# _4.2.3.2 Health_

**The health benefits of electricity stem from cleaner air, reduced risk of burns, fires, and accidents, better nutrition and food safety from refrigeration, and improved health knowledge from access to mass media.**

Having electricity in the home can positively impact health through (a) cleaner air (Pokhrel et al. 2010; ADB 2010) and reduced risk of burns and accidental fires (Peck et al. 2008) from kerosene as well as other liquid fuels and candles used for lighting; (b) fewer accidents (e.g., cuts and burns) due to improved lighting; (c) better nutrition and food safety due to refrigeration of food; and (d) improved health knowledge through better access to mass media and more time to read (IEG 2008). While these benefits surely accrue to women because they spend time in the home, there is little empirical evidence that women benefit significantly more than men. The most suggestive evidence is (i) the persistent finding that electricity is associated with reduced use of fuelwood for cooking (with health impacts, as discussed in section 3), and (ii) impacts on reproductive and maternal health and fertility, which is gender-differentiated by definition.

# _4.2.3.3 Fuelwood use_

**A number of studies have found that electricity is associated with reduced use of fuelwood, whether measured as time collecting fuelwood or choice of cooking technology, although the reason therefore is far from obvious and rival explanations are possible (e.g., Heltberg 2004, Barnes and Sen 2003, Barnes et al. 2004, ADB 2010, Grogan 2011).**

In some cases, the link between electricity and reduced use of fuelwood may be because households adopt electricity for at least some of their cooking needs. For example, Dinkelman (forthcoming) finds that the introduction of electricity in a community decreases the proportion of households using wood as their main cooking fuel by 27 percentage points, while cooking with electricity increases by 23 percentage points, in rural KwaZulu-Natal in South Africa.<sup>43</sup> This average effect is largely a result of fuel-switching by households in the second and third richest quintiles, who can afford complementary investments in new appliances and to pay electricity bills. More commonly, access to electricity is associated with switching to modern cooking fuels and technology other than electricity. For example, Grogan and Sadanand (2011 and 2010) cross-tabulate household electrification and gas or propane for cooking in Nicaragua and Guatemala. In Nicaragua, they find that within income quintiles, electrified households are much more likely to cook with gas in both 1993 and 2005. The same pattern holds in Guatemala, although they report only a simple cross-tabulation with no covariates.

With few exceptions (such as Bhutan, Nambia, South Africa), electricity is not used for cooking in developing countries (IEG 2008; Barnes et al. 2009). Thus, the correlation between electricity and reduced fuelwood use may, possibly, reflect omitted variables that drive placement of electricity projects and household connection decisions. For example, Barnes et al. (2004) speculate that ―one possible explanation is that access proxies for market development. In that case, fewer barriers would constrain other modern fuels in cities where electricity is available.‖ However, they also lay out a possible causal chain: ―availability of lighting and other appliances spurs people to a greater acceptance of modernity and modern fuels.‖ ESMAP (2004) suggests another possibility: ―households with electricity might possibly be able to cook the evening meal just before it is consumed. With the exception of fresh breads and rice, households without electricity often prepare the evening meal during the daylight hours and then reheat it in the evening.‖ This debate has not been resolved, as the

> 43 Dinkelman (forthcoming) using land gradient to instrument for electrification, and includes as covariates household density; fraction of households living below a poverty line; distances to the grid, road and town; fraction of adults that are white or Indian to proxy for local employers; fraction of men and women with a completed high school certificate; the share of femaleheaded households; the female/male sex ratio, and district fixed effects.

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