Why Are Infant and Child Mortality Rates Lower in the MCH‐FP Area of Matlab, Bangladesh?

Abstract

Infant and child mortality rates are significantly lower in the Maternal and Child Health-Family Planning (MCH-FP) area of Matlab, Bangladesh, than in a comparison area. The two areas are similar in terms of socioeconomic characteristics, but the MCH-FP area provides better maternal and child health and family planning services, resulting in different reproductive patterns, including lower fertility rates and longer intervals between pregnancies. We use data from the Matlab Demographic Surveillance System for nearly 126,000 singleton live births that occurred between 1982 and 2002 to investigate the extent to which the different reproductive patterns in the MCH-FP area explain why infant and child mortality rates are lower there. Differences in reproductive patterns account for a small portion (up to 20 percent) of the variation in these rates between the MCH-FP and comparison areas, suggesting that the majority of the difference is due to the quality of MCH services.

Infant death clustering in families: Magnitude, causes, and the influence of better health services, Bangladesh 1982–2005

“…A paper by Hale et al (2006) used the same source of data that we used. They find that about 20 per cent of the differences in infant and child mortality between the intervention area and the comparison area can be explained by differences in reproductive behaviour (birth intervals, parity), and attribute the remaining part to differences in the quality of health services.…”

Respecting Autonomy in Population Policy: An Argument for International Family Planning Programs

“…On average, more educated women have fewer children (due to delays in marriage, staying in school longer and lowered desire for children) and are more likely to have healthier children (in part due to longer spacing between births and also due to better health behaviors and prenatal care) (Phillips et al, 1982;Chen et al, 1983;Bongaarts, 1987;Cleland and Van Ginneken, 1988;Hale et al, 2006;DaVanzo et al, 2008). The effect of universal education on reducing fertility and improving infant and child health is much bigger than any efforts made for family planning.…”

“…There is a seemingly easy answer to this question: comprehensive family planning education has a noted effect on reducing fertility as well as infant, child and maternal mortality (Phillips et al, 1982;Hale et al, 2006). But comprehensive family planning education efforts are not necessarily at the top of the educational agenda.…”

“…For example, one study estimates that the difference between scenarios that have family planning and those that do not is around 4.6 billion people by the year 2100 (Bongaarts et al, 1990). In addition, the experimental MCH/FP program offered to a randomly assigned portion of the demographic surveillance system in Matlab, Bangladesh, show strong evidence that increased access to contraception and maternal and child health services directly reduces fertility (Phillips et al, 1982) and child mortality (Hale et al, 2006). Further, previous literature may have overestimated the effect of education on fertility and health outcomes by failing to account for endogeneity issues (Angeles et al, 2005).…”

Child survival revolutions revisited – lessons learned from Bangladesh, Nicaragua, Rwanda and Vietnam

“…The Matlab achievements in child survival should be related to the high coverage of essential health services in combination with socio‐economic development efforts 22, 23. In this subdistrict of Bangladesh, as in all parts of the country, the national development organisation BRAC has been running development activities, including micro‐credit programmes and educational activities.…”