Projects
Below are links to some of my current and past research projects.
Current projects
Examining the role of discrimination in restricting women’s labor force participation in India
(with Arijit Nandi, Anoushaka Chandrashekar, Rosa Abraham, Nick King, Rahul Lahoti, and Anup Roy)
The objective of this project in the longer term is to estimate the impact of gender discrimination on hiring behavior in India. Using an experimental “correspondence study” approach that submits applications from fictitious candidates for positions advertised in India’s largest cities, we will examine the magnitude of gender discrimination, measured by the gender difference in “callback” rates, and if this varies based on the characteristics of the applicant (e.g., age, occupation) or the employer/job (e.g., part-time vs. full-time work, industry, number of employees). Additionally, we will assess if the degree of gender discrimination in callbacks is greater for women of child-bearing age or with a pre-primary school-aged child, depending on whether the prospective employer is subject to providing benefits as stipulated by the 2017 Amendment to the Indian Maternity Benefit Act.
Early Childhood Education Policies and Child Health
(with Arijit Nandi, Emis Akbari, Jody Heymann, and Linda White)
This project aims to investigate how Early Childhood Education and Care (ECEC) programs have evolved over time in the United States and how these policies affect children’s cognitive and non-cognitive skills, health, and well-being.
The project’s main objectives are to:
- Create a free and publicly-available longitudinal database of state-level ECEC policies and programmatic features, including those regulating access to and quality of state-funded programs, from 1995 to present;
- Estimate the impact of specific state ECEC reforms on the development of children’s cognitive and non-cognitive skills, health, and well-being, as well as heterogeneous effects by children’s gender, race/ethnicity, and socioeconomic position; and
- Estimate the effect of children’s participation in ECEC on the development of cognitive and non-cognitive skills, health, and well-being, as well as heterogeneous effects by gender, race/ethnicity, and socioeconomic position.
Beijing Houshold Energy Transitions [BHET]
(with Jill Baumgartner)
Air pollution is a leading public health problem. Over 400 million Chinese homes burn coal to meet their indoor space heating needs, leading to high levels of air pollution and health impacts in adults and children. Coal burning in China also contributes to poor air quality and mercury contamination in Canada. This project will assess how transitioning away from coal and introducing new clean heating technology in China will impact the health and environment of people who live in homes impacted by policy changes.
Funding: Canadian Institutes for Health Research
Antenatal Steroids and Child Health
(with Jennifer Hutcheon and Erin Strumpf)
RATIONALE: Randomized clinical trials have consistently shown that administering antenatal corticosteroids to pregnant women at risk of preterm delivery can reduce neonatal mortality, respiratory morbidity, and other adverse birth outcomes. Yet, use of this proven treatment remains sub-optimal in Canadian clinical practice, with as many as 40% of eligible preterm births at 24-33 weeks’ gestation not receiving antenatal corticosteroids as recommended in Canadian and international practice guidelines.
One important factor contributing to low antenatal corticosteroids use is the lack of rigorous data on their longer-term safety for child health. There is no clear evidence of adverse effects, but signals of harm from selected animal and human studies have created concerns that antenatal corticosteroids may impair child neurodevelopment. However, all of these studies are low quality. Follow-up studies of randomized trials were hampered by low follow-up rates and small sample sizes, and observational studies were highly susceptible to confounding. High-quality evidence on the longer-term safety of antenatal corticosteroids for child neurodevelopment is critical for optimizing use of this medication.
When randomization is infeasible, regression discontinuity studies can provide evidence on the causal effects of a drug or exposure. The design exploits differences in clinical care among individuals immediately on either side of a clinical or policy cut-point as a pseudo-randomization tool. With antenatal corticosteroids, clinical practice guidelines recommend administration up to 33+6 weeks’ gestation (33 weeks, 6 days) – but not one day later, at 34+0 weeks. This (somewhat) arbitrary cut-off means that infants born as little as hours apart have substantially different chances of receiving this effective treatment. Using preliminary data from over 8500 preterm births in British Columbia, we have shown that regression discontinuity analysis can replicate the clinical trial findings on short-term neonatal respiratory morbidity. We propose to now link our cohort with child development outcomes, and use this novel design to generate rigorous evidence on the longer-term safety of antenatal steroids.
OBJECTIVE: To determine if antenatal corticosteroid administration decreases kindergarten child development scores (primary outcome) or increases risks of adverse neurodevelopmental outcomes such cerebral palsy or attention deficit hyperactivity disorder (ADHD).
APPROACH: We will use a population-based cohort of 12,653 preterm births from British Columbia, Canada, 2000-2013. Obstetrical and neonatal medical records contained in the BC Perinatal Data Registry will be linked with provincial school child development assessments, hospitalization, prescription, and physician visit data. Our primary outcome will be child development scores based on the Early Development Instrument, a validated tool routinely administered by kindergarten teachers across Canada and internationally. International classification of diseases codes and prescriptions will be used to identify our secondary outcomes of cerebral palsy and ADHD. We will use a regression discontinuity design to estimate the effect of antenatal corticosteroids on outcomes among infants born on either side of the 34+0 weeks’ cut-point within a narrow gestational age window.
PUBLIC HEALTH IMPORTANCE: Preterm birth is the single most important cause of neonatal mortality and severe morbidity in Canada, and costs the Canadian health care system over $8 billion per year. Antenatal corticosteroids can reduce this burden of disease by 30% for as low as $1 per dose, but the unknown potential for longer-term harm hinders their use in clinical practice. Our findings will inform evidence-based Canadian clinical practice guidelines that address the potential longer-term harms associated with antenatal corticosteroids. This will enable physicians to optimize use of this treatment with proven neonatal benefits that may currently be being avoided unnecessarily.
Funding: Canadian Institutes for Health Research
Past projects
Affordable Daycare To Empower Indian Women
(with Arijit Nandi)
There are structural barriers to women’s empowerment in India. Among these barriers is the lack of affordable and reliable day-care services. The responsibility of providing childcare is imposed primarily on women and contributes to gender inequalities experienced by women over the life-course. The provision of affordable and reliable day-care services is a potentially important policy lever for empowering Indian women. Access to day-care might reduce barriers to labor force entry and generate economic opportunities for women. However, empirical evidence concerning the effects of day-care programs in low-and-middle-income countries is scarce. We propose a cluster-randomized impact evaluation for estimating the effect of a community-based day-care program on empowerment, economic opportunity, and health among mothers living in rural Rajasthan, India. This interdisciplinary research initiative will address an important research gap and has the potential to inform policies for improving the day-care system in India in ways that promote inclusive economic growth.
Funding: International Development Research Centre
The video below provides some additional details about the project and some essential context for where this work is being done.
Tabora Newborn and Maternal Health Initiative
(with Arijit Nandi, Ifakara Health Institute, CARE Canada)
We are monitoring and evaluating a health systems strengthening program being implemented by CARE Canada, in partnership with the Society of Obstetricians and Gynaecologists of Canada (SOGC) and the Canadian Society for International Health (CSIH), in the Tabora region of Tanzania. The aim of this program is to reduce maternal and newborn mortality and morbidity by improving the availability of quality maternal and newborn healthcare services. Activities include: training and mentoring of Regional and District Council Health Management Teams (R/CHMTs) in data management and usage, supply chain management, budgeting and leadership; development of an emergency transportation system; refurbishing health centre and hospital maternity wards and procuring Basic Emergency Obstetric and Newborn CARE (BEmONC) and Comprehensive Emergency Obstetric and Newborn CARE (CEmONC) equipment; training and mentoring of health care workers (HCWs) on BEmONC, CEmONC and family planning; and training and support of Community Health Workers (CHWs) to deliver quality maternal and newborn health education and promote utilization of health care services. We will be assessing the program’s impacts by integrating monitoring and evaluation with the delivery of interventions using a randomized phase-in or “stepped wedge” design.
Funding: Global Affairs Canada