Echo Effects of Health Shocks: The Intergenerational Consequences of Prenatal and Early-Life Malnutrition during the Great Leap Forward Famine in China

Relatively few studies have examined the ‘echo effect’ of health shocks related to prenatal and early-life malnutrition, that is, whether the legacy of such shocks is transmitted to the next generation. This study addresses this gap by leveraging extreme malnutrition during the Great Leap Forward famine in China, and by examining its intergenerational consequences. Using a difference-in-differences framework, we estimate the effect of the famine on a wide range of outcomes of children of mothers who were exposed in-utero and in early-life including income, education, and employment, indicators that have not been considered in detail before. Using a refined measure of famine exposure at the prefecture level in rural areas, and by exploiting rich data on those directly affected and their children, we find that on average, the famine had negative echo effects on second-generation outcomes. These echo effects are primarily due to adverse impacts on daughters. Mechanisms include impacts of the famine on the human capital of mothers, and suggestive evidence of son preference. Our results withstand a battery of robustness, specification and falsification checks.