Effects of the world bank's maternal and child health intervention on indonesia's poor: Evaluating the safe motherhood project
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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Context - Poverty and maternal and child health are inextricably related; yet few, if any, studies have evaluated the effects of development programs focused on the maternal and child health of the poor.Objective - To examine the impact of the World Bank's Safe Motherhood Project (SMP) intervention on the health outcomes of Indonesia's poor.Design, Setting, Participants - Analysis of infant, child and maternal health outcomes of Indonesia's poor before and after introduction of SMP, comparing membership and non-membership in SMP. Indonesian provincial level data from 1990 to 2005 was analyzed using a difference-in-difference approach with Ordinary Least Squares multivariate regression adjusting for covariates. East and Central Java were compared to seven reference control provinces from neighboring areas.Main Outcome Measures - Infant mortality, under-five mortality, total fertility rate, teenage pregnancy, unmet contraceptive need, and percentage deliveries overseen by trained health personnel.Results - Comparing before and after periods in multivariate analysis, the SMP was significantly associated with a net beneficial change in under-five mortality (N=63, P=0.03), but was not in infant or maternal health outcomes., Unemployment and the pupil-teacher ratio were significantly associated with infant mortality (N=80; P=0.005 and P=0.02, respectively) and with percentage deliveries overseen by trained personnel (N=52; P=0.001 and PConclusions - Taking into account the impact of two other development projects, with the exception of under-five mortality, poor Indonesians living in provinces that were members of SMP had no more beneficial changes in infant and maternal health outcomes as compared to provinces that were not members of SMP. This study does illustrate, however, the connection between unemployment and education and health outcomes and access to healthcare. While this maternal and child health intervention may not have produced sustainable results in the context of two other development projects and nationwide changes in education and employment among the poor; further research is needed to build the evidence base for future development policy.
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