Healthcare reform and gender specific infant mortality in rural Nepal

We estimate to what extent a large scale health care reform disproportionately affects the mortality rate of boys in the context of a developing country with cultural preferences favoring boys. We use arguably exogenous variations due to a health care reform—the National Health Policy—which was implemented in Nepal in 1991 along with data from the Nepal Living Standard Survey 1996 and estimate that improved quality of primary health care facilities (by one standard deviation) reduces the mortality rate of infant boys by 3.43 percentage points but does not affect the mortality rate of infant girls. Our analysis points to societal gender preferences for sons and the consequent neglect of daughters’ health as potential drivers of some of the observed differences in mortality between genders and highlights the important role of cultural norms in shaping the outcomes of large scale health care reforms.