Long Term Effects of Infant Wantedness

描述（由申请人提供）：尽管现代计划生育已经帮助家庭控制生育，但意外怀孕和不合时宜的怀孕在世界各地仍然很常见。在低收入国家，获得计划生育的机会更为有限，低收入国家有1亿多妇女被列为需求未得到满足，因为她们说自己不想怀孕，但无法获得现代计划生育方法。美国政府通过美国国际开发署花费6.49亿美元支持低收入国家的计划生育项目。一些决策者对计划生育仅仅是一种生活方式的选择，还是确实对儿童和家庭的健康有重要影响的模糊不清，降低了为穷人提供计划生育服务的热情。事实证明，关于计划生育对健康影响的证据仍然容易受到严重偏见的影响。没有基于随机试验的研究表明计划生育可以通过帮助妇女预防意外怀孕来改善人口健康。所有以前的研究主题都受到偏见，因为无论是回顾性回忆是否想要出生或有更多不想要的生育的妇女也容易在他们的生活中有更多的不可测量的问题，也损害了他们的家庭健康的问题。这项提案将回答不想要的孩子及其兄弟姐妹和母亲是否会有更差的健康结果和学校成绩。1985年在孟加拉国马拉马特开始的计划生育和保健服务的准实验性分配，在提供比以往任何时候都更好的答案方面取得了巨大进展。该研究能够做出3个创新：1）在产前测量需求; 2）使用Matlab准实验分配，地理空间坐标和卫生工作者分配作为识别工具，打破了由于需求与不可观察因素混淆而导致的偏倚; 3）通过人口监测系统，可以对意外出生后18年的儿童和家庭进行长期随访。该项目将大大提高我们判断计划生育投资与实现妇幼保健千年发展目标的其他战略相比是否具有成本效益的能力。

DESCRIPTION (provided by applicant): Unwanted and mistimed pregnancies are still common everywhere, even though modern family planning has helped families control their fertility. In low income countries access to family planning is more limited and more than 100 million women in low income countries are classified as having unmet need because they say they don't want to get pregnant but do not have access to modern family planning methods. The US government, through USAID spends $649 million to support family planning programs in low income countries. Enthusiasm for spending on family planning services for the poor is diminished for some policymakers by ambiguity over whether family planning is just a life style choice or indeed has important affects on the health of children and families. It turns out that the evidence on the health impact of family planning remains vulnerable to serious bias. There have been no randomized trial based studies to show that family planning could improve population health by helping women prevent unwanted pregnancies. All prior studies of the topic are subject to bias because of either retrospective recall of whether a birth was wanted or the problem where women who have more unwanted births are also prone to have more unmeasured problems in their lives that also impair the health of their families. This proposal will answer whether unwanted children and their siblings and mothers have worse health outcomes and school attainment. The quasi-experimental allocation of family planning and health services that was started in Matlab, Bangladesh in 1985 allows tremendous progress in providing a better answer than ever before. The study is able to make 3 innovations: 1) Wantedness is measured prenatally; 2) The bias due to confounding of wantedness with unobservables is broken using the Matlab quasi-experimental assignment, geospatial coordinates, and health worker assignment as identifying instruments; 3) Long term follow up measures of children and families out to 18 years after an unwanted birth is available through the demographic surveillance system. This project will make significant gains in our ability to say whether investments in family planning are cost effective compared to other strategies for achieving Millennium Development Goals for maternal and child health.