Jakaria 2021

Received: 25 June 2019
| Revised: 15 February 2021

| Accepted: 12 July 2021
DOI: 10.1111/rode.12819
REGULAR ARTICLE
Is maternal employment detrimental to children’s

nutritional status? Evidence from Bangladesh
Mohammad Jakaria1,2 | Rejaul Karim Bakshi3 | M. Mehedi Hasan4
1
Department of Economics, Hajee
Mohammad Danesh Science and
Abstract
Technology University, Dinajpur, This paper explores the effect of maternal employment on the
Bangladesh nutritional status of children below age 5 years in Bangladesh
2
Department of Economics, University of
using data from the 2014 Bangladesh Demographic
South Carolina, Columbia, SC, USA
3 and Health Survey. Since mothers’ choice to participate
Department of Economics, University of
Rajshahi, Rajshahi, Bangladesh in the labor market is endogenous, the estimation of the
4
Department of Economics, Naogaon causal effect of maternal employment on child health is
Government College, Naogaon, Bangladesh statistically challenging. To correct for the endogeneity
Correspondence of maternal employment, we employ instrumental vari-
Rejaul Karim Bakshi, Department of able (IV) estimation. While our ordinary least squares re-
Economics, University of Rajshahi,
sults show that mothers’ employment has no significant
Rajshahi 6205, Bangladesh.
Email: rkbakshi@ru.ac.bd effect on children's nutritional outcome, the IV estimates
suggest that maternal employment significantly decreases
children's height-for-age Z-score. This result is contrary
to conventional wisdom advocating for maternal employ-
ment to positively affect child health and well-being. We,
therefore, argue for effective policy interventions—such as
childcare centers at workplaces, flexibility in working hours
including part-time options for mothers, restraining child
marriages, and strengthening maternal and child health-care
services through community health centers—to foster chil-
dren's health as well as maternal employment in the country.
KEYWORDS
Bangladesh, child health, endogeneity, instrumental variable
regression, maternal employment, South Asia
JEL CLASSIFICATION
E24; E2; I15; I1; J01; J00
Rev Dev Econ. 2021;00:1–27. wileyonlinelibrary.com/journal/rode |

© 2021 John Wiley & Sons Ltd 1
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2 JAKARIA et al.
1 | IN T RO D U C T ION
Childhood undernutrition has long been a major public health concern in developing countries.
Undernourished children not only suffer from stunted physical and mental capabilities throughout
their lives (Bhutta et al., 2013; Haddad, 2013; Hoddinott et al., 2013; Martorell et al., 2010; Martorell
& Zongrone, 2012; Victora et al., 2008) but also transmit their poor nutritional status over the next
generation (Black et al., 2013; Harris, 2014; Victora et al., 2008). About half of the undernourished
children globally live in South Asia (Menon, 2012). Bangladesh has reduced undernourishment
considerably in recent times (Headey, 2013; Headey et al., 2015; Nisbett et al., 2017) though un-
dernourishment remains a big concern, with 36% of children under age 5 years stunted, 33% under-
weight, and 14% wasted (National Institute of Population Research & Training, Mitra Associates, ICF
International, 2015).
There is a large body of literature on the determinants of the nutritional status of children
in Bangladesh (e.g., Alom et al., 2012; Das & Gulshan, 2017; Das & Hossain, 2008; Das &
Rahman, 2011; Siddiqi et al., 2011). The literature commonly identifies parental attributes such as
mothers’ childbearing age, height, health status, and education as major factors in children's nutri-
tional status. However, literature examining the association between maternal employment and chil-
dren's nutritional status in the context of Bangladesh is scant. This study, therefore, attempts to
uncover the impact of maternal employment on children's nutritional status, which is to the best of our
knowledge the first study on this issue in the context of Bangladesh.
Our investigation is crucial, as children's improved health and women's expanded economic op-
portunity are two priority goals for developing countries as set by the United Nations’ Sustainabl
e Development Goals (SDGs; United Nations, 2015). Women's participation in the labor force has
been increasing in almost all developing countries in recent times. Since the 1990s, Bangladesh
has seen a substantial increase in female labor-force participation. Between 1996 and 2016, female
labor-force participation increased in both urban and rural areas of the country by 10.3 percentage
points (from 20.5 to 30.8) and 20.2 percentage points (from 17.4 to 37.6), respectively (BBS, 2017).
Women in the developing countries are subject to triple roles: domestic worker, income earner
outside household chores, and caregivers for family members (Binachi, ; Glick, 2002; Glick & Sahn,
1998). The employment status of women, thus, has potential implications for all aspects of chil-
dren's development, including health and nutrition. In a seminal work, Becker (1965) outlines a trade-
off where maternal employment and income are exchanged for reduced time in childcare. On the one
hand, employed mothers’ increased income allows households to better invest in child health and nu-
trition through enhanced financial accessibility to health inputs like nutritious diets and better health
care (Gennetian et al., 2010; Glick, 2002; Morrill, 2011; Qian, 2008; Smith et al., 2003). However,
the increased investment in child health due to mothers’ increased income may depend on the bargain-
ing power of mothers in household resource allocation (Hossain et al., 2007; Lépine & Strobl, 2013;
Quisumbing, 2003; Shroff et al., 2011; Smith et al., 2003). On the other hand, employed mothers’
reduced time with family may result in poorer supervision or care for their children. Working moth-
ers may lack the time to adequately breastfeed, prepare homemade nutritious food, and visit health
centers for children's vaccination or treatments (Cawely & Liu, 2012; Desai et al., 1989; Glick & Sahn,
1998; Smith et al., 2003). Although there are market substitutes for some time-intensive inputs (e.g.,
prepared food and hired domestic help), they may prove inferior and expensive for many work-
ing women (Glick & Sahn, 1998). Working women may rely on alternative caregivers (including
grandparents, older siblings, neighbors, or relatives) to provide childcare, but such arrangements are
often not readily available and the quality of care may not be similar (Glick & Sahn, 1998). Therefore,
the net effect of maternal employment on child health remains a question for empirical investigation.
JAKARIA et al.
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The empirical evidence on the relationship between maternal employment and children's nutrition
provides mixed and ambiguous results, as discussed further in Section 2. Empirical estimation of
the effect of maternal employment on child health is also statistically challenging because mothers’
choice to participate in the labor market is endogenous for various reasons. One source of endogeneity
is omitted variable bias. For example, individual or household heterogeneity in unobserved prefer-
ences or abilities of mothers may affect both maternal work participation and child health. Omitting
these characteristics will produce biased results. Another source of endogeneity may be the simul-
taneity bias through reverse causality. Just as maternal employment might affect a child's health, a
child's poor health might influence a mother's decision whether to enter the labor market. However,
as most of the existing literature on this issue disregards the potential endogeneity of maternal em-
ployment, the studies hardly represent a causal relationship and are often misleading. In this context,
the present study employs the instrumental variable (IV) regression approach to tackle the problem
of endogeneity.
The empirical results of this study document an adverse effect of maternal employment on child
nutrition in Bangladesh. The results are robust across different estimators and model specifications.
Furthermore, this study explores the heterogeneity of maternal employment effects on child nutrition
among different subgroups of children. First-born children, for example, are found to be even more
negatively impacted by maternal employment than are later-born children. Similarly, the empirical
results show that the negative effects of maternal employment are more pronounced for rural children
compared to that of their urban counterparts. Similarly, our estimates document the negative effects of
maternal employment on both boys and girls, though we do not find significant differences between
the two groups. Finally, for working mothers, formal, year-round jobs and high level of education are
found to have greater adverse impact on child health than informal jobs and a low level of education.
The paper offers important policy recommendations based on these study findings.
The contributions of this study are multifold. First, the paper provides additional evidence on
the causal, unbiased, and consistent estimate of the effect of maternal employment on child nutri-
tion within the context of a developing country like Bangladesh. With some exception (e.g., Diiro
et al., 2017; Glick & Sahn, 1998) most of the previous studies in developing countries fail to address
the endogeneity problem. Second, this study adds to the growing body of literature examining factors af-
fecting undernutrition in children within the context of developing countries. Third, this study fills the
void in the literature on examining the effects of maternal employment on children's nutritional status
in the context of Bangladesh.
2 | L IT E R AT U R E R E V IE W
Studies associating maternal employment with child health and nutrition are often characterized by

a list of indicators measuring the key variables of interest and a great number of methodological ap-
proaches, and they end up with conflicting results. Most of the studies associating maternal employ-
ment with child health in developing countries are correlation based rather than causal. Using a simple
bivariate analysis based on a sample of rural Iranians, Rabiee and Geissler (1992) find that maternal
workload has a negative effect on the nutrition status of young children through mechanisms affecting
food consumption and health that are not directly financial. Using the data of Nicaraguan households,
Lamontagne et al. (1998) show that (with and without controlling for socioeconomic status of the
household, childcare adequacy, and other variables) mothers’ work had positive effects on weight-
for-height for children aged 12–18 months. However, no significant impacts of maternal work were
found on weight-for-age or height-for-age. Abbi et al. (1991) explore the impact of mothers’ work
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4 JAKARIA et al.
status on the nutrition and health status of children in rural India and find an adverse effect with
and without controlling for family income and age of children. In a study of Panama using both
the dietary and anthropometric indicators of nutritional outcome, Tucker and Sanjur (1988) show
that maternal employment had no significant impact on the anthropometric indicators. However, it did
have a positive impact on children's dietary intake and hemoglobin levels, proving that adequate care
was available for the child. Using both bivariate and multivariate analyses, Ukwuani and Suchindran
(2003) examine the relationship between women's work and children's nutritional status (stunting and
wasting) of 5,331 Nigerian children aged 0–59 months. The study documents that mothers’ work de-
creases stunting of their children, while wasting among infants increases when mothers are not taking
their children to workplaces.
Few studies have considered the problem of endogeneity of maternal employment when they in-
vestigate the association between maternal employment and child nutrition. Considering the endog-
eneity concern, Glick and Sahn (1998) use the IV approach to estimate the causal effect of mothers’
employment on child health in West Africa and conclude that the positive income effect of maternal
employment is offset by the negative time allocation effect, resulting in a net negative effect of ma-
ternal employment on child health. However, in a recent study using a rural Indian data set based on
mean and quintile IV estimates, Diiro et al. (2017) find that the positive income effect of maternal
work on child nutrition is greater than the negative effects of decrease in quantity and quality of
childcare. The study focuses on the heterogeneous effects of maternal employment on the distribution
of height-for-age Z-score (HAZ score) of children and finds that positive effects of maternal work
were statistically and economically significant in the lower tail of the distribution but insignificant for
children in the rest of the distribution.
A number of recent empirical studies relate maternal employment to child health in the developed
world context, particularly the United States and Canada. However, since the undernutrition problem
is uncommon in the developed world, most of the studies in this realm focus on obesity or over-
weight problem. Using U.S. data and addressing endogeneity concerns, most of the studies (Anderson
et al., 2003; Courtemanche, 2009; Liu et al., 2009; Ruhm, 2008) document that maternal employ-
ment increases the risk of childhood obesity. Studies based on data from several other countries—
including Canada (Chia, 2008; Phipps et al., 2006), the United Kingdom (Scholder, 2008), Germany
(Meyer, 2016), and Australia (Zhu, 2007)—are found to be consistent with the aforementioned find-
ings. One exception to this is the study of Greve (2011), who finds no statistical relationship between
maternal work hours and the probability of child being overweight in the context of Denmark.
Some studies in developed countries document the adverse effects of maternal employment on
other dimensions of health outcomes, such as chronic illnesses; reduced birth weight; high incidence
of respiratory ailments like asthma, allergies, and ear infections (Baker & Milligan, 2008); infec-
tious disease and injury (Gordon et al., 2007); overnight hospitalizations; asthma episodes, inju-
ries, and poisonings (Morrill, 2011); and overall health status (Gennetian et al., 2010).
3 | DATA , E MP IR ICA L ST R AT EGY, AND VARIABLES
3.1 | Data and sample
The empirical analyses in this study use data from the 2014 Bangladesh Demographic and Health
Survey (BDHS). BDHS 2014 is the seventh survey conducted in Bangladesh, following those im-
plemented in 1993–1994, 1996–1997, 1999–2000, 2004, 2007, and 2011. The sample for the 2014
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BDHS is nationally representative and covers the entire population residing in noninstitutional dwell-
ing units in the country. The 2014 BDHS samples are two-stage-stratified cluster samples.
The BDHS is a nationally representative survey primarily focusing on women in reproductive
periods and their young children aged 0–59 months and is a part of the worldwide Demographic and
Health Survey program. For analytical purposes, this study uses matched records for children under
age 5 years with a mother aged between 15 and 49, leaving 7,886 observations. The BDHS data
set contains children's nutritional indicators, including the HAZ score based on the World Health
Organization (WHO) standard. The BDHS data set also includes a number of other sociodemographic
variables at individual, household, and community levels.
3.2 | Empirical strategy
To examine the effect of maternal employment on children's health, the key equation of interest can
be written as follows:
CHi = 𝛼 + 𝛽MEi + 𝛾Xi + 𝜀i (1)
where CHi is the nutritional status of the child of interest, MEi is the measure of maternal employ-
ment, Xi is the vector of control variables, and εi is the stochastic disturbance term. In this model, β
measures the effect of maternal employment on a child's nutritional status. The key interest of the
study is to estimate the magnitude of β. However, in estimating the causal effect of maternal employ-
ment on child nutrition outcome, the important concern is that maternal employment might be endoge-
nous (Anderson et al., 2003; Cawley & Liu, 2012; Greve, 2011; Morrill, 2011; Scholder, 2008) for several
reasons. (1) Omitted variable bias: omitted variables might bias the results since a mother's decision to
work could reflect underlying and unobserved maternal ability, skills, or preferences that directly affect
child health (Bishop, 2011; Morrill, 2011). (2) Simultaneity bias: reverse causality may also lead to po-
tential bias. A mother whose child suffers from adverse health may choose to leave or skip work and stay
home to meet the caregiving needs of her child, or she may tend to work more to satisfy the increased
expenses for medicine and nutritious foods (Hope et al., 2016; London et al., 2002; Morrill, 2011; Zan
& Scharff, 2017). The potential endogeneity of maternal employment would cause the error term to be
correlated with the ordinary least squares (OLS) estimation (i.e., the covariance of ME and ε is not nec-
essarily equal to zero) picking up both forward and backward effects, leading to inconsistent and biased
estimation (Wooldridge, 2006).
One useful strategy for recovering a consistent estimate of β is to identify an instrument (Z) –a vari-
able that partially determines maternal employment but is uncorrelated with the error term (ε). In the
present study, the selected instrument is mothers’ premarital labor-force participation captured by
a dichotomous variable indicating whether the mother was employed before marriage. A related bi-
nary instrument, whether the mother worked before the child was born, has been previously used to in-
strument maternal employment and is found to predict maternal labor market participation (Reynolds
et al., 2017). Because previous work experience has an influence on present and future work partici-
pation decisions, the women with higher pre-birth work experience will have higher participation in
labor markets following childbirth than women with less experience (McLaughlin, 1982). After se-
lecting the instrument, the IV estimation is employed using the two-stage least squares (2SLS) model
as follows:
First stage: MEi = 𝛼 FS + 𝛽 FS Zi + 𝛾 FS Xi + 𝜇 i (2)

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Second stage: CHi = 𝛼 IV + 𝛽 IV MEi + 𝛾Xi + 𝜀i (3)
The first-stage (FS) equation (Equation 2) relates maternal employment to the IV Zi and the vector
of control variables (Xi). The second-stage equation (Equation 3) relates child health status with ma-
ternal employment and the vector of controls as stated in Equation 2. The present study focuses on the
sign and significance of the βIV coefficient in Equation 3. The consistent estimate of βIV relies on the
validity of the instrument (Cov(Z,ε) = 0). The interpretation of the IV estimate, βIV, as the causal ef-
fect rests on the assumption that the effect of the instrument on the outcome operates solely through
the endogenous variable.
In this study, robust standard errors at the “cluster” level (there are 600 clusters or communities in
the sample) are used to account for heteroskedasticity.
3.3 | Outcome variable: Children's nutritional status
The three standard indices of physical growth that describe the nutritional status of children are HAZ
score, weight-for-height Z-score (WHZ score), and weight-for-age Z-score (WAZ score) as measured against
the WHO Child Growth Standard. A child with HAZ < −2, WHZ < −2, and WAZ < −2 is considered as
stunted, wasted, and underweight, respectively. Stunting reflects the long-term effects of undernutrition in a
population and does not vary appreciably according to recent dietary intake or illness. Wasting reflects acute
or recent nutritional deficit. Weight-for-age is a composite index of weight-for-height and height-for-age
and does not distinguish between acute undernutrition (wasting) and chronic undernutrition (stunting). A
child can be underweight for his or her age because the child is stunted or wasted or both.
Among these commonly used three indicators, this study chooses HAZ score as outcome variable
for analysis because (1) HAZ score is now widely regarded as the single most relevant indicator of
overall nutrition and the reduction in stunting is now considered as the standard metric of nutri-
tional success for setting and monitoring international goals (Headey et al., 2015; UNICEF, 2013) and
(2) HAZ is a long-term health outcome (WHO Multicentre Growth Reference Study Group, 2006)
and is the manifestation of insufficient food, health, and care for the mother before and during preg-
nancy and for the child during the early years of life (Victora et al., 2010).
3.4 | Key explanatory variable: Maternal employment
Maternal employment is the key explanatory variable of interest in the present
study. The 2014 BDHS lacks data on average working hours of mothers, which is used intensively in
the literature for representing maternal labor supply. In the survey, currently married women were
asked whether they were employed at the time of the survey and/or employed at any time during the
12 months preceding the survey. This enables to construct a dichotomous maternal work participation
variable indicating whether the mother is employed in the past 12 months.
3.5 | IV: Mothers’ premarital labor-force participation
As stated earlier, an IV approach is used in the present study to address the endogeneity of maternal
employment in examining the causal effect of maternal employment on child health. In previous lit-
erature, the common variables used to instrument maternal employment were the local unemployment
JAKARIA et al.
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rate (Anderson et al., 2003; Bishop, 2011), child's youngest sibling's eligibility for kindergarten
(Morrril, 2011), proximity to work opportunity for mother (Diiro et al., 2017), and number of younger
siblings in the household (Meyer, 2016).
However, these frequently used IVs are not available in the BDHS data set. Rather, there is informa-
tion on mothers’ premarital labor-force participation captured by a dummy variable indicating whether the
mother worked before marriage. We used mothers’ premarital workforce participation as the instrument
following previous literature. A related binary instrument, whether the mother worked before child was
born, has been previously used to instrument maternal employment and is found to predict maternal labor
market participation (Reynolds et al., 2017). Because past work experience has an influence on the pres-
ent and future work participation decisions, women with higher premarital work experience are also likely
to have higher participation in the labor market following childbirth and vice versa (McLaughlin, 1982). Ho
wever, the health outcomes of the children are independent of mothers’ premarital labor-force participation.
Premarital work may offer, sometimes, opportunity for mothers to accumulate some amount of wealth,
though not large in size, in their possession that they might carry after marriage. However, in our estimation
we include household-level assets, including mothers’ premarital assets, if any. Our estimation, therefore,
controlled for such accumulated assets from mothers’ premarital work. It, therefore, can be argued that our
instrument is exogenous and has no direct effect on children's health outcome.
3.6 | Control variables
The regression model controls for a set of exogenous variables (Xi) that include child characteristics

such as age (in months), age squared, sex, and birth order; parental characteristics such as moth-
ers’ age, mothers’ height, and parental education; and household characteristics such as household
wealth index, sex of household head, household size, access to drinking water, and sanitation. The
model also includes a residential dummy capturing whether the child lives in urban or rural areas and
also includes seven divisional dummies.
Parental attributes such as age, height, and education are strongly correlated with children's health
status. Mothers’ childbearing age is considered to be an important determinant of child nutrition. It af-
fects children's health through biological and social relationships (Ozaltin et al., 2010; Raj et al., 2010;
Richter et al., 2018). Mothers’ height, which reflects both genetic information and living condition, af-
fects the health of the child strongly (Addo et al., 2013; Martorell & Zongrone, 2012; Monden & Smit
s, 2009; Ozaltin et al., 2010; Pandey, 2009; Richter et al., 2018; Subramanian et al., 2009). Parent's ed-
ucational attainment is considered a central factor of children's nutritional status. Education of par-
ents is also used as proxy for parent's knowledge about child health inputs. The higher is parents’
knowledge of good health and dietary habits, the greater is the probability of children to attain better
nutrition (Christiaensen & Alderman, 2004; Smith et al., 2003; Smith & Haddad, 2000). This study,
therefore, includes parental education in the model.
The regression model controls for the effect of mothers’ access to health information using their
exposure to media, captured by a dummy variable indicating whether the household has a radio
or television. The model also controls for household wealth status with an index based on household
assets and dwelling characteristics to proxy for household socioeconomic status. In the BDHS data
set, the wealth index is divided into quintiles of richest, richer, middle, poorer, and finally poorest, our
reference category. The total number of household members is included to represent the family struc-
ture of the household. Previous studies have identified the negative effects of family size on a vari-
ety of health indicators for children in both developed and developing countries (Glick et al., 2007;
Hatton & Martin, 2010).
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The regression model controls for the number of children since mothers’ time allocation can be lim-
ited when there are multiple children in the family (Bernal, 2008; Ejrnæs & Portner, 2004). Access to
water and sanitation is an important factor of children's health status (Fink et al., 2011). Therefore, the
model controls for the effects of water and sanitation situations using a continuous variable, time to
get drinking water source as proxy for households’ access to good-quality water, and a dummy vari-
able, whether the household has a flushing toilet as proxy for better sanitation. The summary statistics
of child HAZ score and its covariates by maternal employment status are provided in Table 1.
4 | R E S U LTS A N D D IS C U S S ION
4.1 | Main results
Table 2 presents the main results of the effect of maternal employment on child nutrition in the full
sample. The analysis presents both the OLS and IV estimates but principally focuses on the IV esti-
mates. The FS estimates are also reported in this analysis.
Column 1 of Table 2 presents the determinants of children's nutritional status using the OLS model
without controlling for the endogeneity of maternal employment. It is observed that mothers’ employ-
ment has a small negative but insignificant effect (coefficient, −0.052; standard error, 0.038) on chil-
dren's health outcome as measured by the HAZ score. Since this relationship might still occur due to
unobserved characteristics of mothers and potential reverse causality between maternal employment
and child health, it cannot be interpreted as a causal relation. Thus, the analysis considers the endog-
eneity of maternal employment and employs the 2SLS method.
The FS, in column 2 of Table 2, regresses maternal employment on the IV (i.e., mothers’ pre-
marital labor-force participation) and other controls. The result shows that the effect of premarital
labor-force participation on maternal employment is positive and statistically significant (coefficient,
0.281***; standard error, 0.023) at the 1% level of significance, which confirms that the instrument
correctly predicts the endogenous variable, maternal employment. The statistical tests, as presented in
Table 2, confirm the endogeneity of maternal employment and the validity of the instrument. The FS
F-statistic is 110.251, and the partial R2 is 0.029. Since the F-statistic is larger than the Stock–Yogo
critical value for producing IV estimates with 5% of bias present in OLS estimates, the IV does not
suffer from weak instrument problem (Stock & Yogo, 2005).
The causal interpretation of the IV estimates rests on a nontestable assumption that the instrument
affects the outcome variable, child health, exclusively through the endogenous variable, maternal
employment.
Column 3 in Table 2 presents the IV estimates using 2SLS. The 2SLS estimates show that
maternal employment has a negative and statistically significant effect (coefficient, −0.592;
standard error, 0.217) on child health at the 1% level of significance. The estimated coefficient indi-
cates that a mother's participation in the labor market decreases her children's height by 0.592 standard
deviation relative to children of nonworking mothers. The estimated coefficient of maternal employ-
ment is a little higher, potentially because of the binary nature of the variable. As the binary variable
captures a drastic shift from 0 to 1, the estimated coefficient of maternal employment is higher in this
case—certainly a caveat of the data. In a similar study, Seid (2013) also documented a fairly large neg-
ative coefficient (−0.217) effect of maternal employment on child nutrition in Ethiopia. Our results
can be observed from two angles: a mother's workforce participation contributes to household income,
which is likely to affect health outcome positively (the income effect); however, a mother's work
outside home can decrease her time to care for children (the substitution effect). While the income
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T A B L E 1 Summary statistics of height-for-age Z-score and its covariates by maternal employment status
Nonworking
mother Working mother All
Characteristics Mean Mean Mean Difference

Outcome variable
Child height-for-age −1.498 (0.019) −1.650 (0.030) −1.539 (0.016) 0.152***
Z-score a
Control variables
Child lives in urban (yes = 1, 0.325 (0.006) 0.290 (0.010) 0.315 (0.005) 0.034***
no = 0)
Child sex (male = 1) 0.518 (0.007) 0.507 (0.011) 0.515 (0.006) 0.010
Age of child (months) 28.358 (0.231) 32.789 (0.371) 29.530 (0.197) −4.430***
Age of child (months) 1,097.525 (13.957) 1,347.896 (23.754) 1,163.71 −250.372***
squared (12.102)
Birth order of child 2.131 (0.019) 2.468 (0.034) 2.222 (0.016) −0.337***
Household has radio or 0.456 (0.007) 0.379 (0.011) 0.434 (0.006) 0.076***
television (yes = 1, no = 0)
Household has flush toilet 0.175 (0.005) 0.138 (0.007) 0.165 (0.004) 0.037***
(yes = 1, no =0)
Time to get water 4.623 (0.149) 4.759 (0.252) 4.660 (0.129) −0.136
source (min)
Family size 6.189 (0.039) 5.549 (0.050) 6.017 (0.031) 0.640***
Number of children 2.11 (0.017) 2.363 (0.030) 2.175 (0.015) −0.257***
Poorest household (yes = 1, 0.211 (0.005) 0.246 (0.009) 0.220 (0.005) −0.036***
no = 0)
Poorer household (yes = 1, 0.180 (0.005) 0.218 (0.009) 0.191 (0.004) −0.038***
no = 0)
Middle household (yes = 1, 0.186 (0.005) 0.208 (0.009) 0.192 (0.004) −0.022**
no = 0)
Richer household (yes = 1, 0.208 (0.005) 0.190 (0.009) 0.203 (0.005) 0.018*
no = 0)
Richest household (yes = 1, 0.215 (0.005) 0.137 (0.007) 0.194 (0.004) 0.078***
no = 0)
Sex of household head 0.907 (0.004) 0.913 (0.006) 0.908 (0.003) −0.006
(male = 1)
Mother's age (years) 25.095 (0.077) 26.747 (0.127) 25.540 (0.066) −1.652***
Mother's height (cm) 151.106 (0.074) 150.899 (0.124) 151.050 (0.064) 0.208
Mother's education (years) 6.188 (0.049) 5.677 (0.090) 6.051 (0.044) 0.511***
Father's education (years) 5.795 (0.061) 4.912 (0.102) 5.558 (0.053) 0.884***
Barisal division (yes = 1, 0.119 (0.004) 0.104 (0.007) 0.115 (0.004) 0.015*
no = 0)
Chittagong division (yes = 1, 0.206 (0.005) 0.155 (0.008) 0.192 (0.004) 0.051***
no = 0)
(Continues)
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10 JAKARIA et al.
T A B L E 1 (Continued)
Nonworking
mother Working mother All
Characteristics Mean Mean Mean Difference

Dhaka division (yes = 1, 0.163 (0.005) 0.208 (0.009) 0.175 (0.004) −0.046***
no = 0)
Khulna division (yes = 1, 0.108 (0.004) 0.114 (0.007) 0.109 (0.004) 0.004
no = 0)
Rajshahi division (yes = 1, 0.100 (0.004) 0.179 (0.008) 0.122 (0.004) −0.079***
no = 0)
Rangpur division (yes = 1, 0.113 (0.004) 0.145 (0.008) 0.121 (0.004) −0.033***
no = 0)
Sylhet division (yes = 1, 0.192 (0.005) 0.094 (0.006) 0.166 (0.004) 0.098***
no = 0)
Instrumental variable
Mother's premarital labor- 0.053 (0.003) 0.148 (0.008) 0.079 (0.003) −0.096***
force participation (yes = 1,
no = 0)
Observations 5,766 2,119 7,885
Notes: Standard errors are provided in parentheses.
a
A mean Z-score of less than 0 suggests that the distribution of an index has shifted downward and that most of (not all) the children
in the population suffer from undernutrition relative to the reference population.
***p < .01; **p < .05; *p < .1.
effect of maternal employment on child health is positive, the substitution effect is negative due to the
mother's time constraint. The negative coefficient of the 2SLS estimate indicates that in our sample,
the negative substitution effect is strong enough to outweigh the positive income effect of mother's
employment on child health in this nationally representative data set of Bangladesh.
It is also observed that the IV estimate is larger than the OLS estimate. There are several possibil-
ities that may lead to the downward bias of the OLS estimate. Certain omitted variables may bias the
OLS estimate downward. As mentioned earlier, the mother's decision to work could reflect underlying
and unobserved abilities, skills, or preferences. Disregarding these characteristics would result in a
downward bias of the OLS estimate. A second possibility is the reverse causality between maternal
employment and child health, which may also result in downward bias of the OLS estimate.
Apart from the main focus of this study, several other coefficients (as shown in column 3
in Table 2) are worth noting. The age of a child is negatively and significantly (coefficient, −0.081; stan-
dard error, 0.004) associated with HAZ, but age squared is positively and significantly (coefficient,
0.001; standard error, 5.99e-05) associated with HAZ, indicating that the relationship between age
and nutritional status of the children is curvilinear. Both the mother's and father's education are
positively and significantly associated with the HAZ score of the children. One additional year of
schooling for the mother and father results in an increase in HAZ score by 0.028 and 0.018 standard
deviations, respectively. The coefficient of the mother's education (0.028) is higher than that of the
father's education (0.018), confirming the importance of girls’ education in a developing country
like Bangladesh. The mother's age also affects the nutritional status of the child positively and sig-
nificantly. This is perhaps because mature mothers are more likely to give birth to healthy, strong
babies than young mothers in a country like Bangladesh where child marriage is still very common (as
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T A B L E 2 The effect of maternal work participation on child nutritional status
Models (1) (2) (3)
OLS FS 2SLS
Maternal work
Variables HAZ participation HAZ
Maternal work participation −0.052 (0.038) −0.592*** (0.217)
Child lives in urban −0.026 (0.040) −0.009 (0.013) −0.031 (0.042)
Child sex (male = 1) 0.003 (0.030) 0.002 (0.011) 0.003 (0.031)
Age of child (months) −0.083*** (0.004) 0.004*** (0.001) −0.081*** (0.004)
Age of child (months) squared 0.001*** (0.000) −0.000 (0.000) 0.001*** (0.000)
***
Birth order of child −0.029 (0.030) 0.043 (0.011) −0.011 (0.031)
* *
Household has radio or television 0.083 (0.044) −0.029 (0.016) 0.063 (0.046)
***
Household has flush toilet 0.169 (0.052) 0.003 (0.018) 0.173*** (0.054)
Time to get to water source (min) −0.002 (0.001) 0.001 (0.001) −0.001 (0.001)
***
Family size −0.000 (0.006) −0.008 (0.002) −0.004 (0.006)
Number of children −0.027 (0.035) −0.015 (0.012) −0.038 (0.036)
Poorer (reference: poorest) 0.195*** (0.046) 0.021 (0.018) 0.201*** (0.048)
Middle 0.162*** (0.055) 0.021 (0.020) 0.171*** (0.057)
***
Richer 0.239 (0.062) −0.022 (0.022) 0.233*** (0.064)
Richest 0.379*** (0.078) −0.092*** (0.028) 0.335*** (0.086)
Sex of household head (male = 1) −0.084 (0.054) −0.000 (0.019) −0.089 (0.056)
*** **
Mother's age (years) 0.019 (0.004) 0.003 (0.001) 0.021*** (0.004)
Mother's height (cm) 0.049*** (0.004) −0.001 (0.001) 0.049*** (0.004)
*** ***
Mother's education (years) 0.024 (0.006) 0.008 (0.002) 0.028*** (0.006)
Father's education (years) 0.021*** (0.005) −0.005*** (0.002) 0.018*** (0.005)
Instrument
Mother's premarital labor-force participation 0.281*** (0.023)
Constant −8.489*** (0.552) 0.037 (0.148) −8.769*** (0.534)
2
R 0.226 0.1059 0.196
First partial R2 0.029
First-stage F-statistic 110.251
First-stage F-test P- value <0.001
Endogeneity test P-value, Ho: exogenous 0.006
Notes: Robust standard errors clustered at the community level are provided in parentheses. All specifications include division
dummy.
FS, first stage; HAZ, height-for-age Z-score; OLS, ordinary least squares; 2SLS, two-stage least squares.
***p < .01; **p < .05; *p < .1.
observed in Table 1, the average age of mothers is 25.54 years in this study). The mother's height is
also found to have a positive and significant (coefficient, 0.049; standard error, 0.004) impact on the
child's nutritional status. The analysis finds large impacts of household wealth on the HAZ scores
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12 JAKARIA et al.
of children. The predicted HAZ difference between a child in the poorest household and the richest
household is 0.335 standard deviations. The children from households with flushing toilets have better
nutritional status than those from households without flushing toilets. In contrast, the analysis finds a
small but statistically insignificant impact of access to water on children's HAZ. This is potentially due
to the fact that in Bangladesh almost 99% of households have access to safe drinking water, with very
little variation, and Table 1 shows that it takes only 4.66 min on average to fetch safe drinking water
for the respondents of this study.
Children's nutritional status is also expressed in literature with WHZ score and sometimes with
WAZ score. While the WHZ score is a measure of short-term health phenomenon, the WAZ score is
a composite of the short-term and the long-term phenomena (WHO Multicentre Growth Reference
Study Group, 2006). Though the primary focus of this study is on the long-term effect of mater-
nal labor-force participation on child health, captured through children's HAZ score, we have also
estimated the effect of maternal employment on the other two measures of child nutrition. The es-
timated results (Table A1) show very similar findings to that presented in Table 2. From the IV
results in Table A1, the effect of maternal employment is negative and statistically significant for
WAZ (composite measure of both short-term and long-term health conditions) but not significant for
the WHZ (short term/acute health condition). The results, thus, confirm a negative effect of maternal
work on children's long-term nutrition level in the context of Bangladesh.
4.2 | Heterogeneity in maternal employment effects on child nutrition
The effects of maternal employment may vary across different groups of children, so this study sepa-
rately estimates regression models on different subgroups of children. Table 3 shows the results of
OLS, FS, and 2SLS estimates for different subsamples of children. The first row of Table 3 repeats
the main results based on the full sample for reference. The subsequent rows show the results for
disaggregate samples.
Previous literature (e.g., Brooks-Gunn et al., 2002; Gennetian et al., 2010) finds that boys suffer
more than girls from the changing condition of mothers’ work status. Waldfogel (2002) further notices
that the effect of maternal employment on children's nutritional status largely depends on the stages
of children's development. Therefore, in our analysis, we estimate the regression models separately
by child age and sex. The second set of rows in Table 3 shows the regression results for girls and boys
separately. The OLS estimates in column 1 suggest that the effect of maternal employment for girls
(coefficient, 0.00352; standard error, 0.0493) is positive but not significant, whereas the estimate for
boys (coefficient, −0.106; standard error, 0.0501) is significantly negative. However, IV estimates do
suggest that maternal employment impacts are negative and statistically significant for both girls and
boys, and though the coefficients are slightly higher for boys, the difference is not statistically sig-
nificant (coefficient, −0.645**; standard error, 0.310) than for girls (coefficient, −0.523*; standard
error, 0.303). Earlier research is more straightforward. For example, Morrill (2011) and Gennetian
et al. (2010) found that boys are more vulnerable than girls and therefore are more negatively affected
by mothers’ employment.
The third set of rows in Table 3 shows the maternal employment effects for children of two age
categories (0–23 and 24–59 months). The IV results suggest that maternal employment effects
are significantly negative for children of the older age group but are insignificant for the younger
age group (below 2 years). This is potentially due to the fact that very young children of working
mothers are provided with better alternative care, as the family members are more concerned at this
age (Morrill, 2011). The negative effects of maternal employment on child health are smaller in such
JAKARIA et al.
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T A B L E 3 Heterogeneous effects of maternal employment by child characteristics
(1) (2) (3)
Model OLS FS 2SLS
Maternal work
Dependent variables HAZ participation HAZ N Mean HAZ
*** ***
All children −0.052 (0.038) 0.281 (0.023) −0.592 (0.217) 7,886 −1.539 (0.016)
Child sex
Girls 0.004 (0.049) 0.286*** (0.033) −0.523* (0.303) 3,825 −1.533 (0.028)
** ***
Boys −0.106 (0.050) 0.279 (0.032) −0.645** (0.310) 4,061 −1.544 (0.027)
Child age
Child aged below −0.141** (0.063) 0.295*** (0.037) −0.520 (0.333) 3,006 −1.225 (0.029)
2 years
Child aged above −0.013 (0.043) 0.270*** (0.030) −0.539* (0.284) 3,006 −1.750 (0.027)
2 years
Birth order
Child first born −0.126** (0.058) 0.289*** (0.035) −0.920*** (0.337) 3,094 −1.439 (0.028)
***
Child not first born −0.020 (0.045) 0.269 (0.031) −0.372 (0.304) 4,792 −1.602 (0.026)
Number of siblings
Zero sibling −0.118** (0.060) 0.291*** (0.036) −0.714** (0.350) 2,450 −1.393 (0.0262)
One or more siblings −0.027 (0.044) 0.268 (0.031) −0.482 (0.296) 4,515 −1.619 (0.020)
Residence
Rural −0.027 (0.044) 0.283*** (0.033) −0.616** (0.285) 5,398 −1.628 (0.026)
Urban
−0.084 (0.071) 0.274*** (0.034) −0.564* (0.339) 2,488 −1.346 (0.041)
Mother's education
Primary or lower 0.004 (0.056) 0.263*** (0.036) −0.542 (0.365) 3,439 −1.855 (0.030)
**
Secondary or above −0.097 (0.048) 0.266*** (0.031) −0.782*** (0.296) 4,447 −1.2990.024
Socioeconomic status
Poor −0.027 (0.050) 0.316*** (0.039) −0.290 (0.307) 3,240 −1.835 (0.031)
Middle 0.102 (0.086) 0.177*** (0.065) −1.075 (0.972) 1,516 −1.592 (0.039)
*** *** **
Rich −0.162 (0.059) 0.291 (0.032) −0.659 (0.307) 3,130 −1.211 (0.031)
Notes: Robust standard errors clustered at the community level are provided in parentheses. All specifications include a full range of
child, mother, and family controls as well as division dummy controls as in Table 2.
***p < .01; **p < .05; *p < .1.
a situation. Simultaneously, working mothers are likely to return to their job and often for longer hours
when their children are older, affecting older children's health adversely.
Because parents’ time and resource allocation may vary with the birth of each child
(Monfardini & See, 2012), we estimate a model categorizing the children into two groups: first-born
and later-born children. The fourth set of rows in Table 3 shows the effect of maternal work partici-
pation on child nutrition, and the results are significantly negative for the first-born child but insig-
nificant for the later-born child. One explanation for this heterogeneity is that a mother with more
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14 JAKARIA et al.
than one child is experienced in arranging and providing alternative childcare and in handling health
concerns of the child compared to the first-born child's younger and inexperienced mother (Whiteman
et al., 2003).
This study also estimates the regression models by different fertility choices: decomposing the
sample by the number of living children in the family. In the fifth set of rows, the IV results show that
the effects of mothers’ labor-force participation on child health are negative and statistically significant
for single-child families, whereas the results are insignificant for multiple-children families. The re-
sults again indicate the vulnerability of the first/single child of the younger and inexperienced mother
compared to the children of mothers with experience.
The sixth set of rows in Table 3 shows the results for children of urban and rural mothers. The OLS
estimates suggest that maternal employment estimates for children of both urban and rural mothers are
statistically insignificant, but the IV results show that maternal employment significantly decreases
the HAZ score for children of both rural and urban mothers. It is also observed that the estimate for
children of rural mothers (coefficient, −0.616**; standard error, 0.285) is larger in magnitude than
that of urban mothers (coefficient, −0.564*; standard error, 0.339). This rural–urban difference may
indicate a lag in rural areas in terms of health and nutrition resources in Bangladesh (BBS, 2015), war-
ranting appropriate policy action.
There might also be heterogeneity of maternal employment effects on child nutrition by ma-
ternal education level. In the seventh set of rows in Table 3, the results are disaggregated by two
levels of maternal education: primary or lower and secondary or above. Both OLS and IV results
show that maternal employment estimates are negative and statistically significant for mothers
with a secondary-or above-level education but not statistically significant for mothers with a pri-
mary-or lower-education level. One reason for this is that women with a higher level of education
often engage in formal and full-time jobs, whereas women with a primary or lower level of edu-
cation usually work in informal sectors and on a part-time and/or seasonal basis. Such differences
in the nature of their jobs might be responsible for the negative effect on the children of working
mothers with a secondary-or above-level education. Speculatively, mothers with higher levels of
education often work in formal jobs that require longer working hours, meaning they have less
time to spend caring for their children and their children suffer because of it. However, this idea
is not directly testable in our analysis, since the detailed nature of maternal employment is not
available in the BDHS data set.
Another dimension along which maternal employment effect might be heterogeneous is mothers’
socioeconomic status. In this study, household assets and dwelling characteristics are used to proxy
for socioeconomic status of the family. Households are segregated into three broad categories: poor,
middle, and rich. In the eighth sets of rows in Table 3, both the OLS and IV results show that the
negative effects of maternal employment on child health are larger and statistically significant for
the mothers of rich families. This result is consistent with recent studies (Brooks-Gunn et al., 2002;
Ruhm, 2008) documenting severe negative consequences of maternal employment for children of
mothers with higher socioeconomic status. This potentially indicates that the positive income effect of
maternal employment on the poor-and middle-income groups is strong enough to cancel the negative
substitution effect. It seems plausible to assume that the income effect will be much stronger for the
income-poor households than for the richer households. On the contrary, the negative and significant
effects of maternal employment for the rich households indicate a stronger negative substitution effect
that outweighs the weaker positive income effect. Simultaneously, the effects imply that alternative
caregivers (e.g., domestic aid) of rich households are unable to fully compensate for maternal care of
the children.
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Following Diiro et al. (2017), the present study also employs quintile IV to explore whether moth-
ers’ work participation has heterogeneous effects on the distribution of the HAZ score of children. The
analysis estimates the coefficient of maternal employment on children's HAZ score across five quan-
tiles (10th, 25th, 50th, 75th, and 90th percentiles). Table 4 shows that the coefficients of maternal
employment, though in the same negative direction across all five quantiles, are statistically signifi-
cant only at the median (50th) and upper (75th) quantiles but insignificant for the rest of the distribu-
tion. The results indicate that the effect of maternal employment is significant for the children with
a median-and upper-level HAZ score. However, mothers’ work does not appear significant for the
lowest 25th and the highest level of the HAZ distribution.
The BDHS survey also questioned if the mothers were working seasonally or year-round. This
enables us to construct an index for seasonality and intensity of labor-force participation of moth-
ers, scoring 1–4 (no work = 1, work occasionally = 2, work seasonally = 3, and work all over the
year = 4). We then estimate the regression model using this variable, capturing maternal employ-
ment intensity and seasonality. The regression results, including seasonality in maternal employment,
are presented in Tables A2 and A3.
In Table A2, we consider maternal employment intensity as a continuous variable. The OLS results
show a negative relationship with child health (coefficient, −0.023*; standard error, 0.01), but the IV re-
sults show a significantly larger negative effect (coefficient, −0.202; standard error, 0.076), indicating that
each point increase in maternal work participation intensity is associated with a 20.2 percentage decrease
in the HAZ score. The FS results from the IV model here also confirm that our instrument predicts mater-
nal employment. The instrument is significant at the 1% level of significance, and the F-statistic from the
FS regression indicates that the instrument is strong enough from the statistical viewpoint.
Furthermore, we considered maternal employment as a categorical variable in which working moth-
ers are subgrouped into mothers working occasionally or seasonally and mothers working year-round,
with a reference group to nonworking mothers. The regression results show that the effect is negative
and statistically significant for mothers working year-round with coefficient −0.077* (standard error,
0.040) but is not significant for mothers who work occasionally or seasonally (see Table A3). One
might argue that, compared to mothers working occasionally or seasonally, mothers working year-
round have limited time to allocate for children's health, which has lasting negative effects. This is plau-
sible in a sense that the mothers working occasionally or seasonally likely get scope to child healthcare
when not working, which is unlikely the case for the mothers working year-round.
T A B L E 4 Heterogeneous effects of maternal employment on the distribution of HAZ of children
Model Instrumental variable quantile regression
Quantiles 10% 25% 50% 75% 90%

Variables
Maternal work −0.521 (0.456) −0.445 (0.305) −0.442* (0.232) −0.507** (0.252) −0.525 (0.346)
participation
Controls Yes Yes Yes Yes Yes
Observations 6,244 6,244 6,244 6,244 6,244
HAZ, height-for-age Z-score.
***p < .01; **p < .05; *p < .1.
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16 JAKARIA et al.
4.3 | Robustness check
The estimation strategy next explores the robustness of the main findings to different specifications

and alternative estimators. First, the study estimates models, including maternal body mass index
(BMI), as additional covariates because maternal nutritional status may affect children's growth in
their early years (Hasan et al., 2016; Subramanian et al., 2010). The results show that the coefficient
of maternal employment is substantially similar in magnitude and direction when maternal BMI is
added as a covariate (Table 5). The study also estimates models, including breastfeeding status (yes/
no) of children as a covariate because breastfeeding might influence mothers’ entry into the labor mar-
ket (Esterik & Greiner, 1981). The estimated results show that the coefficient of maternal employ-
ment is substantially similar in magnitude and direction with the inclusion of breastfeeding status
as an additional confounder (Table 5). Similarly, our empirical strategy controls for the presence of
child's father in the household. It is common, especially in rural Bangladesh, for a woman to raise chil-
dren alone while her husband migrates for work. The presence or absence of the father in the house-
hold can affect the decision of maternal employment and therefore the impact on children's health.
The results presented in Table 5 remain consistent, even when the regression models include the pres-
ence of the father in the household as an additional control.
Finally, as an additional robustness check, the study performs alternative IV estimators, limited
information maximum likelihood and generalized method of moments. These alternative estimators
produced results very similar to the 2SLS estimators (Table 6). These, in brief, indicate that the re-
gression results are robust to different alternative IV estimators.
5 | CO NC LUSION A N D P O L IC Y IM PLICATION
This study examines the effects of maternal employment on children's nutritional status using the
nationally representative BDHS data set. Most of the existing literature concerning maternal employ-
ment and children's nutritional status in developing countries simply reports a correlation between
maternal employment and child health. This study, after controlling a rich set of covariates, offers
unbiased and causal effects of maternal employment on children's health addressing endogeneity of
maternal employment by using the IV approach. The empirical evidence documents the detrimental
effects of maternal employment on the nutritional status of children aged below 5 years in this nation-
ally representative sample.
OLS results suggest that, after controlling for other covariates, maternal employment has a small
negative but insignificant effect on children's health outcomes, measured by the HAZ score. Since this
relationship might still occur due to unobserved characteristics, abilities, and preferences of mothers
and potential reverse causality between maternal employment and child health, it cannot be interpreted
as a causal relation. Therefore, to estimate the causal effect of maternal employment on child nutri-
tion, our analysis considers the endogeneity of maternal employment and employs the IV approach.
Unlike OLS estimates, the IV estimates show a significant negative effect of maternal employment
on child health. It is also observed that the IV estimates were larger than the OLS estimates, implying
that endogeneity of maternal employment biases the OLS results downward.
Our empirical analysis also explores the heterogeneity of maternal employment impacts on child
nutrition across various groups of children. The nutritional status of first-born children, children
aged above 2 years, single children, and children from rural areas is more negatively affected by
maternal participation in labor force than that of their counterparts. Further, the IV quintile regres-
sion results suggest that the negative effect of maternal employment is statistically significant for the
JAKARIA et al.
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T A B L E 5 Results of including additional covariates
Models (1) (2) (3)
OLS FS 2SLS
Maternal work
Dependent variable HAZ participation HAZ
***
Baseline controls −0.052 (0.038) 0.281 (0.023) −0.592*** (0.22)
2
R 0.226 0.1059 0.196
Baseline controls and mother's −0.035 (0.037) 0.279*** (0.024) −0.507** (0.217)
BMI
R2 0.239 0.1067 0.217
***
Baseline control and −0.054 (0.037) 0.282 (0.024) −0.575*** (0.22)
breastfeeding status
2
R 0.230 0.1061 0.203
***
Baseline control and presence of −0.041 (0.038) 0.275 (0.03) −0.542** (0.223)
father in household
2
R 0.228 0.1057 0.203
Notes: Robust standard errors clustered at the community level are provided in parentheses. Baseline controls include a full range of
BMI, body mass index; FS, first stage; HAZ, height-for-age Z-score; OLS, ordinary least squares; 2SLS, two-stage least squares.
***p < .01; **p < .05; *p < .1.
T A B L E 6 Results of alternative IV estimation strategies
(1) (2) (3) (4)
Model OLS 2SLS LIML GMM
Dependent variable HAZ HAZ HAZ HAZ

*** ***
Maternal work −0.052 (0.038) −0.592 (0.217) −0.592 (0.217) −0.592*** (0.217)
participation
Observations 6,347 6,244 6,244 6,244
R2 0.226 0.196 0.196 0.196
FS, first stage; GMM, generalized method of moments; HAZ, height-for-age Z-score; IV, instrumental variable; LIML, limited
information maximum likelihood; OLS, ordinary least squares; 2SLS, two-stage least squares.
***p < .01; **p < .05; *p < .1.
median-and upper-middle (50th and 75th percentiles) distribution of the HAZ score of children but

insignificant for the rest of the distribution. The main results are robust to different sample selection
criteria, specifications, and alternative estimators. The signs and magnitudes of the estimates are con-
sistent across all specifications and alternative estimators.
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18 JAKARIA et al.
In sum, the results of this study reveal, first, an adverse effect of maternal employment on child
nutrition in Bangladesh. The results are contrary to conventional wisdom and therefore warrant care-
ful policy consideration, because improved child health and increased participation of women in eco-
nomic activities are set as priority goals by the government of Bangladesh and by United Nations
agencies. The goals for Bangladesh include the SDGs (3 and 5 specifically). Our results, therefore,
suggest that policy makers must understand that strategies that enhance maternal labor-force partic-
ipation can be counterproductive, especially in terms of child health and nutrition, in the absence
of proper safeguards and caution. This is because whereas the income effect of maternal employment
is positive for children's well-being, the substitution effect due to the time constraint of working moth-
ers has a strong negative effect that can outweigh the positive income effect. The substitution effect
is negative as working mothers are getting less time, energy, and scope to take care of their children
after work. Policy makers must take necessary steps that can facilitate children's care while ensuring
appropriate workspaces to retain working mothers in the labor force.
Second, our results show that the effect of maternal work is most negative and significant for the
health of the children of young and inexperienced mothers compared to the children of mature moth-
ers. This is important considering that the country has long been struggling against child marriage.
It is reported that in Bangladesh as much as 59% of girls get married before their 18th birthday, and
among them about 22% get married before they turn 15. Bangladesh is the fourth highest in the world
in terms of child marriage and second highest in terms of the number of child brides, with a staggering
figure of 4.5 million (Girls Not Brides, 2020). Our findings, therefore, argue for appropriate action
from policy makers to prevent child marriage to boost children's health and nutrition.
Third, the empirical results of this study show that household assets and wealth can affect child
health significantly. The results show that the children of households with flushing toilets, a measure
to proxy for household wealth, have better nutritional status. In Bangladesh, about 6 million people
live in urban slums and about 75% families in these slums live in a single room without any assets or
wealth base (UNICEF, 2020). The condition is no better in the rural areas. This result calls for policy
makers to design specially tailored programs to improve the health of the children of poverty-stricken
households in the country.
Fourth, the study findings also document rural–urban differences in terms of children's health.
Though the effect of maternal employment is negative for both the rural and urban households, the
effect is stronger in the rural areas. This is important considering that the poverty rate in rural areas is
26.4%, and as much as 63.4% of the country's 168 million people still live in rural areas (MoF, 2018).
Policy makers, therefore, must enforce laws to protect children from rural backgrounds. The provision
of comprehensive child health services through union health centers and/or community health centers
can be a viable solution in this regard.
Fifth, formal, year-round jobs and higher level of education for working mothers are factors ob-
served in this study to have a greater adverse impact on child health than working mothers with a
lower level of education and informal jobs. This finding justifies the longstanding demand of women's
rights groups to set up childcare centers at every government and private office in the country. This
is important considering the fact that as much 77% of the employers in Bangladesh do not provide
childcare facilities at workplaces (The Business Standard, 2019). Ensuring quality day-care centers at
workplaces may be an effective solution for child malnutrition because adequate childcare alternatives
for working women can offset nutritional risks associated with maternal employment.
Finally, working mothers may benefit from opportunities for flexible working hours, including
part-time work, which is not widely practiced in Bangladesh at present. The provision of part-time
work could help working mothers to strategically balance their workload and child-rearing responsi-
bilities to ensure their children's health and well-being.
JAKARIA et al.
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19
It is important to note that stunting is a result of undernutrition or complex diseases at an early

age (Golden, 1994). As growth rate is fastest in the earliest years of life, nutritional deficiencies
in the early years can result in a steep decline in a child's growth (Shrimpton et al., 2001; Victora
et al., 2010). However, there is a possibility that the stunted children aged below 5 years can catch up
their potential growth later. In a pioneer study, Tanner (1978) argues that catch-up growth for stunted
children is possible and can occur in two ways. First, children can exhibit early, fast growth spurts that
make up the deficit quickly within a few years. Children in this scenario can maintain their growth
until their adult height is reached. Second, children can grow slowly for years but can continue grow-
ing even after their adolescent years. In this scenario, bone maturation of the child gets delayed to fa-
cilitate growth beyond the normal age. Hirvonen (2014) mentions that the catch-up growth for stunted
children is most likely to occur during puberty. Empirical research also finds evidence that effective
intervention can help make up for the growth faltering of children. For example, Hoare et al. (1996)
mention that a high-energy protein supplement taken for 14 days after diarrhea can overcome the
short-term growth delay of children resulting from diarrhea-induced dehydration and lead to catch-up
growth. Park et al. (2017) offer evidence that taking a zinc supplement for up to 6 months for stunted
children aged 4 months to 6 years can significantly contribute to catch-up growth. Such literature
presents compelling argument that catch-up growth is a real possibility for stunted children if proper
nutrition and medication are provided in time. It also indicates that policy makers have a certain scope
and role to play. They must act to overturn the downside of maternal employment on children's nutri-
tional status, as women's participation in the workforce is essential to promoting equality, eliminating
poverty, and empowering women in a developing country like Bangladesh.
It is undeniable that women comprise half the population, and according to SDG goal 5 a society can-
not progress leaving one-half of its citizens behind. However, the empirical findings of this paper warrant
that there should be appropriate policy action to harness the benefit of maternal employment in fostering
poverty alleviation and household well-being, including children's health, nutrition, and education.
ACK NOW L E D GME N TS
We thank Zahid Hussain, Shahadat Hossain Siddiquee, Nazneen Ahmed, Atonu Rabbani, and nu-
merous participants at BER International Conference for Economists 2019 held in the University
of Dhaka for helpful comment and discussion. We are very grateful to Orgul Ozturk, Amy Stokes,
Lindsay McManus, Rashid Sarker, Khalid Imran, Haimiti Aerfate, Idris Kambala, Mahyar Ibrahim,
and to three anonymous referees for their thoughtful feedback and suggestions. The authors also thank
to NIPROT and DHS program for providing access to the BDHS dataset. We are also thankful for
the constructive feedbacks from editor and the co-editor of the journal. All remaining errors are ours.
D EC LA R AT ION O F IN T E R E ST
None.
DATA AVAILABILIT Y STATEMENT

The authors have no objection to share their name, email address, affiliation, and other contact details
the publication might require to be used for the regular operations of the publication. This includes
sharing data with partners involved in the production and publication process of the manuscript.
However, the data should not be used for marketing purposes.
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20 JAKARIA et al.
ORCID
Rejaul Karim Bakshi https://orcid.org/0000-0001-6741-2761
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APPENDIX
T A B L E A 1 Regression results for alternative measures of child health (WAZ, WHZ)
(1) (2) (3)
Models OLS FS 2SLS

Panel A
Variables WAZ Maternal work WAZ
participation
Maternal work participation −0.0784** (0.0323) −0.478*** (0.181)
Instrument
Mother's premarital labor-force 0.281*** (0.0243)
participation
Constant −6.753*** (0.447) 0.119*** (0.157) −6.699*** (0.443)
R2 0.187 0.1059 0.165
First partial R2 0.0294
First-stage F-test P-value <0.001
Endogeneity test P-value, Ho: 0.021
exogenous
Panel B
Variables WHZ Maternal work WHZ
participation
Maternal work participation −0.0736** (0.0327) −0.139 (0.208)
Instrument
Mother's premarital labor-force 0.281*** (0.0243)
participation
Constant −2.306*** (0.404) 0.119*** (0.157) −2.295*** (0.407)
2
R 0.044 0.1059 0.044
2
First partial R 0.0294
Endogeneity test P-value, Ho: 0.071
exogenous
FS, first stage; OLS, ordinary least squares; 2SLS, two-stage least squares; WAZ, weight-for-age Z-score; WHZ, weight-for-height
Z-score.
***p < .01; **p < .05; *p < .1.
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T A B L E A 2 The effect of maternal work intensity on child nutritional status
(1) (2) (3)
Models OLS FS 2SLS
Variables HAZ Work intensity HAZ

Maternal work intensity −0.023* (0.01) −0.202*** (0.076)
Urban (yes = 1) −0.027 (0.04) −0.0585 (0.0371) −0.038 (0.042)
Child sex (male = 1) 0.005 (0.03) 0.002 (0.031) 0.003 (0.031)
Age of child (months) −0.083*** (0.004) 0.010*** (0.004) −0.081*** (0.004)
Age of child (months) 0.001*** (0.000) −0.000 (0.000) 0.001*** (0.000)
squared
Birth order of child −0.030 (0.031) 0.112*** (0.032) −0.015 (0.031)
* *
Household has radio or 0.085 (0.045) −0.087 (0.045) 0.065 (0.047)
television (yes = 1, no = 0)
Household has flush toilet 0.171*** (0.052) −0.021 (0.051) 0.169*** (0.054)
(yes = 1, no = 0)
Time to get to water source −0.002 (0.001) 0.002 (0.002) −0.001 (0.001)
***
Family size −0.000 (0.001) −0.022 (0.005) −0.003 (0.006)
Number of children −0.026 (0.036) −0.033 (0.034) −0.035 (0.036)
Poorer (reference: poorest) 0.196*** (0.046) 0.058 (0.052) 0.202*** (0.048)
***
Middle 0.161 (0.055) 0.082 (0.057) 0.175*** (0.057)
Richer 0.237*** (0.062) −0.031 (0.064) 0.238*** (0.064)
Richest 0.377*** (0.077) −0.206*** (0.080) 0.346*** (0.085)
Sex of household head −0.088 (0.054) 0.015 (0.054) −0.089 (0.056)
(male = 1)
Mother's age (years) 0.019*** (0.004) 0.010** (0.004) 0.022*** (0.004)
***
Mother's height 0.049 (0.004) −0.002 (0.003) 0.049*** (0.004)
Mother's education 0.024*** (0.006) 0.020*** (0.006) 0.028*** (0.006)
*** ***
Father's education 0.021 (0.005) −0.013 (0.005) 0.018*** (0.005)
Instrument
Mother's premarital labor- 0.797*** (0.068)
force participation (yes = 1,
no = 0)
Constant −8.504*** (0.552) 0.111 (0.429) −8.787*** (0.532)
2
R 0.226 0.1015 0.200
2
First partial R 0.0289
Endogeneity test P-value, 0.010
Ho: exogenous
***p < .01; **p < .05; *p < .1.
JAKARIA et al.
27
|
T A B L E A 3 The effect of seasonality in maternal employment on child nutritional status: OLS regression
Dependent variable: height-
Variables for-age Z-score
Seasonally or occasionally employed (reference = not employed) 0.121 (0.082)
Employed round the year −0.077* (0.040)
Urban (yes = 1) −0.030 (0.040)
Child sex (male = 1) 0.004 (0.030)
Age of child (months) −0.083*** (0.004)
Age of child (months) squared 0.001*** (0.000)
Birth order of child −0.032 (0.031)
Household has radio or television (yes = 1, no = 0) 0.084* (0.044)
Household has flush toilet (yes = 1, no = 0) 0.169*** (0.052)
Time to get to water source −0.002 (0.001)
Family size 0.000 (0.006)
Number of children −0.025 (0.035)
Poorer (reference: poorest) 0.196*** (0.046)
Middle 0.164*** (0.055)
Richer 0.240*** (0.062)
Richest 0.383*** (0.078)
Sex of household head (male = 1) −0.087 (0.054)
Mother's age (years) 0.019*** (0.004)
Mother's height 0.049*** (0.004)
Mother's education 0.024*** (0.006)
Father's education 0.021*** (0.005)
Constant −8.536*** (0.545)
Observations 6,338
2
R 0.227
Notes: Robust standard errors clustered at the community level are provided in parentheses. All specifications include division
dummy.
OLS, ordinary least squares.
***p < .01; **p < .05; *p < .10.

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Received: 25 June 2019

| Revised: 15 February 2021

Is maternal employment detrimental to children’s

Mohammad Jakaria1,2 | Rejaul Karim Bakshi3 | M. Mehedi Hasan4

Rev Dev Econ. 2021;00:1–27. wileyonlinelibrary.com/journal/rode |

Studies associating maternal employment with child health and nutrition are often characterized by

3 | DATA , E MP IR ICA L ST R AT EGY, AND VARIABLES

3.1 | Data and sample

3.2 | Empirical strategy

CHi = 𝛼 + 𝛽MEi + 𝛾Xi + 𝜀i (1)

First stage: MEi = 𝛼 FS + 𝛽 FS Zi + 𝛾 FS Xi + 𝜇 i (2)

Second stage: CHi = 𝛼 IV + 𝛽 IV MEi + 𝛾Xi + 𝜀i (3)

3.3 | Outcome variable: Children's nutritional status

3.4 | Key explanatory variable: Maternal employment

3.5 | IV: Mothers’ premarital labor-­force participation

3.6 | Control variables

The regression model controls for a set of exogenous variables (Xi) that include child characteristics

4.1 | Main results

Characteristics Mean Mean Mean Difference

Characteristics Mean Mean Mean Difference

Models (1) (2) (3)

4.2 | Heterogeneity in maternal employment effects on child nutrition

(1) (2) (3)

Model OLS FS 2SLS

T A B L E 4 Heterogeneous effects of maternal employment on the distribution of HAZ of children

Model Instrumental variable quantile regression

Quantiles 10% 25% 50% 75% 90%

4.3 | Robustness check

The estimation strategy next explores the robustness of the main findings to different specifications

Models (1) (2) (3)

T A B L E 6 Results of alternative IV estimation strategies

(1) (2) (3) (4)

Model OLS 2SLS LIML GMM

Dependent variable HAZ HAZ HAZ HAZ

median-­and upper-­middle (50th and 75th percentiles) distribution of the HAZ score of children but

It is important to note that stunting is a result of undernutrition or complex diseases at an early

ACK NOW L E D GME N TS

DATA AVAILABILIT Y STATEMENT

T A B L E A 1 Regression results for alternative measures of child health (WAZ, WHZ)

(1) (2) (3)

Models OLS FS 2SLS

T A B L E A 2 The effect of maternal work intensity on child nutritional status

(1) (2) (3)

Models OLS FS 2SLS

Variables HAZ Work intensity HAZ

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3.5 | IV: Mothers’ premarital labor-force participation

median-and upper-middle (50th and 75th percentiles) distribution of the HAZ score of children but