Medium-Term Health Impacts of Shocks Experienced In Utero and After Birth: Evidence from Detailed Geographic Information on War Exposure

We estimate the impact of armed conflict on subsequent health outcomes using detailed geographic information on households’ distance from conflict sites—a more accurate measure of conflict exposure—and compare the impact on children exposed in utero versus after birth. The identification strategy relies on exogenous variation in the conflict’s geographic extent and timing and the exposure of different birth cohorts while in utero or after birth. Results show warexposed children subsequently have lower height-for-age Z-scores, and impacts using GPS information are 2-3 times larger than they would be if exposure is measured at the imprecise regional level. Effects of exposure in utero and after birth are comparable in magnitude. Results are robust to including region-specific time trends, alternative conflict measures, and addressing possible bias due to selective migration. Disruptions in health care delivery and maternal stressors are potential mechanisms explaining the negative health effects for conflict exposed children.