Barham Tania, Champion Brachel, Foster Andrew D, Hamadani Jena D, Jochem Warren C, Kagy Gisella, Kuhn Randall, Menken Jane, Razzaque Abdur, Root Elisabeth Dowling, Turner Patrick S
Department of Economics, University of Colorado Boulder, Boulder, CO 80302.
Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO 80302.
Proc Natl Acad Sci U S A. 2021 Jul 13;118(28). doi: 10.1073/pnas.2101160118.
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) and 2012 (0.57 kg/m); fewer were underweight in 1996, but more were overweight or obese in 2012. Overall, there was a +2.5 kg/m 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.
计划生育项目被认为对女性的健康和福祉具有重大的长期益处，但很少有研究确定其长期影响的程度或方向。孟加拉国马特莱的母婴健康/计划生育（MCH/FP）项目提供了一段长达12年的、服务获取差异有充分记录的时期。我们评估了该项目启动35年后对女性终身生育、成人健康和经济成果的影响。我们追踪了1978年至2012年期间在差异获取时期处于育龄的1820名女性（出生于1938年至1973年），使用从马特莱健康与人口监测系统以及1996年和2012年马特莱健康与社会经济调查中前瞻性收集的数据。我们估计了意向性治疗单差异模型，比较了治疗区和对照区的女性。母婴健康/计划生育项目显著增加了避孕药具的使用，降低了终身生育率，延长了生育间隔，并降低了最后一次生育的年龄，但对健康或经济成果没有显著的积极影响。治疗区的女性总体健康状况略差（+0.07标准差），呼吸健康状况略差（+0.12标准差），1950年至1961年出生的女性在1996年（0.76千克/平方米）和2012年（0.57千克/平方米）的体重指数显著更高；1996年体重过轻的人较少，但2012年超重或肥胖的人更多。总体而言，体重指数有+2.5千克/平方米的长期增长。我们发现终身避孕和生育行为有重大变化，但该项目没有长期的健康或经济效益。我们观察到了适度的负面健康影响，这可能是由于接受治疗的女性中营养转型加速所致，而在更早的情况下，这种转型本应是有益的。
