Research
Published papers
Public Policies and Femicides during the COVID-19 Pandemic: Evidence from São Paulo, Brazil (with Fabiana Rocha, Dolores Montoya Montoya Diaz, Paula Pereda, Isadora Bousquat Arabe, Pedro A.C. Oliveira, Noemi Kreif, and Rodrigo Moreno-Serra)
[September 2025], Economics & Human Biology
Abstract
With the outbreak of the COVID-19 pandemic in early 2020, concerns arose that stay-at-home policies could exacerbate Violence Against Women (VAW). Evidence shows an increase in calls to domestic violence helplines in several countries. However, limited economic studies have investigated the pandemic’s effects on femicides, the most extreme form of VAW. This paper examines the effects of social isolation measures and emergency aid policies implemented during the COVID-19 outbreak on femicides in São Paulo, Brazil. Using daily femicide data from 2016 to 2020, a social isolation index, and monthly employment and emergency cash transfer data, we estimate fixed-effects models. Our findings reveal that the probability of femicide more than doubled (0.32 p.p.) during periods of pronounced isolation (March-April 2020). The impact was more significant in poorer municipalities, where male job losses drove this increase. However, the provision of emergency aid in poorer areas, which covered 29.8% of the population in these areas, mitigated this harmful effect, reducing it by more than twice the magnitude of the employment shock. These results underline the interplay between economic conditions, social policies, and gender-based violence during crises.Ripe for Better Post-War Governance? The impact of the 2016 peace agreement on the reestablishment of health services in Colombia (with Nina Caspersen, Urban Jakša and Rodrigo Moreno-Serra)
[May 2024], Political Geography [ Paper | Replication code ]
Abstract
The signing of a peace agreement represents a chance for the state to renew its social contract with the population in conflict-affected areas, by providing protection and other public goods. Failing to meet post-war expectations of a better quality of life risks endangering the negotiated peace. However, in the existing literature there is a lack of focus on post-war public services and very little analysis of challenges to reestablishing effective state governance, especially in areas with significant rebel presence. Much of the literature still assumes that conflict zones are ripe for better governance and the post-war impact of rebel governance remains largely unanalysed. Drawing on original survey data, interviews and focus groups, this mixed-methods article analyses the impact of the 2016 Colombian peace agreement on health services in areas with high conflict intensity and sustained rebel presence. It finds an increase in demand for services but without a corresponding improvement in the perceived quality. In fact, in municipalities that host FARC reintegration camps we find a decline in both demand and quality. Three obstacles are identified: 1) a delay in establishing effective state presence, 2) favourable views of wartime healthcare provided by the rebels, 3) high expectations and mistrust of government provisions. The article demonstrates the considerable difficulty of re-establishing effective post-war governance, the importance of local expectations and trust, and the lasting impact of wartime rebel governance. It thereby makes an original and important contribution to the understanding of peacebuilding obstacles and to the growing literature on rebel governance.Natural Disasters and Local Government Finance: Evidence from Typhoon Haiyan (with Jose Corpuz, and Joseph Capuno)
[April 2024], Journal of Economic Behavior and Organization [ Paper ]
Abstract
This paper examines how natural disasters affect local public finances and their interplay with intergovernmental transfers and external resources. Exploiting the randomized nature of the 2013 Typhoon Haiyan, one of the most devastating natural disasters in recent history, we document its causal effect on the local government fiscal dynamics. Combining data on local government finance with reports on the level of damages and using difference-in-differences with instrumental variable to analyze the data, we show that local public revenue and expenditures remain largely unaffected, except for debt payments. However, we find important heterogeneity in local revenue responses: poorer cities and municipalities raised comparatively lower revenue in the aftermath of the Typhoon. We also provide evidence that external funding did not lead to lower tax collection efforts, but instead leads to higher local expenditures, suggesting that disaster aid does not cause a moral hazard problem in local governments' spending decisions.Public Healthcare Financing during Counterinsurgency Efforts: Evidence from Colombia (with Rodrigo Moreno-Serra, and Noemi Kreif)
[February 2024], Oxford Bulletin of Economics and Statistics [ Paper ]
Abstract
How do government counterinsurgency efforts affect local public health financing during civil conflicts? We investigate this question in the context of the protracted conflict in Colombia. Using data on antinarcotics operations and health transfers from the central government to municipal governments, we employ both panel estimations and an instrumental variable to address concerns of endogeneity. We first show evidence of a government discretionary power over the allocation of health transfers. We do not find evidence that counterinsurgency operations causally affect health transfers to municipalities. Our results rule out political alignment between mayors and the national governing party as an intermediary factor that could influence the flow of fiscal transfers in municipalities exposed to the conflict.COVID-19 and violence against women: current knowledge, gaps, and implications for public policy (with Fabiana Rocha, Dolores Montoya Montoya Diaz, Paula Pereda, Isadora Bousquat Arabe, Filipe Cavalcanti, Noemi Kreif, and Rodrigo Moreno-Serra)
[February 2024] , World Development [ Paper ]
Abstract
On a global scale, 1 in 3 women experience physical and/or sexual violence in their lifetime, and women of disadvantaged backgrounds are at an even higher risk. Since the outbreak of COVID-19, data have shown that violence against women (VAW) has intensified. In this paper, we review an incipient but rapidly growing literature that evaluates the effects of stay-at-home measures to reduce the spread of COVID-19 on VAW. We focus on low and middle-income countries and classify existing studies into three categories according to the quality of the data used and the reliability of the empirical methodology: not causal, less causal, and causal. Overall, the most rigorous literature for low- and middle-income countries offers mixed evidence about the VAW effects of stay-at-home measures, although increases in VAW have been more frequently observed where stay-at-home measures were stricter. Important reasons for the mixed evidence found in the literature seem to be the different types of violence analyzed (physical, sexual, psychological, or economic) and the difficulties associated with the reporting of these types of VAW. The main methodological challenges faced by this literature relate to data availability and the reliability of the methods employed to separate the effects of social isolation on VAW, from those VAW effects associated with the income and emotional shocks induced by the COVID-19 pandemic. Innovative methods and data can help improve our understanding of the unintended VAW consequences of movement restrictions, including its key pathways, so as to reliably inform the design of better policy responses to this major social and public health challenge.Does Aid for Malaria Increase with Exposure to Malaria Risk? Evidence from Mining Sites in the D.R.Congo
[January 2022], Oxford Bulletin of Economics and Statistics [ Paper ]
Abstract
I examine the ability of donors to target the highest exposure to malaria risk when the health information structure is fragmented. I exploit local variations in the risk of malaria transmission induced by mining activities in the Democratic Republic of Congo as well as financial and epidemiological data from health facilities to estimate how local aid is matching the local malaria burden. Using fine-grained data on mines and health infrastructure in a regression discontinuity design, I find no evidence that local populations exposed to the highest risk of malaria transmission receive a proportionately higher share of aid compared to neighbouring areas with reduced exposure to malaria risk.International Geneva Award: Best paper published on a subject related to international studies
Working papers
Where the money flows? Colonial health investment and hospital contemporary outcomes in the D.R.Congo
[Updated, September 2025]
Abstract
This paper examines how the historical development of health institutions shapes contemporary disparities in hospital financing and service provision. Using archival records from the Belgian Congo (1929–1959), we trace the establishment of colonial health settlements and link them to present-day hospitals. Exploiting historical variation driven by sleeping sickness prevalence, we show that colonial origins exert a persistent impact on infrastructure, largely through large colonial health investments. While service provision differences disappear once accounting for staffing, hospitals with colonial roots continue to attract greater government funding, reflecting legacies of post-independence donor support that reinforced their bargaining power and fiscal advantage.Worldwide Child Stunting since the Nineteenth Century (with Eric B. Schneider, and 40 academic collaborators)
[Updated, November 2023]
Abstract
Background: Child stunting is a major global health concern with 148.1 million children stunted in 2022. Global child stunting rates have fallen from 47.2% in 1985 to 22.3% in 2022, but trends before the mid 1980s are unclear including whether child stunting was prevalent in the past in current high-income countries (HICs).Methods: We conducted a systematic review of child growth studies carried out before 1990 to reconstruct historical child stunting rates. The inclusion criteria were numerical reports of mean height by age and sex for children under age 10.99. We excluded studies that were not representative of the targeted population and data for children under age two so that estimates would be comparable across time and space. Stunting rates were computed by converting the means and sds of height to height-for-age Z-scores (HAZ) using the WHO standard/reference, combining the HAZ distributions at each age, and measuring the share of the combined distribution below the stunting threshold.
Findings: We found 930 historical child growth studies allowing child stunting rates to be computed for 122 countries. We supplemented these historical studies with the over age 2 stunting estimates from the Joint Malnutrition Estimates adding another 1051 studies. Many current HICs had high levels of child stunting in the early twentieth century similar to low- and middle-income countries (LMICs) today. However, stunting rates were unusually low in Scandinavia, the European settler colonies and in the Caribbean. Interpretation: Child stunting has declined in most parts of the world across the twentieth century, suggesting that the global child stunting rate would have been significantly higher in the past and that the eradication of child stunting was an essential part of the health transition. The high stunting rates in HICs in the past and their subsequent eradication of stunting suggests that eradicating child stunting is possible in all LMICs and that current HICs could provide clues for eliminating stunting.
The Impact of Mental Health Status on Economic Outcomes: Evidence from the MIND-ECON trial in South Africa (with Nikita Jacob, Susan Cleary, Rowena Jacobs, Noemi Kreif, Vimbayi Mutyambizi-Mafunda, Bronwyn Myers and Marc Suhrcke)
[Updated, March 2025]
Abstract
For low- and middle-income countries (LMICs), there is scarce evidence on the relationship between mental disorders and economic outcomes, including income, poverty risk and labour market performance. By leveraging exogenous variation induced by a mental health intervention, this paper explores the impact of depression on employment, income, expenditure, and out-of-pocket payments for healthcare in South Africa. The econometric approach uses the randomized intervention as an instrumental variable for the change in mental health and utilises a panel data structure with a long 24-month follow-up survey. Building on the estimated beneficial impact of the mental health intervention on depression severity, our findings suggest that observed changes in mental health within the considered time period can substantially improve economic outcomes for the population under study. The study contributes to informed decision-making regarding investment in mental health interventions, particularly in resource-constrained settings, such as LMICs.Choosing coverage, using care: Disentangling direct and indirect effects of premium subsidies on healthcare demand (with Noel Ackermann, and Stefan Boes)
[Updated, October 2025]