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

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/m2) and 2012 (0.57 kg/m2); fewer were underweight in 1996, but more were overweight or obese in 2012. Overall, there was a +2.5 kg/m2 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.

The effects of spousal migration on perinatal healthcare utilization

“…The study area was the site for the Maternal Child Health/Family Planning (MCH/FP) Program that was initiated in Matlab in 1977 by the International Center for Diarrheal Disease Research, Bangladesh (icddr,b). This program has had notable positive effects on women's health in the area, including substantial changes in lifetime contraceptive use and fertility behaviors [ 41 ].…”

“…The study sample was identified using the Matlab Health and Demographic Surveillance System (MHDSS), which is a unique longitudinal demographic registration system that has recorded all births, deaths, marriages, and migrations occurring in the area since 1974. The first Matlab Health and Socioeconomic Survey sampled 7% of households included in the MHDSS in 1996 (MHSS1) [ 41 ]. This study primarily used MHSS2, which was a panel follow-up of MHSS1 conducted from 2012 to 2014.…”

“…This study primarily used MHSS2, which was a panel follow-up of MHSS1 conducted from 2012 to 2014. MHSS2 includes data from over 90% of households that were surveyed in MHSS1 [ 41 ]. Protection of human participants during fieldwork and data analysis was ensured under the icddr,b Ethical Review Committee Protocol #PR-10005.…”

FPsim: An agent-based model of family planning

“…Yet, much of the existing FP modeling landscape has focused on macro- or population-level dynamics of family planning, with far less attention paid to individual needs and preferences (Brunson 2020; Speizer, Bremner, and Farid 2022) or individual-level consequences (Barham et al 2021; Brunson and Suh 2020; Finlay and Lee 2018; Okenwa, Lawoko, and Jansson 2011; Schwarz et al 2019). Due to the individual nature of the biological and behavioral underpinnings of family planning and its consequences, deeper understanding of how family planning is intertwined with individuals’ lives and health at the micro -level can contribute to more effective, person-centered design of both contraceptive technologies and programmatic interventions.…”

Rural Development in Bangladesh Over Four Decades: Findings from Mahabub Hossain Panel Data and the Way Forward

“…Among these data sets, MHPD is unique in several contexts (Table 2): (i) The MHPD has been tracking the rural households of the country for a period of over three decades , (ii) it has already been used in more than 70 academic studies which might have enhanced the government, non-governmental, and international development policies since the late 1980s (Hossain 2002;Hossain and Bose 2004;IMF 2005;World Bank 2012;Madhur and Faruqee 2016;Hossain, Kairy, and Bayes 2016); and (iii) In terms of content, while all three studies have many common dimensions of a standard LSMS, the MHPD has been collecting more detailed time use of households' earning members and a detailed account of the costs and returns of a parcel of land that the respondent could remember the best. In addition to those nationally representative panel studies, there is a unique and rich longitudinal demographic study on births, deaths, marriages, and migrations in small Upazila, Matlab, in Bangladesh (Barham et al 2021). 1957/58, 1963/64, 1974/5, 1983/4, 1993, 2008-10 • 1989, 1991, 1993, 1997, 2000, 2004, 2006, 2009 The MHPD was maintained by the late Dr. Mahabub Hossain, a well-known agriculture and development economist who worked with several reputed organizations in Bangladesh and other regions.…”