Does market access protect children against poor health conditions at birth ?

Seasonal fluctuations in early life circumstances can be associated with later differences in health outcomes, especially for rural people in developing countries. Other evidence finds that access to markets and public services can help rural households improve their well-being. This study links these two phenomena, using spatial diversity across the Democratic Republic of Congo (DRC) to investigate whether proximity to towns confers resilience against seasonal determinants of maternal and infant health. To identify a potentially causal effect, we use the random component of birth timing relative to the intensity of seasonal climate fluctuations and households’ distance to the nearest town. This spatial difference-in-differences approach is made possible by systematic variation in the intensity and duration of a dry “winter” season from north to south across DRC, independent variation in geographic isolation among survey sites, and uniform distribution in birth timing within years. Controlling for mother fixed effects and a variety of robustness tests, we find that that children in households closer to towns have significantly smaller impact of their birth timing on their subsequent heights and risk of death. The protective effect of market access could involve a variety of mechanisms such as consumption smoothing, health services and public assistance. Future work might find ways to distinguish among these channels using additional data. For this initial study, we merged geocoded Demographic and Health Survey (DHS) results with remote-sensing measures of physical geography as well as administrative data on civil conflict and other factors, providing an unusual opportunity to identify the consequences of geographic isolation for child health.