Parental bargaining and rural–urban child health differential in Tanzania

Figures & data

Table 1. Comparison of determinants of child health outcomes across urban and rural areas.

Variables	All	Rural	Urban
Child health outcomes Child survival rate (percentage)	88.9(0.32)	88.8(0.32)	90.6*(0.31)
Percentage of stunted children	35.4(0.48)	37.8(0.49)	25.2*(0.43)
Percentage of children underweight	21.0(0.41)	22.2(0.42)	15.9*(0.37)
Percentage of wasted children	4.16(0.20)	4.07(0.20)	4.55(0.21)
Maternal and partner’s characteristics Age at first birth (10–19)	0.01(0.12)	0.01(0.12)	0.01(0.12)
Age at first birth (20–34)	0.42(0.49)	0.40(0.49)	0.49*(0.50)
Age at first birth (35+)	0.57(0.50)	0.58(0.49)	0.50*(0.50)
No formal education	0.27(0.44)	0.30(0.46)	0.13*(0.34)
Completed primary education	0.68(0.47)	0.67(0.47)	0.71(0.45)
At least secondary education	0.05(0.22)	0.03(0.16)	0.16*(0.36)
Individual is employed	0.83(0.34)	0.77(0.34)	0.89*(0.38)
Maternal health status (height-for-age)	−1.22(1.02)	−1.22(1.01)	−1.24*(0.03)
Child is singleton birth	0.97(0.17)	0.97(0.17)	0.96(0.19)
Partner has no formal education	0.18(0.39)	0.21(0.16)	0.06(0.24)
Partner has completed primary education	0.73(0.44)	0.74(0.41)	0.68(0.47)
Partner completed secondary education	0.09(0.28)	0.04(0.20)	0.26(0.44)
Attributes of couple bargaining Spouses cooperate on health care decision	0.62(0.49)	0.60(0.49)	0.69*(0.46)
Spouses cooperate in daily purchase decision	0.40(0.49)	0.40(0.49)	0.46*(0.50)
Getting money for health care is problematic	0.49(0.50)	0.53(0.50)	0.35*(0.48)
Wife beaten if she goes out without telling him	0.41(0.49)	0.43(0.50)	0.33*(0.47)
Wife beaten if she neglects children	0.44(0.50)	0.46(0.50)	0.36*(0.48)
Wife beaten if argues with partner	0.41(0.49)	0.43(0.50)	0.33*(0.47)
Wife beaten if she refuses to have sex	0.37(0.48)	0.39(0.49)	0.26*(0.44)
Wife beaten if she burns food	0.20(0.40)	0.22(0.41)	0.14*(0.35)
Domestic violence index	0.31(0.38)	0.33(0.38)	0.23(0.34)
Household characteristics Household is in the first wealth quintile	0.21(0.41)	0.26(0.44)	0.04*(0.20)
Household is in the second wealth quintile	0.23(0.42)	0.27(0.45)	0.03*(0.17)
Household is in the third wealth quintile	0.22(0.42)	0.26(0.44)	0.07*(0.25)
Household is in the fourth wealth quintile	0.20(0.40)	0.17(0.38)	0.28*(0.45)
Household is in the fifth wealth quintile	0.14(0.35)	0.03(0.18)	0.58*(0.49)
Distance to health facility is problematic	0.46(0.50)	0.51(0.50)	0.23*(0.42)
Access to clean source of drinking water	0.44(0.50)	0.37(0.48)	0.76*(0.43)
Access to at least a pit latrine	0.83(0.38)	0.80(0.40)	0.97*(0.16)
Number of children under age five (mean)	1.64(1.48)	1.76(1.56)	1.15*(0.99)
Household size (mean number)	7.14(4.05)	7.34(4.26)	6.32*(2.90)

Note: Standard deviation in parentheses and * indicates that the rural–urban gap is significant at 5%.

Figure 1. Correlation between survival and nutrition.

Table 2. Marginal effects of child survival rate in 2004 on child survival probability in 2010

Variables	Pooled	Rural	Urban
Child survival rate 2004	0.01***	0.01***	0.01***
	(0.00)	(0.00)	(0.00)
Observations	29,458	23,956	5,502

Table 3. Mean comparison of child stunting across various characteristics.

Variables	Mean	Mean	Mean Difference
	Yes (%)	No (%)	(Yes–No)
Child is delivered in a health facility	30.0	37.2	−0.072*(0.115)
Individual is employed	26.8	35.0	−0.082*(0.016)
Child is singleton birth	33.2	58.3	−0.251*(0.037)
Wife beaten if she (violence): Goes out without telling her partner	36.5	31.8	0.046*(0.012)
Neglects their children	36.2	32.2	0.040*(0.012)
Argues with her partner	36.1	32.4	0.038*(0.012)
Refuses to have sex with her partner	37.1	32.3	0.048*(0.012)
Burns food	38.4	32.8	0.056*(0.015)
Spouses cooperate in health care decision	32.7	35.1	−0.024‡(0.013)
Spouses cooperate in household visit decision	33.4	33.7	−0.003(0.013)
Spouses cooperate in household purchases	31.5	34.4	−0.029†(0.014)
Getting money for medical care is problematic	37.4	30.7	0.066*(0.012)
Distance to facility is problematic	36.8	31.6	0.052*(0.012)
Individual belongs to first wealth quintile	41.7	31.8	0.110*(0.014)
Individual belongs to second wealth quintile	38.1	32.5	0.056*(0.014)
Individual belongs to third wealth quintile	35.0	33.5	0.015(0.014)
Individual belongs to fourth wealth quintile	29.8	34.8	−0.050*(0.014)
Individual belongs to fifth wealth quintile	19.8	36.2	−0.164*(0.016)

Note: Standard errors in parenthesis, level of significance: * P < 0.01, †P < 0.05, ‡ P < 0.1. The mean values are percentages of children who are stunted. Yes = individual has such characteristics and No = individual does not have such attributes. The Yes and No columns show the proportion of stunted children.

Table 4. Marginal effects and regression estimates of parental bargaining including other controls.

Variables	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)
Panel A: Marginal effects estimates from the probit regression
Domestic violence index	0.01***	0.01*	0.02***	0.01***	0.01**	0.02**	0.01*	0.01*	0.01*
	(0.00)	(0.00)	(0.01)	(0.00)	(0.00)	(0.01)	(0.00)	(0.00)	(0.01)
Limited discretion over household wealth	0.07***	0.05***	0.07**	0.05***	0.04***	0.04	0.0j3**	0.02*	0.03
	(0.01)	(0.01)	(0.03)	(0.01)	(0.01)	(0.03)	(0.01)	(0.01)	(0.03)
Both partners decide on daily purchases	−0.04**	−0.04**	−0.04	−0.04**	−0.03*	−0.04	−0.04**	−0.04**	−0.04
	(0.02)	(0.02)	(0.03)	(0.02)	(0.02)	(0.03)	(0.02)	(0.02)	(0.03)
Partner alone decides on daily purchases	0.08***	0.10***	0.02	0.08**	0.09**	0.02	0.07**	0.08**	0.02
	(0.03)	(0.04)	(0.06)	(0.03)	(0.03)	(0.06)	(0.03)	(0.03)	(0.06)
Both partners decide on health care use	−0.09***	−0.08***	−0.07*	−0.09***	−0.09***	−0.06	−0.08***	−0.09***	−0.05
	(0.02)	(0.02)	(0.04)	(0.02)	(0.02)	(0.04)	(0.02)	(0.02)	(0.04)
Partner alone decides on health care use	0.02	0.03	0.01	0.02	0.01	0.04	0.02	0.01	0.03
	(0.02)	(0.02)	(0.03)	(0.02)	(0.02)	(0.03)	(0.02)	(0.02)	(0.03)
Maternal and child characteristics	No	No	No	Yes	Yes	Yes	Yes	Yes	Yes
Household socioeconomic status	No	No	No	No	No	No	Yes	Yes	Yes
Observations	5,560	4,565	995	5,478	4,489	989	5,478	4,489	989
Panel B: OLS regression estimates
Variables	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)
Domestic violence index	−0.04***	−0.02*	−0.08***	−0.03***	−0.02**	−0.05**	−0.02*	−0.01	−0.04
	(0.01)	(0.01)	(0.03)	(0.01)	(0.01)	(0.03)	(0.01)	(0.01)	(0.03)
Limited discretion over household wealth	−0.22***	−0.15***	−0.29***	−0.14***	−0.10***	−0.18*	−0.06	−0.04	−0.11
	(0.04)	(0.04)	(0.10)	(0.04)	(0.04)	(0.10)	(0.04)	(0.04)	(0.10)
Both partners decide on daily purchases	0.05	0.09*	−0.13	0.04	0.07	−0.13	0.05	0.10*	−0.17*
	(0.05)	(0.05)	(0.10)	(0.05)	(0.05)	(0.10)	(0.05)	(0.05)	(0.10)
Partner alone decides on daily purchases	−0.27***	−0.25**	−0.26	−0.24***	−0.21**	−0.23	−0.20**	−0.16*	−0.28
	(0.09)	(0.10)	(0.19)	(0.09)	(0.10)	(0.19)	(0.09)	(0.10)	(0.19)
Both partners decide on health care use	0.24***	0.15**	0.38***	0.21***	0.17***	0.29**	0.18***	0.14**	0.29**
	(0.06)	(0.07)	(0.12)	(0.06)	(0.07)	(0.12)	(0.06)	(0.07)	(0.12)
Partner alone decides on health care use	−0.04	−0.08*	0.07	−0.04	−0.05	−0.01	−0.04	−0.05	0.04
	(0.05)	(0.05)	(0.11)	(0.04)	(0.05)	(0.11)	(0.04)	(0.05)	(0.11)
Maternal and child characteristics	No	No	No	Yes	Yes	Yes	Yes	Yes	Yes
Household socioeconomic status	No	No	No	No	No	No	Yes	Yes	Yes
Constant	−1.56***	−1.54***	−1.75***	−2.10***	−1.98***	−2.27***	−2.28***	−2.19***	−2.31***
	(0.11)	(0.12)	(0.26)	(0.17)	(0.18)	(0.50)	(0.18)	(0.19)	(0.57)
Observations	5,560	4,565	995	5,478	4,489	989	5,478	4,489	989
R-squared	0.02	0.01	0.04	0.10	0.08	0.10	0.11	0.10	0.12

Notes: Standard errors are given in parentheses. The results in Panel A obtained from the probit estimation, and the results in Panel B are from the OLS regression. In column (1) to (3), both maternal and household characteristics are excluded. In column (4) to (6) maternal and child characteristics are included, and in column (7) to (9) both maternal and household characteristics are included. Column 1, 4, and 7 present estimates from the pooled sample, column 2, 5, and 8 present estimates from the rural sample, and column 3, 6, and 9 present estimates from the urban sample. It should be noted that the dependent variable for the probit is child stunting (1 if child is stunted 0 otherwise). For the OLS, the height-for-age index is used, with higher values indicating better child nutritional outcomes (positive estimates indicate that child nutrition status improves with the covariate in question and vice versa for negative estimates). Other control variables include maternal age at first birth, employment status, education, differences in age and education of parents, place of child birth, birth interval, singleton births, gender of child, number of under-five in household and household wealth. * denotes statistical significant at 10%, ** denotes significant at the 5% level and *** denotes significant at the 1% level.

Table 5. Extended rural–urban child health decomposition (sample selection corrected).

	Selection bias adjusted	Selection bias not adjusted	Nonlinear (child survival)
Predicted mean for urban population	−1.3901***	−1.1427***	0.9206
	(0.1134)	(0.0738)
Predicted mean for rural population	−1.8876***	−1.5887***	0.8958
	(0.0490)	(0.0314)
Total gap (Urban–Rural)	0.4975***	0.4461***	0.0248
	(0.1235)	(0.0802)
Total explained gap	0.3065***	0.3065***	0.0197
	(0.0693)	(0.0693)
Percentage of explained gap	61.6%	68.7%	79.12%
Total unexplained gap	0.1910	0.1396*	0.0052
	(0.1246)	(0.0767)
Percentage of unexplained gap	38.4%	31.3%	20.88%
Total gap in predicted means	0.4975***	0.4460***	0.0249
	(0.1235)	(0.0802)
Percentage of total gap	100%	100%	100%
Number of observations	4,570	4,570	17,642

Note: Robust standard errors in parentheses: level of significance: *** P < 0.01, ** P < 0.05, * P < 0.1.

Table 6. Detailed decomposition of rural–urban child nutrition correcting for sample selection.

Variables	With selection bias	Without selection bias
	Explained (%)	Explained (%)
Domestic violence index	0.11	0.10
Spouses cooperate in household purchases	0.47	0.42
Spouses cooperate in health care decisions	0.72	0.64
Getting money for care not problematic	2.49	2.23
Absolute difference in education	0.52	0.46
Absolute difference in age	0.20	0.18
Contribution from bargaining	4.51	4.03
Contribution from maternal factors	10.84	9.72
Household wealth index	32.31	28.97
Contribution from household factors	53.38	47.86
Total explained/Unexplained	68.73	61.61
Observations	4,570	4,570

Figure 2. Percentage contribution of grouped covariates.