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

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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. Significance Few studies have addressed links between family planning programs and long-term benefits for women’s health and economic outcomes, especially in societies where old-age support and women’s status are tied to childbearing and where smaller families may carry negative consequences for women. We analyzed the maternal and child health/family planning (MCH/FP) program, a highly effective intervention introduced in the rural Matlab subdistrict of Bangladesh in 1977 with a subsequent 12-y differential in service access. We found significant differences in lifetime contraceptive behavior and completed fertility among women born 1938−1973. We found few effects on later health or economic outcomes except for an association of MCH/FP with poorer overall health and poorer metabolic health among women born 1950−1961.
Funding Information
  • HHS | NIH | National Institute on Aging (R01 AG033713)
  • HHS | NIH | Eunice Kennedy Shriver National Institute of Child Health and Human Development (R03 HD09398)
  • International Initiative for Impact Evaluation (OW3/1060)
  • Population Reference Bureau (OCG5643G)
  • National Science Foundation (BCS 1459184)
  • National Science Foundation (DGE 1144083)

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