In this article, we append information from four cross-sectional household surveys (Multiple Indictors Cluster Survey of the United Nations International Children's Emergency Fund) in Punjab, Pakistan, collected between 2007 and2018 to create a data set of 140,000-150,000 child-level observations. Using linear regression, we document a strongly negative birth-order gradient in the nutritional status (measured as height-for-age z-scores) of children below age 5, indicating a pattern of disinvestment in later-born children that is even greater than that documented for poorer countries in sub-Saharan Africa in an earlier study. Consistent with other empirical work in developing-country contexts, girls have on average higher z-scores than boys, but their advantage is lower in Pakistan than other countries outside of the South Asian region, and worryingly, the negative birth-order gradient is steeper for girls than boys. Son-biased fertility stopping rules and close-birth spacing appear to play key roles in Pakistan; following the birth of daughters, parents reduce contraceptive use and breastfeeding (a natural birth control). Using an IV strategy based on the genders of the previously born children, we find that shortened intervals between births harm children's nutritional status, especially that of boys.
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| INTRODUCTION AND LITERATURE REVIEWPakistan's population growth rate remains high compared to the rest of South Asia at 2.2% per annum, and it is now the world's fifth most populous country. Because of its population growth, the country has struggled to develop its human capital, in terms of both nutrition and educational achievement. 1 Continued high fertility (currently at 3.8 children per woman) will not only exacerbate these problems but will also make it difficult for the country to further progress in reducing child and maternal health undernutrition, key Millennium Development Goals that Pakistan failed to meet by the target date, 2015 (Rizvi et al., 2015). In this study, we aim at demonstrating how son-biased fertility stopping and short birth intervals are important to understanding both child malnutrition and excess fertility in Pakistan.While the disadvantages women and girls encounter have been a persistent concern for researchers, aid agencies, and policymakers, another less-discussed but important type of disinvestment in children and affecting both genders occurs with higher birth order. Therefore, earlier-born children tend to have better health outcomes than their younger siblings. Although a few studies suggest that later-born children are advantaged compared to earlier-born children when parents gain experience with additional pregnancies (Girma & Genebo, 2002), the majority of research demonstrates that first-born children are favored in terms of parental investment because they benefit from lack of sibling competition (Hatton & Martin, 2008), are born to younger mothers, or are expected to care for parents in their old age (Bhalotra & Attfield, 1998). Time is an endowment ...