Reproductive health services such as family planning, pregnancy care, and HIV prevention services are readily accessible in the developed world. Yet in poor countries, even basic reproductive health services are often unavailable. Though governments and non-governmental organizations struggle to increase coverage of these services, the benefits accruing from increased access are relatively unknown. The purpose of this study is to assess the impacts of reproductive health services (RHS) in the context of poor countries in Africa. Primary benefits resulting from increased access to RHS may include improvements in maternal health, especially post-partum, increased satisfaction with family size, and lower incidence of HIV infections. However, the secondary benefits have longer-term impacts on the wellbeing of individuals and the development of the country economically. Such secondary impacts include improvements to the health of the children of recipients, increases in education, and the resulting benefits to future labor markets.
By correctly estimating the benefits of RHS in terms of maternal and child health, child education, and HIV infection, this study will inform decisions regarding efforts to increase or sustain access to such services. The broad impact of this study will be to provide donors and service providers with the information necessary to accurately compare the benefits of RHS with the cost of providing the services. Current knowledge of such benefits is often contradictory and is plagued with methodological shortcomings. Studies that have attempted to quantify the benefits of RHS have been generally confounded by important unobserved factors, such as family choice in receiving such services. Without methodologically dealing with these unobservables, it is impossible to identify the true causal effect of RHS on outcomes. In addition to the broader impacts of this study discussed above, this project will also exhibit intellectual merit in the methods used to address these substantial challenges.
The researcher will make use of an exogenous change in U.S. policy to circumvent endogeneity issues that typically hamper research of this ature. The 2001 implementation of the Mexico City Policy affected U.S. development assistance and reduced funding to major RHS service providers in around 10 African countries. The policy effectively reduced availability of RHS to vrying degrees in communities throughout these countries. First, the impact of the policy on service provision in affected communities will be assessed. The analysis will combine existing household survey data with institutional survey data to be collected by the researcher. This preliminary analysis will involve differencing methods based on the exogeneity of policy timing and location of organizational cut-backs. After assessing the impact of the policy on service provision, the policy change will be used as an instrument to identify the impact of RHS on outcomes of interest.
By examining the impact of exogenous availability on outcomes, the project will abstract from the family choice to receive services that would otherwise bias the results. Outcomes of interest will be: indicators of maternal post-partum health, indicators of health-at-birth such as prevalence of pre-term births and prevalence of low birth weight;indicators of child health such as weight-for-height and height-for-age of children under age six; and indicators of human capital development such as percent enrolled in primary school.
