Effects of Early Life Events on Health and Human Capital Outcomes
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Abstract
The exploration of how health in early life is associated with outcomes in adulthood has become a central theme within health economics. Connecting insights from economics and the medical sciences, the research field quests to identify the determinants of health and human capital outcomes over the life course. This dissertation both contributes to the empirical evidence on the effects of more subtle prenatal shocks on later-life outcomes and conceptual advancements in the fetal origins literature. Central to all chapters is the exploration of Ramadan during pregnancy and its associations with health outcomes among Muslim offspring. During Ramadan, the 9th months of the Islamic calendar and the Muslim holy month of fasting, many pregnant Muslims decide to adhere to an intermittent fast. Intermittent daytime fasting during Ramadan, with unrestricted nutritional intake during nighttime, is a more subtle prenatal shock than famines and has been linked to various later-life health and human capital outcomes. However, the mechanisms linking Ramadan during pregnancy to later-life outcomes have remained under-researched, as well as effects on the functionality of specific organs and metabolic functions.
By investigating the effects of Ramadan during pregnancy on respiratory function in adulthood, linear growth and infectious disease occurrence in childhood, as well as reproductive outcomes among women using data from the Indonesian Family Life Survey, this dissertation adds to this evidence base. Moreover, the effects of Ramadan during pregnancy are largely attributed to the maternal intermittent fasting. However, besides daytime fasting, the practice of Ramadan involves further behavioral changes related to nutritional composition and sleep rhythm. Using data from the Mainz Survey Study on Ramadan during Pregnancy, this dissertation explores the behaviors of pregnant Muslims during Ramadan in Germany and links those to newborn health outcomes. Furthermore, first evidence on the practice of Ramadan among pregnant Muslims in Germany is provided.
From a conceptual perspective, this dissertation accounts for several recent advances in the literature. Besides the consideration of further behavioral changes beyond the decision to fast, the role of the preconceptional period and potential interactions between prenatal shocks and postnatal living circumstances are inspected empirically. Moreover, the dissertation puts a focus on identifying causal relationships between Ramadan during pregnancy and outcomes along the life course. Taken together, the four chapters of this dissertation contribute to an improved understanding of the conditions and populations among which the effects of Ramadan during pregnancy are most likely to materialize, which is pivotal to policy design. The adherence to the Ramadan fast is largely a religious tradition and not only guided by health considerations. Identifying factors that might moderate the association between Ramadan during pregnancy and offspring health outcomes is therefore highly relevant from a public health perspective.