Fatal fluctuations? Cyclicality in infant mortality in India

This paper investigates the impact of macroeconomic shocks on infant mortality in India and investigates likely mechanisms. A recent OECD-dominated literature shows that mortality at most ages is pro-cyclical but similar analyses for poorer countries are scarce, and both income risk and mortality risk are greater in poor countries. This paper uses individual data on infant mortality for about 150000 children born in 1970-1997, merged by birth-cohort with a state panel containing information on aggregate income. Identification rests upon comparing the effects of annual deviations in income from trend on the mortality risks of children born at different times to the same mother, conditional upon a number of state-time varying covariates including rainshocks. I cannot reject the null that income shocks have no effect on mortality in urban households, but I find that rural infant mortality is counter-cyclical, the elasticity being about -0.46. This is despite the possibility that relatively high risk women avert birth or suffer fetal loss in recessions. It seems related to the fact that women's participation in the (informal) labour market increases in recessions, presumably, to compensate a decline in their husband's wages. Consistent with this but, in contrast to results for richer countries, antenatal and postnatal health-care decline in recessions. These effects are reinforced by pro-cyclicality in state health and development expenditure. Another interesting finding that is informative about the underlying mechanisms is that the effect of aggregate income on rural mortality is driven by non-agricultural income.