in school does not raisehealthknowledge;indeed,it has a stronglysignificant negativeeffect. Is this plausible?It may be. In Moroccanschools, basic healthknowledgeis not that the impact so curriculum,25 one should not be surprised part of the standard of schooling is not positive. Even a negative impactmay occur-because school reducesthe time girls spendat home with theirmothers,it may reduce attendance healthknowledgeat home.Thatis, timegirls spend for opportunities themto acquire with girls' schooling; at home is an omittedvariablethat is negativelycorrelated schooling itself does not reducehealthknowledge,but it implies an allocationof time thatresultsin lower healthon knowledge. the Turningto the rest of the decomposition, main avenueby which schooling the raiseshealthknowledgeis by raisingArabicandmathematics skills, particularly latter,which can in turnbe used to acquirehealthknowledge.In contrast,French that was significantly skills have a small negative impact,based on a parameter differentfromzero only at the 10 percentlevel. While the positiveimpactof Arabic
24. Intuitively,while it is plausiblethat a sickly child will increaseparents'healthknowledge,thereis skills in responseto boutsof sickness obtaingreater less reasonto thinkthatparents literacyandnumeracy tests clearlyrejected in theirchildren.This is consistentwith the findingsin SectionIVB; the Hausman Arabicand the exogeneityof healthknowledgebut could not rejectthe joint exogeneityof mathematics, for variables thesethree it matter is very difficultto findinstrumental Frenchskills. Finally,as a practical of skills in the 1990-91 ENNVMthatdo not also affect the acquisition healthknowledge. withWorldBankstaffwhohaveworkedon healthandeducation is 25. Thisstatement basedon discussions issues in Morocco.

Glewwe various womencan acquire healthknowledgebe reading literacyis plausible(literate is the materials), positiveimpactof numeracy less intuitive.It is probably lnpwritten skills help mothersmonitortheirchildren'sillnesses and the case thatmathematical In more accurately applymedicinesand treatments. addition,it may be thatmathematicalskills developmothers'abstract reasoningabilities,whichin turnhelps them to organizeand refinethe healthknowledgethey acquire. Given the high colinearitybetween schooling,literacyand numeracy,as shown variin Table2, morepreciseestimatesmightbe obtained dropping insignificant by in ables.Thusin the secondregressionreported Table7 the Frenchliteracyvariable is was dropped. The resultingdecomposition shown in the secondline of Table 8. the Overall,the resultsdo not changevery much.In particular, significantly negative yearsof schoolingas well, impactof yearsin school does not "go away." Dropping was which is hardto justify econometrically, done in the thirdcolumnof Table 7, are andthe associateddecompositions shownin the thirdrow of Table8. The overall resultis not very satisfyingbecausenow Arabicskills have no significanteffect on healthknowledge,andthe estimateof 32shownin the last columnof Table8 (0.273) is much largerthan the estimategiven in Table 3 (0.165). The bottomhalf of Table8 examinesdecompositions basedon Equation which 5', includesthe impactof income. The firstrow (thatis, the fourthrow of Table 8) is based on the firstregressionin Table 7. The total impactof educationis estimated to be 0.285. This is also much higherthanthe estimateof 0.165 in Table 3, so the it underlying maynotbe veryprecise.Thatbeing said,the decompodecompositions sition indicatesthatthe effect of educationvia its effect on income is 0.089, which is about one third of the total effect. The rest of the decomposition(that is, the differentimpactsvia healthknowledge)is very similarto the case whereincome is out. substituted Thus the previousdiscussionapplieshere. as The findingsof this sectioncan be summarized follows. The evidencesuggests that educationimproveschild healthprimarily increasinghealthknowledge.It by also has an impactby raisinghouseholdincome, but roughestimatesindicatethat this income effect is only aboutone thirdof the total effect. This is similarto the findingsof Thomas,Strauss,andHenriques (1991), who foundlittle impactthrough improvedhouseholdincome. There is no direct effect of either Arabic or French skills, on child health.Neitheris thereevidencethat literacyskills, nor of numeracy otheraspectsof schooling,particularly changesin mothers'values, have any direct effect. The questionthenarisesas to how mothersobtainhealthknowledge.Schooland ing alone has no contribution, may even have a negativeeffect (due to reduced time spent at home by girls in school). The lack of a positive effect is consistent with the fact thatMoroccanschools do not teachhealthknowledgeto students.Instead,childrenacquirehealthknowledgeby acquiring literacyand numeracyskills in school, which they then use to attainhealthknowledgeoutside of school. Only Arabicliteracyappearsto matter;Frenchliteracyhas no significanteffect. and Overall,these findingsare quiteinteresting have some immediatepolicy implications.However,furtherresearchto confirm,or possibly refute,these findings here are based on simple functionalforms and the is in order.The decompositions precise.They shouldbe treatedas suggestivebut pointestimatesarenot particularly not definitive.

151

Table 7 Direct and Indirect Impacts of Schooling on Health Knowledge

Determi

of Determinants HealthKnowledge Constant Arabic French Math Mother'sschooling Mother'sheight Mother'sfather'sschooling 0.001 (0.00) 0.088 (3.19) -0.052 (-1.77) 0.184
(5.53)

Mathematics 0.031 (0.07)

0.014 (0.03) 0.077 (2.78) 0.175 (5.38) -0.220 (-4.38)

0.004

0.078 (0.17) 0.011 (0.47) 0.133 (4.39) 0.004 (1.29) -0.020 (-0.26)

-0.185
(-3.35)

0.004 (1.44) 0.036 (0.48)

(1.42) 0.035
(0.45)

1.268 (34.41) 0.002 (0.67) 0.054 (0.47)

Mother'smother'sschooling Fatherbornhere Numberof radios Numberof televisions Availabilityof newspapers Mother'smarried sisters Father'smarried sisters Father'smarried sistersmissing
R2

Samplesize

-0.146 (-1.36) 0.067 (1.66) -0.028 (-0.83) 0.086 (2.28) 0.184 (2.91) 0.015 (1.42) -0.006 (-0.58) -0.005 (-0.09) 0.468 884

-0.150 (-1.42) 0.065 (1.58) -0.028 (-0.82) 0.084 (2.22) 0.191 (3.03) 0.014 (1.36) -0.007 (-0.62) -0.009 (-0.17) 0.466 884

-0.205 (-2.05) 0.072 (1.76) -0.029 (-0.87) 0.091 (2.37) 0.168 (2.65) 0.016 (1.48) -0.005 (-0.44) 0.010 (0.18) 0.458 884

-0.230
(-0.91)

-0.042 (-0.89) 0.003 (0.09) 0.121 (2.99) 0.058 (0.72) 0.003 (0.24) 0.022 (1.66) 0.114 (2.14) 0.843 904

Notes: 1. All regressions fixed effects. community incorporate 2. Asymptotic shown in parentheses. t-statistics

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Table 8
Decompositions of Impact of Mother's Schooling on Child Health ThroughHealthKnowledge Direct
(aHK)

Via Via Via Through Arabic French Numeracy Income Total Effect (T1L L) (66o 4) (rINaN) (ILaOL) 0.221 0.194 0.028 0.220 0.193 0.028 -0.095 -0.095 0.338 0.322 0.245 0.337 0.320 0.243 0.090 0.090 0.090 0.196 0.197 0.273 0.285 0.286 0.361

on Not conditioning income -0.268 -0.319 on Conditioning income -0.267 -0.317

VI. Summary and Conclusion

Three major conclusions can be drawn from the empirical work in this paper. First, health knowledge appears to be the most importantskill that mothers (indirectly) obtain from their schooling that prepares them to provide for their children's health. Second, estimating the impact of health knowledge on child health could suffer from substantial endogeneity bias that can underestimate its true impact if one does not instrument the health knowledge variable. Third, the analysis suggests that schooling contributes to mother's health knowledge in Morocco only indirectly-health knowledge is not directly learned in school but instead is learned using literacy and numeracy skills acquired in school. The above conclusions have direct policy implications for Morocco. First, they suggest that health knowledge should be directly taught in Moroccan schools.26They should be taught at an early age because girls who drop out early may never acquire sufficient numeracy and literacy skills to allow them to acquire health knowledge on their own. Many girls in Morocco leave school at a very early age; only 28 percent of women aged 18-20 in the 1990-91 ENNVM continued their schooling beyond primary school. Even more disturbing is that 51 percent of these women never attended school at all-this latter fact suggests the need for a major effort to teach young women basic health knowledge in adult education programs. These results and their policy implications may well apply to other developing countries. If the finding that health knowledge is the key skill for improving child health is confirmed in other countries (an important task for future research), any country where a large proportion of women do not go beyond primary school should
is 26. One objectionto this policy recommendation thathealthknowledgetaughtin school will merely will healthknowledgeattained not change. elsewhere,so thateventual displacehealthknowledgeobtained in Yet if literacyand numeracyskills acquired school are low, theremay be little acquisitionof health skills, knowledgelaterin life. Moreover,for women who leave school with good literacyand numeracy a higher"initialstock" of healthknowledgewill allow themto reacha higherlevel of healthknowledge initial stock. thanthey would have reachedwith a low or nonexistent

Glewwe In add basic healtheducationto its primaryschool curriculum. addition,if a large of womendo not even attendprimary school, healtheducationprograms proportion for women of child-bearing shouldalso receive high priority.Finally,the findage for ings here supporttwo general policy recommendations developing countries: 1. Educationof girls shouldbe a high priority;and 2. School qualitymust not be neglected, since women will not be able to raise their level of health knowledge after their schooling is completedif they leave school withoutbasic literacy and numeracyskills.

155

Appendix 1 Descriptionof Health KnowledgeTest The healthknowledgetest used in the 1990-91 MoroccanEnqueteNationaledes Niveaux de Vie des Menages(ENNVM)consistedof the following five questions, in language: given to the respondent his or her maternal 1. Is it possible to get vaccinationsfor childrenwithout paying money? If yes, where? (Answer:Yes, at public hospitals,Red-Crosscenters,or visits by nurses to villages). 2. Whatshouldone do to a woundto avoid infection? (Answer:Wash it well with soap, apply alcohol and cover it). 3. Whatis the best way to preventchildrenfrom gettingpolio? (Answer:Vaccination). 4. If a child develops diarrhea, what shouldone do if no doctoris available? (Answer:Use boiledwater,feed rice or carrots, give salts,avoidmilk andfats). 5. In places where the wateris not safe to drink,what should one do to it before drinking? (Answer:Boil it or add dropsof "javel").

Appendix 2 Tables Supplementary Table Al First Stage Regressions TestScore Variables for HealthKnowledge Including Arabic, French,and Mathematics iatmers scnooiing Mother'sschooling Arabic French Mathematics Sex Age Age2 Mother'sheight Father'sheight
.~ q
I-_ lC4 1

Per Expenditures Ca Including Arabic, French,and Mathematics

(U.U11
n

Excluding Arabic, French,and Mathematics

U.UOu
Ix xi

Exc A Fren Mat

"t

U.U3Z)

tx t

(3.22) -0.195
(-4.17)

(3.27)

0.997 (4.07) -0.073

(-2.65)

0.125 (6.43)

-0.053
(-2.45)

(5.11) 0.153 (3.51)

0.186 (6.80) -0.015

0.044 (1.75) 0.039

(1.54)

(-0.60) -0.002

-0.013 (-0.51) -0.001

(-0.45)

-0.029
(-1.40)

-0

(-1

(-0.66) 0.000 (0.44)

0.005

(2.28) 0.001 (0.51)

0.000 (0.23) 0.006 (2.43) 0.001

(0.53)

-0.002 (-0.84) 0.000 (0.74) 0.009 (4.84) 0.002 (1.00)

-0 (-0

Father'sheight missing Rentalincome Childrenoverseas Irrigated crop land Unirrigated crop land Tree crop land Mother'sfather'sschooling Mother'smother'sschooling Fatherbor here Mother'smarriedsisters Father'smarriedsisters Father'smarriedsistersmissing Numberof radios Numberof televisions Availabilityof newspapers R2

-0.046 (-1.33) 0.007 (1.12) -0.133 (-1.69) 0.001 (0.62) -0.000 (-1.82) -0.033
(-2.13)

-0.041 (-1.15) 0.003 (0.53) -0.001 (-0.01) 0.001 (0.76) -0.000 (-2.01) -0.034 0.092 (1.06) -0.315 (-3.37) 0.069 (2.24) 0.014 (1.66) -0.013 (-1.31) -0.009 (-0.19) -0.014 (-0.51) 0.069 (2.24) 0.195 (3.56) 0.424
(-2.35)

0.029 (1.05) 0.010 (2.15) 0.072 (0.61) 0.006 (6.89) 0.000 (1.95) 0.015 0.136 (1.40) -0.059 (-0.55) -0.082 (-2.69) 0.003 (0.45) 0.017 (1.99) -0.027 (-0.75) 0.118 (5.36) 0.211 (7.69) 0.035 (0.65) 0.653
(1.57)

0.053 (0.64) -0.228 (-2.49) 0.059 (1.72) 0.015 (1.75) -0.018 (-1.93) -0.038 (-0.84) -0.023 (-0.85) 0.057 (1.93) 0.207 (3.78) 0.469

( -0 (-0 -0 (-2

-0 (-0

Notes: 1. Asymptotict-statistics parentheses. in 2. All regressions fixed effects. incorporate community

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The Journal of Human Resources

Table A2
Partial R2 Statistics for Instrumented Variables Instrument Sets Nine Health Nine Health Knowledge Instruments Plus Knowledge Instruments Mother's Schooling 0.143 0.273 0.218 0.200 0.231 0.179 0.773 0.788 0.808 -0.394 0.682 Nine Health Knowledge Instruments Plus Five Income Instruments 0.158 0.283 0.224 0.203

Instrumented Variable Health knowledge Mathematics French Arabic Income Reading a medicine bottle

Notes: are: 1. The nine healthknowledgeinstruments mother'smarried sisters,father'smarried sisters,father's of of of sistersmissing,fatherbornhere,number televisions,number radios,availability newspamarried pers, mother'sfather'sschooling,and mother'smother'sschooling. of are: 2. The five incomeinstruments rentalincome,number children cropland, living overseas,irrigated unirrigated crop land, and tree crop land.

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