Periodic Reporting for period 1 - YouCDF (Young Children of Disadvantaged Families: A Comprehensive Analysis of Parental Human Capital Investment and Child Health)
Reporting period: 2023-09-01 to 2024-08-31
Promoting newborn and children's health is a key priority for sustainable development. However, disparities in access to essential healthcare persist, particularly for vulnerable groups such as undocumented migrants and children living in poverty. The lack of universal health coverage is a major barrier for irregular migrants. Even where universal health rights exist, the socioeconomic challenges faced by parents further restrict healthcare access for vulnerable children. Some barriers to maternal investment such as traditional gender roles, lower levels of maternal education, and limited workforce participation make it harder to invest in children as mothers are usually the main caregivers. “Young Children of Disadvantaged Families: A Comprehensive Analysis of Parental Human Capital Investment and Child Health (YouCDF)” project aims to investigate the extent to which the limitations at the household level (restricted financial resources available to the main caregivers) could be compensated by a universal healthcare system. The project's main objective is to provide a systematic and comprehensive analysis of the amount, types and short- and long-term consequences of parental investment to children. The project brings together two important concepts for children’s use of health care: maternal bargaining power and universal health coverage.
The primary scientific goal of YouCDF is to empirically examine the causal impact of household resources on child health and well-being when health care is available with universal health coverage. The study addresses a wide range of outcomes, including children's physical health, health care utilization, birth weight and prenatal care, child labor and education, as well as nutrition and developmental indicators. The project’s findings will provide valuable information to support evidence-based policy and decision-making in order to overcome inequality in health for European countries.
The primary scientific goal of YouCDF is to empirically examine the causal impact of household resources on child health and well-being when health care is available with universal health coverage. The study addresses a wide range of outcomes, including children's physical health, health care utilization, birth weight and prenatal care, child labor and education, as well as nutrition and developmental indicators. The project’s findings will provide valuable information to support evidence-based policy and decision-making in order to overcome inequality in health for European countries.
The YouCDF project is organized into three work packages (WPs) designed to achieve its scientific and technical objectives:
1. WP1: Conceptual Framework Development – This WP focuses on building the conceptual framework of the project. The main achievement for this WP was the preparation of the scientific background with the literature review and incorporation of expert feedback.
2. WP2: Empirical Analysis – Significant progress has been made on three working papers that use alternative methods to examine the relationship between household resources and child health outcomes. One method involves using the sex composition of the first two-born children as an instrumental variable for fertility. This approach assumes that parents of same-sex children are more likely to have additional children to achieve a balanced gender composition and investigates how having more children affects parent's likelihood of seeking treatment for their children. WP2 also leverages policy changes in Turkey, using natural experiments to assess their impacts on children’s health and well-being. A key investigation centers on the 2016 minimum wage increase in Turkey, which raised wages by 33%. Using a difference-in-differences approach, the research assesses its effects on infant birth weight, particularly among families of low socioeconomic status (SES), while accounting for regional variations in minimum wage levels. Additionally, WP2 examines the effects of unconditional cash transfers provided by Turkey's Family Support Program. A regression discontinuity design, based on income eligibility thresholds, is employed to evaluate the short-term impacts of these cash transfers on child labor, school attendance, and health. The main achievements of this WP are progress for three working papers and achieving methodological milestones to enhance robustness in findings and integration of alternative data sources (Demographic Health Survey, Turkey Child Survey, Turkey Health Survey) for a comprehensive analysis.
3. WP3: Documentation of Undernutrition and Mental Development Links – For this work package, data cleaning and calculation of critical metrics, such as the prevalence of stunting, wasting, and underweight among children, have been completed to document the association between undernutrition and children's mental development. The main achievements are presenting the data that outlines the scope of undernutrition, and supporting broader research on the long-term effects of household resources on child health.
Each WP contributes to a comprehensive understanding of how household resources affect children's health and well-being and provides valuable insights to support policies aimed at reducing inequalities in child health. The outcomes of the project can be relevant for other stakeholders such as ministries of health, social workers and practitioners on the field such as doctors, nurses, and other health professionals who are focusing on child health.
1. WP1: Conceptual Framework Development – This WP focuses on building the conceptual framework of the project. The main achievement for this WP was the preparation of the scientific background with the literature review and incorporation of expert feedback.
2. WP2: Empirical Analysis – Significant progress has been made on three working papers that use alternative methods to examine the relationship between household resources and child health outcomes. One method involves using the sex composition of the first two-born children as an instrumental variable for fertility. This approach assumes that parents of same-sex children are more likely to have additional children to achieve a balanced gender composition and investigates how having more children affects parent's likelihood of seeking treatment for their children. WP2 also leverages policy changes in Turkey, using natural experiments to assess their impacts on children’s health and well-being. A key investigation centers on the 2016 minimum wage increase in Turkey, which raised wages by 33%. Using a difference-in-differences approach, the research assesses its effects on infant birth weight, particularly among families of low socioeconomic status (SES), while accounting for regional variations in minimum wage levels. Additionally, WP2 examines the effects of unconditional cash transfers provided by Turkey's Family Support Program. A regression discontinuity design, based on income eligibility thresholds, is employed to evaluate the short-term impacts of these cash transfers on child labor, school attendance, and health. The main achievements of this WP are progress for three working papers and achieving methodological milestones to enhance robustness in findings and integration of alternative data sources (Demographic Health Survey, Turkey Child Survey, Turkey Health Survey) for a comprehensive analysis.
3. WP3: Documentation of Undernutrition and Mental Development Links – For this work package, data cleaning and calculation of critical metrics, such as the prevalence of stunting, wasting, and underweight among children, have been completed to document the association between undernutrition and children's mental development. The main achievements are presenting the data that outlines the scope of undernutrition, and supporting broader research on the long-term effects of household resources on child health.
Each WP contributes to a comprehensive understanding of how household resources affect children's health and well-being and provides valuable insights to support policies aimed at reducing inequalities in child health. The outcomes of the project can be relevant for other stakeholders such as ministries of health, social workers and practitioners on the field such as doctors, nurses, and other health professionals who are focusing on child health.
State-of-the-art of the limited bargaining power of women and its relation to investment in children within the household focuses on the developing world, mostly of African countries or agriculture-based economies. In the European context, household bargaining power was previously investigated in relation to labour supply decisions of spouses but not in the form of human capital investment to children. A need for understanding the relationship between the maternal bargaining power and health care use of children in Europe exists with the increasing number of refugees arriving from the Middle East and African countries due to the ongoing conflict in those regions. YouCDF provides a systematic analysis of the key determinants and outcomes of parental investment to children by rigorous empirical analysis.
The results from using an instrumental variable for defining the fertility of mothers (as an indicator of women's bargaining power shifter) indicate that there is no significant increase in untreated health problems when the number of children increases. Further research could make it clear if this is a result of universal health coverage with a comparison of the situation in European countries with and without universal health coverage.
Another set of results indicates that exposure to a minimum wage increase leads to a decrease in the likelihood of low birth weight only for the babies of mothers with low socioeconomic status. In this paper, the minimum wage, hence the change in the earned income for low-skilled women in the labor force is seen as an instrument to change the household bargaining power. This implies that the welfare effect of the minimum wage policies does not extend to improved health for the population. The research could be expanded by testing whether the minimum wage increases lead to any significant changes in education and health expenditures as a more direct test of the link between family resources (paid income) and children's well-being.
Finally, the unconditional cash transfers paid to low-income families (a change in the unearned income as a factor to alter the bargaining power within the family) in Turkey led to no significant change in children's self-assessed health and their likelihood of reporting health problems. Further research could identify if there is some heterogeneity by the household's demographic composition. International comparisons could further identify if the short-term cash transfers were too modest(in terms of the amount paid) to generate a significant change in children's health.
The results from using an instrumental variable for defining the fertility of mothers (as an indicator of women's bargaining power shifter) indicate that there is no significant increase in untreated health problems when the number of children increases. Further research could make it clear if this is a result of universal health coverage with a comparison of the situation in European countries with and without universal health coverage.
Another set of results indicates that exposure to a minimum wage increase leads to a decrease in the likelihood of low birth weight only for the babies of mothers with low socioeconomic status. In this paper, the minimum wage, hence the change in the earned income for low-skilled women in the labor force is seen as an instrument to change the household bargaining power. This implies that the welfare effect of the minimum wage policies does not extend to improved health for the population. The research could be expanded by testing whether the minimum wage increases lead to any significant changes in education and health expenditures as a more direct test of the link between family resources (paid income) and children's well-being.
Finally, the unconditional cash transfers paid to low-income families (a change in the unearned income as a factor to alter the bargaining power within the family) in Turkey led to no significant change in children's self-assessed health and their likelihood of reporting health problems. Further research could identify if there is some heterogeneity by the household's demographic composition. International comparisons could further identify if the short-term cash transfers were too modest(in terms of the amount paid) to generate a significant change in children's health.