Water scarcity and birth outcomes in the Brazilian semiarid

Roughly one-third of the rural population in developing countries lives in arid and semiarid regions, facing recurrent water scarcity. This is likely to become an even more common situation with climate change. This paper analyzes the impact of rainfall fluctuations during the gestational period on health at birth in the Brazilian semiarid, highlighting the role of water scarcity as a determinant of early life health. We find that negative rainfall shocks are robustly correlated with higher infant mortality, lower birth weight and shorter gestation periods. Mortality effects are concentrated on intestinal infections and malnutrition, and are greatly minimized when the local public health infrastructure is sufficiently developed (municipality coverage of piped water and sanitation). We also find that effects are stronger during the fetal period (2nd trimester of gestation), for children born during the dry season, and for mortality immediately after birth. Our estimates suggest that expansions in public health infrastructure would be a cost-effective way of reducing the response of infant mortality to rainfall scarcity. (C) 2014 Elsevier B.V. All rights reserved.