Publications by authors named "Diane Coffey"

13 Publications

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Measurement of population mental health: evidence from a mobile phone survey in India.

Health Policy Plan 2021 Mar 9. Epub 2021 Mar 9.

r.i.c.e., a research institute for compassionate economics, Delhi, India.

In high-income countries, population health surveys often measure mental health. This is less common in low- and middle-income countries (LMICs), including in India, where mental health is under-researched relative to its disease burden. The objective of this study is to assess the performance of two questionnaires for measuring population mental health in a mobile phone survey. We adapt the Kessler-6 screening questionnaire and the World Health Organization's Self-Reporting Questionnaire (SRQ) for a mobile phone survey in the Indian states of Bihar, Jharkhand and Maharashtra. The questionnaires differ in the symptoms they measure and in the number of response options offered. Questionnaires are randomly assigned to respondents. We consider a questionnaire to perform well if it identifies geographic and demographic disparities in mental health that are consistent with the literature and does not suffer from selective non-response. Both questionnaires measured less mental distress in Maharashtra than in Bihar and Jharkhand, which is consistent with Maharashtra's higher human development indicators. The adapted SRQ, but not the adapted Kessler-6, identified women as having worse mental health than men in all three states. Conclusions about population mental health based on the adapted Kessler-6 are likely to be influenced by low response rates (about 82% across the three samples). Respondents were different from non-respondents: non-respondents were less educated and more likely to be female. The SRQ's higher response rate (about 94% across the three states) may reflect the fact that it was developed for use in LMICs and that it focuses on physical, rather than emotional, symptoms, which may be less stigmatized.
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http://dx.doi.org/10.1093/heapol/czab023DOI Listing
March 2021

When women eat last: Discrimination at home and women's mental health.

PLoS One 2021 2;16(3):e0247065. Epub 2021 Mar 2.

r.i.c.e., a Research Institute for Compassionate Economics, India.

The 2011 India Human Development Survey found that in about a quarter of Indian households, women are expected to have their meals after men have finished eating. This study investigates whether this form of gender discrimination is associated with worse mental health outcomes for women. Our primary data source is a new, state-representative mobile phone survey of women ages 18-65 in Bihar, Jharkhand, and Maharashtra in 2018. We measure mental health using questions from the World Health Organization's Self-Reporting Questionnaire. We find that, for women in these states, eating last is correlated with worse mental health, even after accounting for differences in socioeconomic status. We discuss two possible mechanisms for this relationship: eating last may be associated with worse mental health because it is associated with worse physical health, or eating last may be associated with poor mental health because it is associated with less autonomy, or both.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247065PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924788PMC
March 2021

Measuring open defecation in India using survey questions: evidence from a randomised survey experiment.

BMJ Open 2019 09 26;9(9):e030152. Epub 2019 Sep 26.

r.i.c.e, India.

Objectives: To investigate differences in reported open defecation between a question about latrine use or open defecation for every household member and a household-level question.

Setting: Rural India is home to most of the world's open defecation. India's Demographic and Health Survey (DHS) 2015-2016 estimates that 54% of households in rural India defecate in the open. This measure is based on a question asking about the behaviour of all household members in one question. Yet, studies in rural India find substantial open defecation among individuals living in households with latrines, suggesting that household-level questions underestimate true open defecation.

Participants: In 2018, we randomly assigned latrine-owning households in rural parts of four Indian states to receive one of two survey modules measuring sanitation behaviour. 1215 households were asked about latrine use or open defecation individually for every household member. 1216 households were asked the household-level question used in India's DHS: what type of facility do members of the household usually use?

Results: We compare reported open defecation between households asked the individual-level questions and those asked the household-level question. Using two methods for comparing open defecation by question type, the individual-level question found 20-21 (95% CI 16 to 25 for both estimates) percentage points more open defecation than the household-level question, among all households, and 28-29 (95% CI 22 to 35 for both estimates) percentage points more open defecation among households that received assistance to construct their latrines.

Conclusions: We provide the first evidence that individual-level questions find more open defecation than household-level questions. Because reducing open defecation in India is essential to meeting the Sustainable Development Goals, and exposure to open defecation has consequences for child mortality and development, it is essential to accurately monitor its progress.

Trial Registration Number: Registry for International Development Impact Evaluations (5b55458ca54d1).
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http://dx.doi.org/10.1136/bmjopen-2019-030152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773353PMC
September 2019

Assessing public awareness and use of medical abortion via mobile phone survey in India

Contraception 2019 12 28;100(6):457-463. Epub 2019 Aug 28.

Population Research Center, University of Texas at Austin, 305 E 23rd St, RLP 2.602, Austin, TX 78712, United States. Electronic address:

Objective: We assess the feasibility of measuring awareness and use of medical abortion via a mobile phone survey on social attitudes in India.

Study Design: In 2018, we conducted a mobile phone survey with 3455 married men and women in Bihar and Maharashtra, two of India's most populous states. As part of a broader survey on social inequality, welfare programs, and health, we asked respondents about their awareness of medical abortion and whether they (or their wife) had ever had a medical abortion.

Results: Among men and women in Bihar and Maharashtra, one fifth to one third of respondents said that they had heard of medical abortion. In Bihar, men were more likely than women to report having heard of pills that can be used to end a pregnancy. Awareness of medical abortion was positively associated with education and with women's status within the household. Consistent with results from representative face-to-face surveys, reported use of abortion medications was low.

Conclusion: Our findings demonstrate that respondents are willing to answer abortion-related questions via mobile phone survey and reveal differences in reported awareness of medical abortion according to region, sex, education, and household status.

Implications: Inclusion of abortion-related questions in a large-scale, social attitudes phone survey is a feasible option for assessing public awareness of medical abortion in India.
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http://dx.doi.org/10.1016/j.contraception.2019.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893080PMC
December 2019

Local Social Inequality, Economic Inequality, and Disparities in Child Height in India.

Demography 2019 08;56(4):1427-1452

The Population Research Center, University of Texas, Austin, TX, USA.

This study investigates disparities in child height-an important marker of population-level health-among population groups in rural India. India is an informative context in which to study processes of health disparities because of wide heterogeneity in the degree of local segregation or integration among caste groups. Building on a literature that identifies discrimination by quantifying whether differences in socioeconomic status (SES) can account for differences in health, we decompose height differences between rural children from higher castes and rural children from three disadvantaged groups. We find that socioeconomic differences can explain the height gap for children from Scheduled Tribes (STs), who tend to live in geographically isolated places. However, SES does not fully explain height gaps for children from the Scheduled Castes (SC) and Other Backward Classes (OBCs). Among SC and OBC children, local processes of discrimination also matter: the fraction of households in a child's locality that outrank her household in the caste hierarchy predicts her height. SC and OBC children who are surrounded by other lower-caste households are no shorter than higher-caste children of the same SES. Our results contrast with studies from other populations where segregation or apartheid are negatively associated with health.
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http://dx.doi.org/10.1007/s13524-019-00794-2DOI Listing
August 2019

Sanitation, Disease Externalities and Anaemia: Evidence From Nepal.

Econ J (London) 2018 Jun 7;128(611):1395-1432. Epub 2017 Aug 7.

University of Texas at Austin, Indian Statistical Institute.

Anaemia impairs physical and cognitive development in children and reduces human capital accumulation. The prior economics literature has focused on the role of inadequate nutrition in causing anaemia. This article is the first to show that sanitation, a public good, significantly contributes to preventing anaemia. We identify effects by exploiting rapid and differential improvement in sanitation across regions of Nepal between 2006 and 2011. Within regions over time, cohorts of children exposed to better community sanitation developed higher haemoglobin levels. Our results highlight a previously undocumented externality of open defaecation, which is today practiced by over a billion people worldwide.
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http://dx.doi.org/10.1111/ecoj.12491DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001781PMC
June 2018

Implications of WASH Benefits trials for water and sanitation.

Lancet Glob Health 2018 06 26;6(6):e615. Epub 2018 Apr 26.

Department of Economics and Population Research Center, University of Texas at Austin, Austin, TX 78712, USA. Electronic address:

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http://dx.doi.org/10.1016/S2214-109X(18)30225-0DOI Listing
June 2018

Switching to sanitation: Understanding latrine adoption in a representative panel of rural Indian households.

Soc Sci Med 2017 09 6;188:41-50. Epub 2017 Jul 6.

r.i.c.e., India.

Open defecation, which is still practiced by about a billion people worldwide, is one of the most compelling examples of how place influences health in developing countries. Efforts by governments and development organizations to address the world's remaining open defecation would be greatly supported by a better understanding of why some people adopt latrines and others do not. We analyze the 2005 and 2012 rounds of the India Human Development Survey (IHDS), a nationally representative panel of households in India, the country which is home to 60% of the people worldwide who defecate in the open. Among rural households that defecated in the open in 2005, we investigate what baseline properties and what changes over time are associated with switching to latrine use between 2005 and 2012. We find that households that are richer or better educated, that have certain demographic properties, or that improved their homes over this period were more likely to switch to using a latrine or toilet. However, each of these effect sizes is small; overall switching to latrine use from open defecation is low; and no ready household-level mechanisms are available for sanitation programs to widely influence these factors. Our research adds to a growing consensus in the literature that the social context should not be overlooked when trying to understand and bring about change in sanitation behavior.
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http://dx.doi.org/10.1016/j.socscimed.2017.07.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641475PMC
September 2017

Place and Child Health: The Interaction of Population Density and Sanitation in Developing Countries.

Demography 2017 02;54(1):337-360

r.i.c.e., a research institute for compassionate economics, New Delhi, India.

A long literature in demography has debated the importance of place for health, especially children's health. In this study, we assess whether the importance of dense settlement for infant mortality and child height is moderated by exposure to local sanitation behavior. Is open defecation (i.e., without a toilet or latrine) worse for infant mortality and child height where population density is greater? Is poor sanitation is an important mechanism by which population density influences child health outcomes? We present two complementary analyses using newly assembled data sets, which represent two points in a trade-off between external and internal validity. First, we concentrate on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. Second, we concentrate on internal validity by studying child height in Bangladeshi districts, using a new data set constructed with GIS techniques that allows us to control for fixed effects at a high level of geographic resolution. We find a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together.
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http://dx.doi.org/10.1007/s13524-016-0538-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5306240PMC
February 2017

Prepregnancy body mass and weight gain during pregnancy in India and sub-Saharan Africa.

Authors:
Diane Coffey

Proc Natl Acad Sci U S A 2015 Mar 2;112(11):3302-7. Epub 2015 Mar 2.

Office of Population Research, Princeton University, Princeton, NJ 08540

Despite being wealthier, Indian children are significantly shorter and smaller than African children. These differences begin very early in life, suggesting that they may in part reflect differences in maternal health. By applying reweighting estimation strategies to the Demographic and Health Surveys, this paper reports, to my knowledge, the first representative estimates of prepregnancy body mass index and weight gain during pregnancy for India and sub-Saharan Africa. I find that 42.2% of prepregnant women in India are underweight compared with 16.5% of prepregnant women in sub-Saharan Africa. Levels of prepregnancy underweight for India are almost seven percentage points higher than the average fraction underweight among women 15-49 y old. This difference in part reflects a previously unquantified relationship among age, fertility, and underweight; childbearing is concentrated in the narrow age range in which Indian women are most likely to be underweight. Further, because weight gain during pregnancy is low, averaging about 7 kg for a full-term pregnancy in both regions, the average woman in India ends pregnancy weighing less than the average woman in sub-Saharan Africa begins pregnancy. Poor maternal health among Indian women is of global significance because India is home to one fifth of the world's births.
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http://dx.doi.org/10.1073/pnas.1416964112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4371959PMC
March 2015

Early life mortality and height in Indian states.

Authors:
Diane Coffey

Econ Hum Biol 2015 Apr 20;17:177-89. Epub 2014 Nov 20.

Princeton University, Office of Population Research, United States. Electronic address:

Height is a marker for health, cognitive ability and economic productivity. Recent research on the determinants of height suggests that postneonatal mortality predicts height because it is a measure of the early life disease environment to which a cohort is exposed. This article advances the literature on the determinants of height by examining the role of early life mortality, including neonatal mortality, in India, a large developing country with a very short population. It uses state level variation in neonatal mortality, postneonatal mortality, and pre-adult mortality to predict the heights of adults born between 1970 and 1983, and neonatal and postneonatal mortality to predict the heights of children born between 1995 and 2005. In contrast to what is found in the literature on developed countries, I find that state level variation in neonatal mortality is a strong predictor of adult and child heights. This may be due to state level variation in, and overall poor levels of, pre-natal nutrition in India.
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http://dx.doi.org/10.1016/j.ehb.2014.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393754PMC
April 2015

Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India.

Authors:
Diane Coffey

Soc Sci Med 2014 Aug 21;114:89-96. Epub 2014 May 21.

Office of Population Research, 225 Wallace Hall, Princeton University, Princeton, NJ 08540, USA. Electronic address:

The Janani Suraksha Yojana, India's "safe motherhood program," is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program's apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes.
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http://dx.doi.org/10.1016/j.socscimed.2014.05.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122674PMC
August 2014

Children's welfare and short term migration from rural India.

Authors:
Diane Coffey

J Dev Stud 2013 ;49(8):1101-1117

Office of Population Research & Woodrow Wilson School, Princeton University, 225 Wallace Hall, Princeton University, Princeton, NJ 08540.

Few papers in the literature provide quantitative analysis of the difficult circumstances faced by children of short-term labour migrants. This paper uses new survey data from rural northwest India to study both children who migrate and those left behind. It finds that, unlike in other contexts, children who migrate rarely work when they accompany adult migrants. Additionally, this paper reports a robust, previously unquantified negative relationship between children's migration and educational outcomes and investments. It calls for further research about externalities of migration for children and suggests that expansion of a large public employment program might help these children.
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http://dx.doi.org/10.1080/00220388.2013.794934DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3773470PMC
January 2013