The Impact of Cleft Lip/Palate and CLP Surgical Intervention on the Social Integration of Adolescents in India

Cleft Lip/Palate, a congenital orofacial anomaly, carries an incidence rate of approximately 1 in every 1000 births. In addition to the stigma associated with the condition, the varying levels of cleft severity might result in lower life outcomes which could include lower cognitive ability, physical and psychological well-being, social and behavioral outcomes of adolescents. This paper focuses on the social integration element of life outcomes, which is composed of the social inclusion and prosocial behavior of the adolescent. Despite the affordability of restorative surgeries, patients in rural areas of Low and Middle-Income Countries (LMICs) such as India face accessibility and affordability constraints. Nevertheless, efforts by NGOs in providing free CLP restorative surgeries exist in LMICs. The literature on the impact of CLP and its correction through surgeries lacks causally identified evaluations, which this study provides. In this paper, using a difference in differences method with household fixed effects, we estimate the impact of CLP and receiving CLP reparative surgeries on the social Integration of adolescents in India. Our results indicate that the average level of cleft severity carries a statistically significant negative impact on social integration of patients. The estimate is mainly driven by the negative effect of CLP on the social inclusion. Utilizing a Directed Acyclical Graph framework, we find that speech impediment mediates the relationship between CLP and social inclusion, while CLP indirectly affects prosocial behavior through its relationship with social inclusion