High Variance

Pregnant Women and Ramadan

Doug Almond has turned out an impressive amount of work in recent years on how bad stuff that happens to fetuses early in pregnancy can cause long-lasting problems. His first paper on this (AER 1985) showed that babies who were in utero during the 1918 American flu pandemic “displayed reduced educational attainment, increased rates of disability, lower income, and lower socioeconomic status.”

In the last year, he has produced two more papers in this area (AEJ Applied 2011, NBER Working Paper 17713) that focus specifically on the long-term effects of the fasting of pregnant Muslim women during Ramadan. And one of his co-authors (Reyn van Ewijk) has a forthcoming paper in the Journal of Health Economics on this topic as well. While none of the papers is truly convincing on its own, taken together, the results are striking. In Michigan, England, and Indonesia, Muslim babies who were in their first trimester during Ramadan go on to experience worse health and schooling outcomes than other babies.

What’s surprising about this finding is that the Koran specifically states that pregnant women are exempt from fasting during Ramadan if the health of their baby is at risk. Van Ewijk’s paper has a terrific background section where he explains that in fact most pregnant Muslims from around the world do tend to fast during Ramadan. There are three main reasons:

  • differing beliefs about whether fasting is harmful to fetuses or mothers,
  • the requirement that any fasting that doesn’t happen during Ramadan must be made up later, or
  • an obligation to make up the fasting with a charitable donation.

It certainly seems to me that as the results from these three papers diffuse into the popular press, they could really affect mothers’ and physicians’ beliefs. That is, this research really could have pretty direct positive effects on child health. More research like this please!