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Nearly a quarter of all children under the age of two in China are left behind in the countryside as parents migrate to urban areas for work. We use a longitudinal survey following young children and their caregivers from 6 to 30 months of age to estimate the effects of maternal migration on development, health, and nutritional outcomes in the critical first stages of life.We find significant negative effects on cognitive development and indicators of dietary quality. Taken together with research showing long-term consequences of early life insults, our results imply that, although the reallocation of labor from rural to urban areas has been a key driver of China’s prosperity in recent decades, it may entail a significant human capital cost for the next generation.

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Working Papers
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Working Paper
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Scott Rozelle
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Purpose

The purpose of this paper is to evaluate the effect of adult children migration on the health status of elderlyparents. Increased labor migration in developing countries that lack adequate social security systems and institutionalized care for the elderly is a phenomenon that is important to understand. When their adultchildren go away to work, it is not clear what effect there will be on “left-behind” elderly parents.

Design/methodology/approach

This study employs nearly nationally representative data from five provinces, 25 counties, 101 villages and 2,000 households, collected from two waves of data in 2007 and 2011. This sample comprises a subset of households which include both elderly individuals (above 60 years old) and their grown (working-aged)children in order to estimate the impact of adult child migration on the health of elderly parents in ruralChina.

Findings

This study finds that adult child migration has a significant positive impact on the health of elderly family members.

Practical implications

These findings are consistent with the explanation that migration raises family resources, which in turn may contribute to better health outcomes for elderly household members.

Originality/value

This is the first paper to attempt to identify the relationship between household migration and the health of elderly parents within the Chinese context.

 

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China Economic Agricultural Review
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4
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Purpose

The purpose of this paper is to measure the turnover (or stability in employment) of village clinicians in rural China over the past decade. The authors also want to provide quantitative evidence on the individual characteristics of the clinicians who provide health care to villagers in rural China and whether we should expect these individuals to be interested in continuing to supply quality health care in China’s villages in the coming years.

Design/methodology/approach

This paper uses data from a survey of rural China’s village clinicians conducted in five provinces, 25 counties, and 101 villages in 2005 and 2012. This paper also uses qualitative data from interviews with 31 village clinicians. Using a mixed methods approach, this study describes the turnover of village clinicians and the main factors that impact the career decisions of clinicians.

Findings
Turnover of China’s village doctors, while not trivial (about 25 percent of village doctors exited their field between 2005 and 2012), is still not overly high. Only five out of 101 villages did not have village clinicians in 2012. Of those that lost village doctors between 2005 and 2012, nearly all of them still had a village doctor in 2012 (either taken over by another local clinician or the position was taken by a newcomer). The authors find that three main sets of factors are correlated with the career decisions of village clinicians: village clinicians’ opportunity cost, the profitability of running a village clinic, and commitment to the field of medicine. In general, clinicians who left the village faced a much higher opportunity cost, had been running a clinic that was not profitable, and had fewer ties to the field of medicine. Newcomers over the same period had higher levels of education, went to higher profit clinics between 2005 and 2012, and had a stronger commitment to the field.
Originality/value

This study makes use of a data set with a large and nationally representative sample to provide a new perspective to better understand clinician turnover at village clinics, the career decisions of clinicians, and the implied trends for the quality and access to rural health care services in the future.

 

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China Agricultural Economic Review
Authors
Alexis Medina
Number
4
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The debate over whether boarding school is beneficial for students still exists in both developing and developed countries. In rural China, as a result of a national school merger program that began in 2001, the number of boarding students has increased dramatically. Little research has been done, however, to measure how boarding status may be correlated with nutrition, health and educational outcomes. In this paper, we compare the outcomes of boarding to those of non-boarding students using a large, aggregate dataset that includes 59 rural counties across five provinces in China. We fi nd that for all outcomes boarding students perform worse than non-boarding students. Despite these differences, the absolute levels of all outcomes are low for both boarding and non-boarding students, indicating a need for new policies that will target all rural students regardless of their boarding status.

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China & World Economy
Authors
Alexis Medina
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Purpose

  • Many public health systems have struggled with the dual questions of: why the uptake rate of maternal health (MH) services is low among some subpopulations; and how to raise it. The purpose of this paper is to assess the uptake rate of a new set of MH services in poor rural areas of China.
 

Design/methodology/approach

  • The analysis is based on the survey responses of women’s representatives and village cadres from almost 1,000 villages in June 2012 as part of a wide-scale public health survey in Sichuan, Gansu and Yunnan provinces in the western part of China.
 

Findings

  • The authors find that the uptake rate of MH services (including in-hospital delivery, antenatal care visits and post-partum care visits) in poor rural areas of Western China are far below average in China, and that the rates vary across provinces and ethnic groups. The analyses demonstrate that distance, income, ethnicity and availability appear to be systematically correlated with low uptake rates of all MH services. Demand-side factors seem to be by far the most important sources of the differences between subpopulations. The authors also find that there is potential for creating a Conditional Cash Transfer program to improve the usage of MH services.
 

Originality/value

  • The authors believe that the results will contribute positively to the exploration of answers to the dual questions that many public health systems have struggled with: why the uptake rate of MH services is low among some subpopulations; and how to raise it.

 

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Journal Articles
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China Agricultural Economic Review
Authors
Alexis Medina
Scott Rozelle
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Background and Objectives: Development during the first two years of life is critical and has a lasting impact on a child’s health. Poor child nutrition can lead to a weakened immune system and deficiencies in essential micronutrients, which in turn have lasting and detrimental impacts on a child’s development. Recent studies in rural Shaanxi Province found an anemia prevalence of 54.3% among rural children aged six to twelve months. While new large-scale, quantitative research has begun to catalogue the extent of child malnutrition and anemia, no effort has yet been made to look more closely at the potential reasons for rural children’s nutritional deficiencies through a more richly textured qualitative analysis. This study aims to elucidate some of the fundamental causes of poor feeding practices that may lead to anemia among children in rural Shaanxi Province, China.

Methodology: We interviewed a total of sixty caregivers from villages participating in a study of 1808 families enrolled in a larger survey of child health and nutrition outcomes. We conducted three waves of interviews with children’s primary caregivers in seventeen rural villages within four nationally-designated poverty counties in the southern part of Shaanxi Province.

Results: The qualitative analysis reveals that poor infant feeding practices are persistent across our qualitative sample. Information gathered from our qualitative interviews suggests that proper feeding practices are impeded by two constraints: a lack of knowledge on infant nutrition and inadequate sources of accurate information on the topic. We find that the poverty does not appear to constrain child feeding practices.

Conclusion: Our research uncovers an absence of accurate information on infant nutrition, which hampers caregiver efforts to provide adequate nutrition to their children. This situation ultimately results in the failure of caregivers to supply an age-appropriate micronutrient-rich diet that can stimulate children’s physical and cognitive development, the absence of which may lead to iron-deficiency anemia among children. We suggest that steps be taken to educate caregivers in nutritional care for their infants

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Journal Articles
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PLOS One
Authors
Alexis Medina
Scott Rozelle
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Objectives: To test whether text message reminders sent to caregivers will improve the effectiveness of a home micronutrient fortification program in western China.

Methods: A cluster-randomized controlled trial was carried out in 351 villages in Shaanxi province in 2013-14. We enrolled children aged 6-12 months in target villages. Each village/cluster was randomly assigned into one of three groups: Free Delivery Group (FDG; caregivers received free micronutrient packets); Text Messaging Group (TMG; FDG treatment plus daily text message); and Control Group. We collected information on compliance with treatments and hemoglobin concentrations from all children at baseline and 6-month follow-up. We estimated the intent-to-treat (ITT) effects on compliance and child anemia using a logistic regression model, controlling for infant, caregiver and household characteristics.

Results: There were 1393 eligible children. We found that assignment to TMG led to an increase full compliance (marginal effect = 0.10, 95% CI = 0.03, 0.16) and decrease in the rate of anemia at endline (marginal effect=-0.07, 95% CI= -0.12, -0.01).

Conclusions: Text messages improved compliance of caregivers to a home fortification program and children’s nutrition.

 

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Journal Articles
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AJPH Research
Authors
Alexis Medina
Scott Rozelle
Number
106
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Abstract: China’s rapid development and urbanization has induced large numbers of rural residents to migrate from their homes in the countryside to urban areas in search of higher wages. It is estimated that there are more than 60 million left behind children (LBCs) remain in the countryside after their parents migrate. This paper examines the changes in mental health before and after the parents of fourth and fifth grade students out- or return-migrate. We draw on a panel dataset collected by the authors of more than 19,000 students from 252 rural primary schools in northwestern China. Using difference-in-difference and propensity score matching approaches, our results indicate that parental out-migration has a significant negative impact on the mental health of LBCs, as they tend to exhibit higher levels of anxiety and lower levels of self-esteem. However, we find that parental return-migration has no significant effect on the mental health of LBCs. 

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China & World Economy
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Scott Rozelle
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Abstract: The general goal of the present study is to analyze whether children with siblings lag behind their only-child counterparts in terms of health and nutrition, cognition and educational performance, and non-cognitive outcomes. We draw on a dataset containing 25 871 observations constructed from three school-level surveys spanning four provinces in China. The analysis compares children with siblings and only children aged 9 to 14 years old in terms of eight different health, cognitive and non-cognitive indicators. We find that with the exception of the anemia rate, health outcomes of children with siblings are statistically indistinguishable from those of only children. In terms of cognition, children with siblings performed better than only children. Moreover, outcomes of children with siblings are statistically indistinguishable from those of only children in terms of the non-cognitive outcomes provided by measures of anxiety. According to our results, the same general findings are true regardless of whether the difference between children with and without siblings is disaggregated by gender.

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China & World Economy
Authors
Scott Rozelle
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China’s rapid development and urbanization have induced large numbers of rural residents to migrate from their homes to urban areas in search of better job opportunities. Parents typically leave their children behind with a caregiver, creating a new, potentially vulnerable subpopulation of left-behind children in rural areas. A growing number of policies and nongovernmental organization efforts target these children. The primary objective of this study was to examine whether left-behind children are really the most vulnerable and in need of special programs. Pulling data from a comprehensive data set covering 141,000 children in ten provinces (from twenty-seven surveys conducted between 2009 and 2013), we analyzed nine indicators of health, nutrition, and education. We found that for all nine indicators, left-behind children performed as well as or better than children living with both parents. However, both groups of children performed poorly on most of these indicators. Based on these findings, we recommend that special programs designed to improve health, nutrition, and education among left-behind children be expanded to cover all children in rural China.

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Journal Articles
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Health Affairs Volume 34, Issue 11
Authors
Prashant Loyalka
Alexis Medina
Scott Rozelle
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