Long-term Effects of Health and Development Interventions in Rural Bangladesh

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DESCRIPTION (provided by applicant): We plan to study long-term effects of health and human capital interventions in the developing world. Matlab, Bangladesh, is one of the few settings that combines targeted interventions, long duration of follow-up (over 30 years), and detailed tracking of attrition across an unusually rich set of outcomes and for several generations of potential beneficiaries. A population of over 200,000 has been followed since the mid-1970s. A quasi- randomized maternal and child health and family planning (MCH/FP) program was introduced in the late 1970s. Considerable evidence demonstrates key pre-program similarities in the MCH/FP and comparison areas. When flood control and microcredit interventions were later introduced, villages had access to none or 1-3 interventions. The NIA-funded Matlab Health and Socioeconomic Survey (MHSS1) was carried out in 1996. We propose a follow-up survey to MHSS1 and a new archive of existing longitudinal data from 1974- 2011. MHSS2 will provide detailed information on health, human capital, labor and marriage outcomes, old-age support, and socioeconomic status 30 years after the initiation of the MCH/FP intervention. The intended outputs of this project are unique datasets for longitudinal health and demographic research; a detailed first report; and several initial studies related to the specific aims. We address three specific aims. First: Study the impacts of MCH/FP interventions on long-term health and welfare outcomes in the two generations targeted by interventions - women of reproductive age at program placement (age 38-73 in 2011) and individuals who were children during a period of program variation (age 22- 34 in 2011). Data on SES prior to intervention and information on those who left the population prior to MHSS1 permit analysis of program effects with unusually effective accounting of self-selection and attrition. Second: Study the impact of the MCH/FP interventions through intergenerational relationships and transmission of poverty. We ask how improvements in child health and reduced family size affect social support and well-being of elders and how the program affected children of program participants. Rich data on family connections in 1996 and 2011 will facilitate understanding intergenerational effects of the program. Third: Study the impact of the MCH/FP interventions in the context of microcredit and flood control interventions as well as social, demographic, and cultural changes. Detailed community data, including historical mapping of infrastructure and facilities, permit testing detailed hypotheses about relative contributions of and interactions between health, credit, and infrastructure interventions on the path to human development. These interventions - in maternal and child health and family planning, poverty alleviation, and environmental protection - pertain to four of the eight UN Millennium Development Goals. Impacts of single and multiple interventions on health, wealth, and life chances can be studied for four generations defined by age at access to interventions. PUBLIC HEALTH RELEVANCE: Maternal and child health and family planning programs are essential to public health programs worldwide; their effectiveness in improving child health and their relationship to fertility reduction in developing countries is well-established. Excellent continuously collected records exist for a large population in which an MCH/FP program was introduced 30 years ago and two programs to improve economic wellbeing were introduced more recently. These data combined with a follow-up survey permit examination of long-term effects on health and other aspects of individual and family social and economic well-being. The study will inform evidence-based public health policy and strategies to improve health.