Family planning and women's and children's health: long-term consequences of an outreach program in Matlab, Bangladesh.

We analyze the impact of an experimental maternal and child health and family planning program that was established in Matlab, Bangladesh, in 1977. Village data from 1974, 1982, and 1996 suggest that program villages experienced a decline in fertility of about 17 %. Household data from 1996 confirm that this decline in "surviving fertility" persisted for nearly two decades. Women in program villages also experienced other benefits: increased birth spacing, lower child mortality, improved health status, and greater use of preventive health inputs. Some benefits also diffused beyond the boundaries of the program villages into neighboring comparison villages. These effects are robust to the inclusion of individual, household, and community characteristics. We conclude that the benefits of this reproductive and child health program in rural Bangladesh have many dimensions extending well beyond fertility reduction, which do not appear to dissipate rapidly after two decades.

The economic consequences of reproductive health and family planning.

We consider the evidence for the effect of access to reproductive health services on the achievement of Millennium Development Goals 1, 2, and 3, which aim to eradicate extreme poverty and hunger, achieve universal primary education, and promote gender equality and empower women. At the household level, controlled trials in Matlab, Bangladesh, and Navrongo, Ghana, have shown that increasing access to family planning services reduces fertility and improves birth spacing. In the Matlab study, findings from long-term follow-up showed that women's earnings, assets, and body-mass indexes, and children's schooling and body-mass indexes, substantially improved in areas with improved access to family planning services compared with outcomes in control areas. At the macroeconomic level, reductions in fertility enhance economic growth as a result of reduced youth dependency and an increased number of women participating in paid labour.

Health economics and applications in developing countries.

The concept of health human capital guides the statistical study of (1) health production functions, (2) derived demands for medical and behavioral health inputs, and (3) determinants of health and productivity outcomes. Health inputs are generally endogenous to health outcomes, and prices of health inputs are the most common instrumental variable for identifying estimates of the causal effects of health inputs. But when health input prices are modified by individual regional migration, the regional prices no longer satisfy the requirement of being independent of preferences and omitted variables. Then the difficulty of evaluating health program effects reinforces the need to design randomized regional treatments, in order to be able to evaluate without bias the consequences of critical health interventions, such as are needed today to deal with the HIV/AIDS epidemic.

Human capital, schooling and health.

A consensus has been forged in the last decade that recent periods of sustained growth in total factor productivity and reduced poverty are closely associated with improvements in a population's child nutrition, adult health, and schooling, particularly in low-income countries. Estimates of the productive returns from these three forms of human capital investment are nonetheless qualified by a number of limitations in our data and analytical methods. This paper reviews the problems that occupy researchers in this field and summarizes accumulating evidence of empirical regularities. Social experiments must be designed to assess how randomized policy interventions motivate families and individuals to invest in human capital, and then measure the changed wage opportunities of those who have been induced to make these investments. Statistical estimation of wage functions that seek to represent the relationship between wage rates and a variety of human capital stocks may yield biased estimates of private rates of return from these investments for a variety of reasons. The paper summarizes several of these problems and illustrates how data and statistical methods can be used to deal with some of them. The measures of labor productivity and the proxies specified for schooling and adult health are first discussed, and then the functional relationships between human capital and wages are described. Three types of estimation problem are discussed: (1) bias due to omitted variables, such as ability or frailty; (2) bias due to the measurement of an aggregation of multiple sources of human capital, e.g. genetic and socially reproducible variation, which may contribute to different gains in worker productivity; and (3) errors in measurement of the human capital stocks. Empirical examples and illustrative estimates are surveyed.