Essays on health inequalities, female leaders and women’s wellbeing

Wahab, Samiratu (2025). Essays on health inequalities, female leaders and women’s wellbeing. University of Birmingham. Ph.D.

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Abstract

This thesis consists of three chapters that examine the effects of female representation on women’s wellbeing and as well as health inequalities among children under age 5. In the first chapter, we investigate whether the election of female leaders in state legislatures in the districts where they are elected in India has an impact on women’s health. Individual level data from the National Family Health Surveys (NFHS) of India are matched with political data from the Trivedi Centre for Political Data - Indian Elections Dataset (TCPD-IED). We exploit information on close elections and use the fraction of women who win in close elections against men as an instrument for the share of female leaders in the instrumental variable (IV) approach we employ. Our findings from the IV analysis provide some evidence of a positive effect of exposure to female leaders on women’s health, measured by Body Mass Index (BMI). Our results show that a one percentage point increase in the share of female leaders is associated with a 0.250 percentage points increase in women’s BMI and a 0.159 percentage points increase in BMI for women classified as underweight. In addition, our estimates show that female representation results in a fall in the likelihood of being underweight and severely or moderately underweight. We find that when testing for heterogeneous effects, our results appear to be driven by women with less decision-making power, women with more tolerance for violence, rural women, lower castes women and women with lower levels of education, indicating that female leader policies may affect more marginalised women. A potential channel for the health effect seen is an improvement in the provision of healthcare facilities, health workers and other initiatives that are of importance to women’s health as a result of electing female leaders. The second chapter investigates the role that female leaders have in shaping women’s early 1 birth outcomes and fertility decisions in India. We pool the last three rounds of NFHS cross sectional data of India for 19 states and merge these with political data from the TCPD-IED. Employing the IV approach to account for the endogeneity of electing female leaders, we find evidence of a significant decline in the likelihood of first birth before age 17, before age 19, and from age 19 to 23. We also find a fall in the likelihood that a woman would desire more children than she actually has. A look into some possible reasons behind these reveal that the effect of female leaders on early birth appears to be driven by a delay in age at first marriage but not by educational attainments or labour market outcomes. Further heterogeneous effects show that Christian and Scheduled Tribes women may be driving the results. Finally, the third chapter employs the Alkire and Foster approach to multidimensionality and data from the most recent Demographic and Health Surveys of eight Sub-Saharan African countries to examine the nature, variations and sources of health deprivations among under age 5 children in the region. Using equal weights for the four dimensions of health considered including nutrition, morbidity, environment and natal care, we find significant inequalities in health of under-5 children across countries with children from Ethiopia and Congo DR experiencing the largest deprivations. In addition, we find significant differences by child’s sex, location and region of residence. Male and rural children exhibit higher deprivations compared to female and urban children respectively. Also, we find that, morbidity contributes the largest whiles nutrition contributes the least to health deprivations in more than half of the countries. Moreover, the ranking of countries is robust to using different weights on all dimensions indicating that such a multidimensional framework is reliable to measuring health deprivations. We conclude that, countries should consider equitable distribution of resources to meet the healthcare requirements of children in the region.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):