Son Preference and Early Childhood Investments in China Douglas AlmondColumbia University & NBER Hongbin LiTsinghua University Lingsheng MengUniversity of Maryland

Research Question  Do parental investment decisions change when they are able to know child gender during pregnancy in China? ◦ Recent research finds big long-term effects of the early- childhood environment and parental investments ◦ There is son preference in China  E.G., high sex ratios (excess of male births) ◦ During 1980s, sex no longer revealed at birth but increasingly revealed during pregnancy  Rapid diffusion of ultrasound (poorly observed in data until now)  Might change prenatal investments: reduce investments when fetus is a girl?  Might affect decision to continue pregnancy

1. Meng (2009) o Collects and analyzes data on county-by-county diffusion of ultrasound machines across China during the 1980s o Finds that the local access to ultrasound is strongly predictive of increased sex ratios at birth (more males). o My job market paper! 2. Lhila and Simon (2008) o Considers Asian immigrants to the USA o Ultrasound use reported on birth certificate data (natality data), proxies for knowing sex o Finds no effect on prenatal health investments in US

Hypothesized effect #1  Consider Postnatal investments ◦ Before ultrasound, knew sex prior to making postnatal investments (obviously) ◦ But if there is heterogeneity in son preference across families, then increases in the sex ratio at birth with ultrasound availability would suggest that following ultrasound availability, girls are born to parents with a weaker son preference (relative to parents of girls prior to ultrasound). ◦ We hypothesize that postnatal investments in girls increased following ultrasound availability.

 Consider Prenatal investments  Reduction in prenatal investments in girls following ultrasound availability  Before ultrasound was available, sex was presumably unknown until delivery, which would tend to equalize prenatal investments in girls versus boys.  Increased preference sorting with ultrasound access would tend to increase prenatal investments in girls. ◦ The prediction for prenatal investments in girls following ultrasound availability is ambiguous

Empirical Approach Girl= 1 if child is female Ultrasound= 1 if ultrasound is available in the county when mother is pregnant μcμc county fixed effect νtνt year fixed effect μc×tμc×tcounty-specific linear time trend Outcomesprenatal investment: neonatal mortality (outcome) postnatal investment: vaccination, breastfeeding, who is taking care of the child

Outcomes of interest 1.Neonatal mortality  Usually caused by congenital anomalies, prematurity and complications of delivery (Grossmand and Jacobowitz, 1981)  May capture impacts on child survival through prenatal investment on which we do not have data 2.Post-neonatal mortality  Usually caused by post-neonatal infections and accidents (Grossmand and Jacobowitz, 1981)  May partly capture impacts on child survival through postnatal investment 3.Direct postnatal investment measures

Data on Diffusion of Ultrasound  From thousands of volumes of Local Gazetteers of China  Local Gazetteers: ◦ “encyclopedia” of a particular region ◦ compiled by local governments ◦ introduction time of ultrasound machines often recorded as achievement in the public health sector  Reports the year of the introduction of ultrasound machines for 1,572 counties

The spread of ultrasound across Chinese counties  1985  1995  1980  1990

Percent of counties with ultrasound devices in the sample

Data: births  Chinese Children Survey ◦ Conducted by the National Bureau of Statistics of China in June 1992 ◦ Representative national data: 560,000 households surveyed ◦ Pregnancy history records for women  pregnancy order, date of conception, use of prenatal care, gestation  pregnancy outcome (miscarriage, abortion, birth …)  live births: gender, DOB  Infant mortality ◦ Retrospective reports of parental investments  breastfeeding, and childhood vaccinations.

 Include mother FE into the model  Use the sub-sample of families with 2 or more kids and where the births “straddle” the introduction of ultrasound  Advantage: control for unobservable factors that are common to siblings  Caveat: “ straddling” may also be endogenous!

Conclusions  Postnatal investments do not seem to change as a result of preference-sorting induced by the availability of ultrasound  Female neonatal mortality increases following ultrasound availability ◦ Effect concentrated soon after birth  Suggests that parents withhold investment in female fetuses after prenatal sex determination became available ◦ “Inframarginal” effect on prenatal investments outstrips the potential increase in prenatal investments from preference sorting