Assessing the impact of in utero exposure to famine on fecundity: evidence from the 1959-61 famine in China.Popul Stud (Camb). 2013; 67(3):293-308.PS
This study identifies a significant increase in sterility among rural, but not urban, Chinese women who were conceived and born during the 1959-61 famine that resulted from the Great Leap Forward. Applied to data from two large-scale, nationally representative, sample surveys of Chinese women of childbearing age conducted in 1997 and 2001 by the State Family Planning Commission, difference-in-differences analysis revealed that exposure to the famine while in the womb caused an increase in the risk of sterility amongst the adult women surveyed of 1.1 per cent. This is a substantial increase given that the overall prevalence of primary and permanent sterility is only slightly over 1 per cent in China. These findings support the hypothesis that a woman exposed to acute malnutrition while in the womb may experience a long-term negative impact on her reproductive system, which could result in permanently impaired fecundity.