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Impact of International Monetary Fund programs on child health

Wednesday, 24th of May 2017 Print

Impact of International Monetary Fund programs on child health

Adel Daouda,1,

Elias Nosratib,

Bernhard Reinsberga,

Alexander E. Kentikelenisa,c,d,

Thomas H. Stubbsa,e, and                     

Lawrence P. Kinga,b

Author Affiliations

aCentre for Business Research, Cambridge Judge Business School, University of Cambridge, Cambridge CB2 1AG, United Kingdom;

bDepartment of Sociology, University of Cambridge, Cambridge CB2 3RQ, United Kingdom;

cTrinity College, University of Oxford, Oxford OX1 3BH, United Kingdom;

dDepartment of Sociology, University of Amsterdam, 1018 WV Amsterdam, The Netherlands;

eSchool of Social Sciences, University of Waikato, Hamilton 3240, New Zealand

Edited by Arjumand Siddiqi, University of Toronto, Toronto, ON, Canada, and accepted by Editorial Board Member Mary C. Waters April 14, 2017 (received for review October 20, 2016)

Excerpts below; full text is at



This study adds to the state of the art by analyzing the impact of International Monetary Fund (IMF) programs on child health, mediated by parental education. It is the first to combine macrodata and microdata to address this issue systematically across five dimensions of child health: water, malnutrition, shelter, sanitation, and health care access. The sample represents about 2.8 billion (about 50%) of the world population in year 2000. Using multilevel models, we find that, although IMF programs do not correlate directly with child health indicators, they reduce the protective effect of parental education on child health, especially in rural areas, and have a mixed impact across the five dimensions of urban child health.


Parental education is located at the center of global efforts to improve child health. In a developing-country context, the International Monetary Fund (IMF) plays a crucial role in determining how governments allocate scarce resources to education and public health interventions. Under reforms mandated by IMF structural adjustment programs, it may become harder for parents to reap the benefits of their education due to wage contraction, welfare retrenchment, and generalized social insecurity. This study assesses how the protective effect of education changes under IMF programs, and thus how parental ability to guard their childrens health is affected by structural adjustment. We combine cross-sectional stratified data (countries, 67; children, 1,941,734) from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys. The sample represents 2.8 billion (about 50%) of the world population in year 2000. Based on multilevel models, our findings reveal that programs reduce the protective effect of parental education on child health, especially in rural areas. For instance, in the absence of IMF programs, living in an household with educated parents reduces the odds of child malnourishment by 38% [odds ratio (OR), 0.62; 95% CI, 0.66–0.58]; in the presence of programs, this drops to 21% (OR, 0.79; 95% CI, 0.86–0.74). In other words, the presence of IMF conditionality decreases the protective effect of parental education on child malnourishment by no less than 17%. We observe similar adverse effects in sanitation, shelter, and health care access (including immunization), but a beneficial effect in countering water deprivation.

1To whom correspondence should be addressed. Email: ad836@cam.ac.uk.

Author contributions: A.D. and L.P.K. designed research; A.D. performed research; A.D. collected the data; A.D. analyzed data; and A.D. wrote the paper in collaboration with E.N., B.R., A.E.K., T.H.S., and L.P.K.

The authors declare no conflict of interest.

This article is a PNAS Direct Submission. A.S. is a guest editor invited by the Editorial Board.

This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1617353114/-/DCSupplemental.






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