Children's stunting in sub-Saharan Africa: Is there an externality effect of high fertility?

A positive relationship between the number of siblings and a child’s chance of being stunted has been seen in several studies. It is possible that individual stunting risks are also raised by high fertility in the community, partly because of the impact of aggregate fertility on the local economy, but this issue has not been addressed in earlier investigations. In this study we estimate the independent effect of the child dependency ratio in the province (or governorate, region, or larger geopolitical zone within a country), using DHS data on up to 145,000 children in 152 provinces in 23 countries with at least two such surveys. The data design allows inclusion of lagged province variables and province fixed effects (to control for constant unobserved province characteristics). Three types of regression models for a child’s chance of being stunted are estimated. Some estimates suggest an adverse effect of the current child dependency ratio, net of the child’s number of siblings, while others do not point in this direction. When the child dependency ratio measured in an earlier survey is included instead, no significant effects appear. Thus, we conclude that there is only weak support for the idea that a child’s stunting risk may be raised by high fertility in the community.