Thirty-five years later: Long-term effects of the Matlab maternal and child health/family planning program on older women’s well-being

Tania Barham, Brachel Champion, Andrew D. Foster, Jena D. Hamadani, Warren C. Jochem, Gisella Kagy, Randall Kuhn (), Jane Menkenb (), Abdur Razzaque, Elisabeth Dowling Root and Patrick Turner
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Tania Barham: Department of Economics, University of Colorado Boulder, Boulder, CO 80302; Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO 80302
Andrew D. Foster: Department of Economics, Brown University, Providence, RI 02903; Department of Health Services, Policy and Practice, Brown University, Providence, RI 02903
Jena D. Hamadani: Maternal and Child Health Division, icddr,b, Dhaka 1212, Bangladesh
Warren C. Jochem: School of Geography and Environmental Science, University of Southampton, Southampton SO17 1BJ, United Kingdom
Gisella Kagy: Department of Economics, Vassar College, Poughkeepsie, NY 12604
Randall Kuhn: Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA 90095
Jane Menkenb: Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO 80302; Department of Sociology, University of Colorado Boulder, Boulder, CO 80302
Abdur Razzaque: Health System and Population Studies Division, icddr,b, Dhaka 1212, Bangladesh
Elisabeth Dowling Root: Department of Geography, The Ohio State University, Columbus, OH 43210

Proceedings of the National Academy of Sciences, 2021, vol. 118, issue 28, e2101160118

Abstract: Family planning programs are believed to have substantial long-term benefits for women’s health and well-being, yet few studies have established either extent or direction of long-term effects. The Matlab, Bangladesh, maternal and child health/family planning (MCH/FP) program afforded a 12-y period of well-documented differential access to services. We evaluate its impacts on women’s lifetime fertility, adult health, and economic outcomes 35 y after program initiation. We followed 1,820 women who were of reproductive age during the differential access period (born 1938–1973) from 1978 to 2012 using prospectively collected data from the Matlab Health and Demographic Surveillance System and the 1996 and 2012 Matlab Health and Socioeconomic Surveys. We estimated intent-to-treat single-difference models comparing treatment and comparison area women. MCH/FP significantly increased contraceptive use, reduced completed fertility, lengthened birth intervals, and reduced age at last birth, but had no significant positive impacts on health or economic outcomes. Treatment area women had modestly poorer overall health (+0.07 SD) and respiratory health (+0.12 SD), and those born 1950–1961 had significantly higher body mass index (BMI) in 1996 (0.76 kg/m 2 ) and 2012 (0.57 kg/m 2 ); fewer were underweight in 1996, but more were overweight or obese in 2012. Overall, there was a +2.5 kg/m 2 secular increase in BMI. We found substantial changes in lifetime contraceptive and fertility behavior but no long-term health or economic benefits of the program. We observed modest negative health impacts that likely result from an accelerated nutritional transition among treated women, a transition that would, in an earlier context, have been beneficial.

Keywords: family planning; long-term follow-up; health (search for similar items in EconPapers)
Date: 2021
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