Ethnoracial child health inequalities in Latin America: Multilevel evidence from Bolivia, Colombia, Guatemala, and Peru

Using Demographic and Health Survey (DHS) data for Bolivia, Colombia, Guatemala, and Peru, between 1986 and 2015, this paper explores the relationship between self-identifying as indigenous and/or afro-descendant on child under-5 mortality (n=20,770), stunting (n=15,828), wasting (n=15,827), and anemia (n=13,294). Rural-urban risk analysis suggest that indigenous and/or afro-descendent respondents have higher risk of under-5 mortality, stunting, wasting, and anemia. The same pattern is observed for cross-country risks, particularly for Bolivia and Colombia. Results from logistic multilevel regression models suggest that, even after controlling for geographic, socioeconomic, individual, reproductive, healthcare, and nutritional variables, self-identifying as indigenous and/or afro-descendant is associated with a higher risk of child stunting and wasting, but not necessarily a higher risk of under-5 mortality and anemia. While previous research has largely focused on the protective role of maternal education, results from this study suggest that paternal education, as well as, individual characteristics and early reproductive decisions, play a significant role in child health outcomes. My findings imply that efforts to improve child health in Latin America should account for ethnicity and/or race, since minority ethnoracial groups have higher risk of childhood morbidity in the region. In addition, these efforts should accompany education for both men and women, as well as, information about the effects of reproductive decisions on their children's health.