The fetal origins hypothesis posits that adverse prenatal exposures,
particularly malnutrition, increase the risk of poor adult health. Studies using
famine as a natural experiment to test the fetal origins hypothesis present
conflicting findings, partly because of data limitations and modeling flaws.
Capitalizing on the biomarker data and prefecture-level geographic information
from the 2011 China Health and Retirement Longitudinal Study, this study
estimates the effects of prenatal exposure to China’s 1959–61
famine on later-life risks of cardiovascular and metabolic diseases. Our
analysis addresses the problems of measurement error and intrinsic cohort
differences that challenge prior studies. We use provincial and prefecture-level
geographic variations in famine severity, a proxy for prenatal malnutrition, for
model identification. We construct instrumental variables from geocoded
newspaper archive data to adjust for measurement error in famine exposure. We
find that estimates of the famine effects are highly sensitive to the choices of
health indicators, measures of famine severity, and regression model
specifications. Overall, we find little evidence supporting the fetal origins
hypothesis. In fact, it appears that prenatal exposure to famine reduces
later-life disease risks in certain cases. We interpret this finding as evidence
of mortality selection among the famine survivors at work. We conclude that
using famine as a natural experiment in itself does not guarantee correct
statistical inference about the long-term health impacts of prenatal
malnutrition when other analytical challenges remain unresolved.