#186 – Dean Spears on why babies are born small in Uttar Pradesh, and how to save their lives

80,000 Hours Podcast

"I work in a place called Uttar Pradesh, which is a state in India with 240 million people. One in every 33 people in the whole world lives in Uttar Pradesh. It would be the fifth largest country if it were its own country. And if it were its own country, you’d probably know about its human development challenges, because it would have the highest neonatal mortality rate of any country except for South Sudan and Pakistan. Forty percent of children there are stunted. Only two-thirds of women are literate. So Uttar Pradesh is a place where there are lots of health challenges.

"And then even within that, we’re working in a district called Bahraich, where about 4 million people live. So even that district of Uttar Pradesh is the size of a country, and if it were its own country, it would have a higher neonatal mortality rate than any other country. In other words, babies born in Bahraich district are more likely to die in their first month of life than babies born in any country around the world." — Dean Spears

In today’s episode, host Luisa Rodriguez speaks to Dean Spears — associate professor of economics at the University of Texas at Austin and founding director of r.i.c.e. — about his experience implementing a surprisingly low-tech but highly cost-effective kangaroo mother care programme in Uttar Pradesh, India to save the lives of vulnerable newborn infants.

Links to learn more, highlights, and full transcript.

They cover:

• The shockingly high neonatal mortality rates in Uttar Pradesh, India, and how social inequality and gender dynamics contribute to poor health outcomes for both mothers and babies.
• The remarkable benefits for vulnerable newborns that come from skin-to-skin contact and breastfeeding support.
• The challenges and opportunities that come with working with a government hospital to implement new, evidence-based programmes.
• How the currently small programme might be scaled up to save more newborns’ lives in other regions of Uttar Pradesh and beyond.
• How targeted health interventions stack up against direct cash transfers.
• Plus, a sneak peak into Dean’s new book, which explores the looming global population peak that’s expected around 2080, and the consequences of global depopulation.
• And much more.

Chapters:

• Why is low birthweight a major problem in Uttar Pradesh? (00:02:45)
• Neonatal mortality and maternal health in Uttar Pradesh (00:06:10)
• Kangaroo mother care (00:12:08)
• What would happen without this intervention? (00:16:07)
• Evidence of KMC’s effectiveness (00:18:15)
• Longer-term outcomes (00:32:14)
• GiveWell’s support and implementation challenges (00:41:13)
• How can KMC be so cost effective? (00:52:38)
• Programme evaluation (00:57:21)
• Is KMC is better than direct cash transfers? (00:59:12)
• Expanding the programme and what skills are needed (01:01:29)
• Fertility and population decline (01:07:28)
• What advice Dean would give his younger self (01:16:09)

Producer and editor: Keiran Harris
Audio engineering lead: Ben Cordell
Technical editing: Simon Monsour, Milo McGuire, and Dominic Armstrong
Additional content editing: Katy Moore and Luisa Rodriguez
Transcriptions: Katy Moore