Children of the Revolution: Fetal and Child Health amidst Violent Civil Conflict

This paper considers the impact of exposure to violent conflict in utero, and after birth, on a range of fetal and child health inputs and outcomes, using the Maoist insurgency that a ected Nepal between 1996 and 2006 as a case study. Conflict intensity is measured by the number of conflict deaths by district and month and merged with pregnancy histories from the 2001 and 2006 Demographic and Health Surveys. Maternal mixed-effects estimation allows me to control for-, and shed light on- selection into becoming pregnant and giving birth at times of more intense conflict. Exposure to conflict in the rst few years of life has an adverse effect on child nutritional status. However, exposure to conflict in utero has both scarring and selection effects on survivors. As conflict intensity increases, the likelihood of miscarriage increases, and so a smaller share of the frailer fetuses is carried to term. This selection effect tends to dominate in the second trimester of pregnancy, whilst scarring effects are stronger in the third trimester. Use of health care such as antenatal care, (medical) help with delivery, and immunization do not appear to decrease when conflict intensites, and there is no evidence of acute maternal malnutrition, thus suggesting a role for other factors such as psychological stress in the increased probability of miscarriage.