Despite being wealthier, Indian children are significantly shorter and smaller than African children. These differences begin very early in life, suggesting that they may in part reflect differences in maternal health. By applying reweighting estimation strategies to the Demographic and Health Surveys, this paper reports, to my knowledge, the first representative estimates of prepregnancy body mass index and weight gain during pregnancy for India and subSaharan Africa. I find that 42.2% of prepregnant women in India are underweight compared with 16.5% of prepregnant women in sub-Saharan Africa. Levels of prepregnancy underweight for India are almost seven percentage points higher than the average fraction underweight among women 15-49 y old. This difference in part reflects a previously unquantified relationship among age, fertility, and underweight; childbearing is concentrated in the narrow age range in which Indian women are most likely to be underweight. Further, because weight gain during pregnancy is low, averaging about 7 kg for a full-term pregnancy in both regions, the average woman in India ends pregnancy weighing less than the average woman in sub-Saharan Africa begins pregnancy. Poor maternal health among Indian women is of global significance because India is home to one fifth of the world's births. maternal health | nutrition | India | sub-Saharan Africa C hildren in India are significantly shorter and smaller than children in sub-Saharan Africa. Because Indian children are much richer, on average, than African children, scholars have described anthropometric differences between Indians and Africans as an "Asian enigma" (1-4). Although there are likely many reasons why Indian children are shorter than African children (5, 6) and why Indian children are shorter than economic indicators predict, demographic and health surveys show that physical differences between Indian and African children begin very early in life, suggesting that the Asian enigma may in part reflect differences in maternal health. That Indian women have worse health during pregnancy than African women is also consistent with an anomalously high rate of neonatal mortality in India, as well as high rates of low birth weight, even among relatively privileged groups (7). Poor maternal health and nutrition among Indian women is of global significance because India is home to one sixth of the world's population and one fifth of the world's births.In recent decades, India has experienced rapid economic growth and significant reductions in poverty. Despite this economic success, however, measures of women's nutrition remain exceptionally poor. The latest Demographic and Health Survey (DHS), in 2005, showed that 35.5% of women aged 15-49 y are underweight, suggesting that maternal health and nutrition are extremely also poor. India's high rate of underweight among women is worrisome in light of mounting evidence that nutrition during pregnancy is important not only for neonatal survival but also for birth weight (8, 9), which is associated...

A long literature in demography has debated the importance of place for health, especially children’s health. In this study, we assess whether the importance of dense settlement for infant mortality and child height is moderated by exposure to local sanitation behavior. Is open defecation (i.e., without a toilet or latrine) worse for infant mortality and child height where population density is greater? Is poor sanitation is an important mechanism by which population density influences child health outcomes? We present two complementary analyses using newly assembled data sets, which represent two points in a trade-off between external and internal validity. First, we concentrate on external validity by studying infant mortality and child height in a large, international child-level data set of 172 Demographic and Health Surveys, matched to census population density data for 1,800 subnational regions. Second, we concentrate on internal validity by studying child height in Bangladeshi districts, using a new data set constructed with GIS techniques that allows us to control for fixed effects at a high level of geographic resolution. We find a statistically robust and quantitatively comparable interaction between sanitation and population density with both approaches: open defecation externalities are more important for child health outcomes where people live more closely together.Electronic supplementary materialThe online version of this article (doi:10.1007/s13524-016-0538-y) contains supplementary material, which is available to authorized users.

Open defecation, which is still practiced by about a billion people worldwide, is one of the most compelling examples of how place influences health in developing countries. Efforts by governments and development organizations to address the world’s remaining open defecation would be greatly supported by a better understanding of why some people adopt latrines and others do not. We analyze the 2005 and 2012 rounds of the India Human Development Survey (IHDS), a nationally representative panel of households in India, the country which is home to 60% of the people worldwide who defecate in the open. Among rural households that defecated in the open in 2005, we investigate what baseline properties and what changes over time are associated with switching to latrine use between 2005 and 2012. We find that households that are richer or better educated, that have certain demographic properties, or that improved their homes over this period were more likely to switch to using a latrine or toilet. However, each of these effect sizes is small; overall switching to latrine use from open defecation is low; and no ready household-level mechanisms are available for sanitation programs to widely influence these factors. Our research adds to a growing consensus in the literature that the social context should not be overlooked when trying to understand and bring about change in sanitation behavior.