published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

This thesis comprises three chapters on topics in development economics. The first chapter studies access to maternal healthcare in markets with vertically differentiated public and private providers. The second chapter studies the efficacy of induction stoves in reducing indoor air pollution in rural households when faced with erratic power supply. Finally, the third chapter studies the role of financial incentives in correcting disparities in sex ratios. All three chapters study the context of India but are representative of important development issues in low-income countries. The first chapter titled "Equilibrium Effects of Subsidizing Public Services" studies one of India's largest welfare schemes Janani Suraksha Yojana (JSY) that incentivized pregnant women in India to access institutional maternal care at public hospitals. We argue that governments can make complementary investments to improve welfare gains from large scale policies. JSY did not improve health outcomes despite a substantial increase in the take-up of institutional care. We document three equilibrium responses that explain this policy failure. First, JSY led to a mismatch of risk across health facilities -- high-risk mothers sorted out of highest quality care at private facilities. Second, in line with the literature, public sector quality deteriorated as a result of congestion. This resulted in lower quality care for both marginal as well as infra-marginal patients at public hospitals. We show that only mothers with high socio-economic status adapted to the worsening quality of care at public hospitals by sorting into more expensive private hospitals. Third, despite increased competition, private hospitals maintained high prices, crowding out riskier and poorer mothers. We do not find evidence that private hospitals improved healthcare quality to justify higher prices. The second chapter titled "Electric Stoves as a Solution for Household Air Pollution" is an interdisciplinary field-based research study that studies the role of reliable electricity in inducing rural Indian households to switch away from dirty cooking fuels towards a clean cooking technology, induction cookstoves, thereby reducing the exposure to high levels of indoor air pollution. We collected minute-by-minute data on electricity availability, electric induction stove use, and kitchen and outdoor particulate pollution in a sample of rural Indian households for one year. Using within household-month variation generated by unpredictable outages, we estimate the effects of electricity availability and electric induction stove use on kitchen PM2.5 concentration at each hour of the day. Electricity availability reduces kitchen PM2.5 by up to 50 ??/?3, which is between 10 and 20 percent of peak concentrations during cooking hours. Induction stove use instrumented by electricity availability reduces PM2.5 in kitchens by 200-450 ??/?3 during cooking hours. The final chapter titled "Can Large-Scale Conditional Cash Transfers Resolve the Fertility-Sex Ratio Trade-off? Evidence from India" studies a large-scale conditional cash transfer (CCT) scheme Ladli Laxmi Yojana that offered cash incentives to households upon the birth of girl children. The policy also offered substantial incentive for investing in girls' education. In my evaluation of the Ladli Laxmi Yojana in Madhya Pradesh, India. I find that financial incentives aimed at the girl child increased average fertility by about 0.15 children per household (on baseline average of 0.93 children) children per household and improved sex-ratio by 3%. This points to the well known fertility-sex ratio trade-off. Moreover, these effects are quite opposite to a similar CCT scheme in Haryana (Anukriti, 2018) suggesting context dependence of such policies.

The impact of environmental degradation on well-being is largely ignored in terms of economic costs of development. Due in large part to measurement difficulties, the environment in the daily welfare of the world's poorest remains inadequately accounted for in development policies. The aim of this work is, therefore, to advance our understanding of the relationship between the environment and human health. Anthropogenic activities in Central Asia have severely disrupted the natural environment. The poorest, most vulnerable members of society are at an increased risk of mortality and a life-time of illness associated with worsening ecological conditions in the region. The work is by nature inter-disciplinary and pulls from many social sciences in an attempt to provide new insight into the role of long term environmental degradation and the impact on social welfare. There are three main original contributions of this work. Firstly, the research demonstrates the traditional emphasis in the literature on socioeconomic factors in explaining high rates of child mortality in Central Asia is inadequate. Secondly, for the first time in an international cross-section examining the determinants of child survival, the macro-level environment is put forth as a key determinant of excess child mortality in Central Asia. An improved measure of income is used for the first time in such a study to control for important distributional effects within and between countries. The results confirm the hypothesis that traditional determinants do not account for endemically high rates of mortality in the region. Secondly, using administrative (oblast) data from Uzbekistan, Chapter 6 presents the first study of its kind to incorporate important geographic as well as socioeconomic information in explaining variation in infant mortality due likely to ecological degradation. Ultimately, the findings demonstrate the environment must be adequately considered in all policy making aimed at improving health outcomes in the region.