Political decentralisation and the spatial distribution of infant mortality in less developed nations

This paper focuses on political decentralisation as an institutional determinant of the level and spatial distribution of infant mortality rates (IMR). At the national level, we show that political decentralisation is linked to lower IMR, but these benefits are concentrated in high-income decentralised nations. In developing nations, decentralisation is associated with significantly higher spatial variation in IMR. We explore the mechanisms driving these patterns by leveraging floods as plausibly exogenous events in our global sample and a detailed analysis of Brazil. In Brazil, floods increase municipal variation in IMR, with impacts disproportionately accruing in low-income municipalities with limited government services.