Terrorism and early childhood health outcomes: Evidence from Pakistan

Objective: To study how the recent rise in terrorist activity affects health of children exposed to violence. Method: Using spatial and temporal variation in terrorist attacks in Pakistan, combined with a fixed effect strategy at various levels, we identify the causal effect of terrorist activity on height, weight, and health behaviors of children. Results: A one-standard deviation increased intensity of attack, defined as number of fatalities per attack, leads to approximately 5 more children per 1000 being stunted if attacks occur during gestation and between 12 and 19 more children per 1000 being stunted if attacks occur post birth. For low weight, a measure of short-term malnutrition, we find a one-standard deviation increased intensity of terrorist attack leads to between 8 and 12 more children per 1000 being low weight if attacks occur post birth. For both severely stunted and very low weight, we find statistically significant effects only for attacks during gestation. We also document a reduction of between 2 and 8 per 1000 children in vaccination take-up, in response to terrorism immediately before birth. Conclusions: Overall, we conclude that violent events experienced in utero or in early childhood can have long lasting impacts on health and human capital development. Reduced interaction with healthcare infrastructure is a possible mechanism at work.