Date of Degree


Document Type


Degree Name





Theodore Joyce

Committee Members

Michael Grossman

David Jaeger

Wim Vijverberg

Subject Categories

Economics | Health Economics


health, fertility, son preference, demography, sex ratio, gender


Chapter 1: Couples in Turkey exhibit son preference through son-biased differential stopping behavior that does not cause a sex ratio imbalance in the population. Demand for sons leads to lower ratios of boys to girls in larger families but higher ratios in smaller families. Girls are born earlier than their male siblings, and son-biased fertility behavior is persistent in response to decline in fertility over time and across households with parents from different backgrounds. Parents use contraceptive methods to halt fertility following a male birth. The sibling sex composition is associated with gender disparities in health. Among third- or later-born children, female infant mortality is 1.5 percentage points lower if the previous sibling is male. The female survival advantage, however, disappears if the previous sibling is female. Having an older female sibling shifts the gender gap in infant mortality rate by 2 percentage points in favor of males. The improvement in infant mortality is strongest in favor of males who do not have an older male sibling.

Chapter 2: My co-authors and I examine the causal of impact of increased fertility on labor market outcomes in Turkey. Because Turkish parents exhibit a strong preference for sons and there is no evidence of selective abortion in Turkey, we use female births in the first two parities as instruments for family size. Using the 2000 Census, we find that although OLS estimates indicate a negative effect of fertility on labor supply for women, there is no evidence that this effect is causal. For men we find a small positive increase in labor force participation when the first child born is female. Analyzing the characteristics of compliers (i.e. those parents whose fertility is influenced by having a preference for sons), we find little difference with the overall population, suggesting that the finding of no effect of fertility is likely to be generalizable to the overall population. Results from the 2004-2012 Household and Labor Force Survey confirm our results from the Census and also indicate that there is little impact of fertility on the intensive margin of labor supply (i.e. hours or wages).

Chapter 3: A long-standing tension within the Special Supplemental Nutrition Program forWomen, Infants and Children or WIC is promotion of breastfeeding while making available free infant formula. The WIC program purchases over half of all infant formula sold in the US and unsurprisingly, breastfeeding initiation and duration is substantially lower among WIC participants than their eligible non-participants. In an effort to improve breastfeeding, the Oregon WIC Program tested whether a relatively low-cost telephone peer counseling initiative to support breastfeeding could increase the initiation and duration of exclusive breastfeeding among its participants. They conducted a large randomized field experiment (RFE) with over 1900 women from four WIC agencies in the state. They found significant increases in exclusive breastfeeding among Spanish- but not English-speaking clients. In this study, my co-authors and I use data from the RFE along with administrative data from the rest of the state to assess whether the results from the RFE can be extended to other agencies in the state. We use randomization as an instrument to estimate the effect of treatment on the treated and we compare these to non-experimental estimates of the effect of peer counseling from the same or similar WIC agencies as the RFE. We find small or non-existent effects of peer counseling in the non-experimental settings, which suggest that the experimental estimates may reflect Hawthorne effects. We present evidence of selection into RFE in that exclusive breastfeeding among the controls is significantly greater than among women who were offered but declined to participate in the RFE as well as from women in the rest of the state who had no access to peer counseling. We conclude that despite the strong internal validity of the RFE, extending the program to other agencies in the state would have a limited impact at best on exclusive breastfeeding.