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We evaluate the medium-term impacts of treating maternal depression on women’s mental health, financial empowerment, and parenting decisions. We leverage variation induced by a cluster-randomized controlled trial that provided psychotherapy to 903 prenatally depressed mothers in rural Pakistan. It was one of the world’s largest psych otherapy interventions, and it dramatically reduced postpartum depression. Seven years after psychotherapy concluded, we returned to the study site to find that impacts on women’s mental health had persisted, with a 17 percent reduction in depression rates. The intervention also improved women’s financial empowerment and increased both time- and money-intensive parental investments by between 0.2 and 0.3 standard deviations. (JEL G51, I12, J16, O15)

To reduce the burden of the HIV/AIDS epidemic, international donors recently began providing free antiretroviral therapy (ART) in parts of Sub-Saharan Africa. ART dramatically prolongs life and reduces infectiousness for people with HIV. This paper shows that ART availability increases work time for HIV-negative people without caretaker obligations, who do not directly benefit from the medicine. A difference-in-difference design compares people living near and far from ART, before and after treatment becomes available. Next we explore the possible reasons for this pattern. Although we cannot pinpoint the mechanism, we find that ART availability substantially reduces subjective mortality risk and improves mental health. These results show an undocumented economic consequence of the HIV/AIDS epidemic and an important externality of medical innovation. They also provide the first evidence of a link between the disease environment and mental health.

In the past decade, antiretroviral therapy (ART), a highly effective drug treatment that slows the progression of AIDS, has become widely available in sub-Saharan Africa. The medication is rapidly reversing the steep decline in life expectancy, which had fallen by 14 years in southern Africa, due to the AIDS epidemic (United Nations Population Division 2012). Economic models of life-cycle consumption suggest that life expectancy plays a role in decisions about savings, investment, * Baranov: University of Melbourne, 111 Barry Street, Carlton VIC 3053, Australia (email: victoria.baranov@ unimelb.edu.au); Kohler: University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA 19104 (email: hpkohler@pop.upenn.edu). We would like to thank anonymous referees for comments and suggestions that substantially improved the paper. This paper is a revised version of the first chapter of Baranov's dissertation at the University of Chicago. We also thank

IntroductionEarly childhood interventions primarily focus on the mother–child relationship, but grandmothers are often critical in childcare in low-resource settings. Prior research is mixed on how grandmother involvement influences child outcomes and there is a paucity of research on grandmother caregiving in low-income and middle-income countries. We examined the role of grandmother involvement on child growth and development in the first 2 years of life cross sectionally and longitudinally in rural Pakistan.MethodsWe used data from the Bachpan Cohort, a longitudinal birth cohort in rural Pakistan. Maternally reported grandmother involvement in daily instrumental and non-instrumental caregiving was collected at 3 and 12 months. A summed score was created and categorised into non-involved, low and high. Outcomes included 12-month and 24-month child growth, 12-month Bayley Scales of Infant and Toddler Development and 24-month Ages and Stages Questionnaire—Socioemotional. We used multivariable generalised linear models to estimate mean differences (MD) at 12 months (n=727) and 24 months (n=712). Inverse probability weighting was used to account for missingness and sampling.ResultsIn our sample, 68% of children lived with a grandmother, and most grandmothers were involved in caregiving. Greater 3-month grandmother involvement was positively associated with 12-month weight z-scores; however, greater involvement was associated with lower 24-month weight z-scores. High 12-month grandmother involvement was associated with improved 12-month cognitive (MD=0.38, 95% CI −0.01 to 0.76), fine motor skills (MD=0.45, 95% CI 0.08 to 0.83) and 24-month socioemotional development (MD=−17.83, 95% CI −31.47 to –4.19). No meaningful associations were found for length z-scores or language development.ConclusionIn rural Pakistan, grandmothers provide caregiving that influences early child development. Our findings highlight the complex relationship between grandmother involvement and child weight, and suggest that grandmothers may positively promote early child cognitive, fine motor and socioemotional development. Understanding how grandmother involvement affects child outcomes in early life is necessary to inform caregiving interventions.