Women's Health and Pregnancy Outcomes: Does Access to Services Make a Difference
Abstract
The question of how access to services affects health outcomes is critical for policy makers allocating resources across different programs, but it is difficult to answer with cross-sectional data sets. We use data from a panel survey in Indonesia (the Indonesia Family Life Survey) that spans a period of a major expansion in access to midwifery services to investigate whether the expansion resulted in improved health and pregnancy outcomes for women of reproductive age. Between 1990 and 1998 Indonesia trained and posted some 50,000 midwives to communities throughout the country. Results from the lFLS data reveal that between 1993 and 1997 these midwives tended to be placed in communities that were relatively poor and that were relatively distant from public health centers. We show that the addition of a Village Midwife to communities between 1993 and 1997 is associated with a significant increase in BMI in 1997 relative to 1993 for women of reproductive age, but not for men in that age range or for older men and women. We also show that the presence of a Village Midwife during pregnancy is associated with increased birthweight. Both results are robust to inclusion of community-level fixed effects-a strategy that addresses many of the concerns about biases resulting from non-random program placement. The quantitative results are complemented by interviews conducted with Village Midwives themselves. Those interviews provide evidence that the midwives offer a wide array of preventive and curative services, which explains why they are associated not just with positive pregnancy outcomes, but also with improvements in BMI, a more general indicator of health status.
Document Details
- Document Type
- Technical Report
- Publication Date
- May 01, 2000
- Accession Number
- ADA381301
Entities
People
- Duncan Thomas
- Elizabeth Frankenberg
Organizations
- RAND Corporation