Doctoral Dissertation Research: Measuring the Benefits of Reproductive Health Services

在发达国家，计划生育、孕期保健和艾滋病毒预防服务等生殖健康服务都很容易获得。然而，在贫穷国家，甚至连基本的生殖健康服务也往往得不到。虽然各国政府和非政府组织努力扩大这些服务的覆盖面，但增加获得服务的机会所带来的好处相对来说并不清楚。本研究的目的是评估生殖健康服务在非洲贫穷国家的影响。增加生殖保健服务的主要好处可能包括改善产妇保健，特别是产后保健，提高对家庭规模的满意度，以及降低艾滋病毒感染率。然而，次级利益对个人的福祉和国家的经济发展具有长期影响。这些次级影响包括受益人子女健康状况的改善、教育水平的提高以及由此对未来劳动力市场的好处。通过正确估计RHS在孕产妇和儿童健康、儿童教育和艾滋病毒感染方面的好处，本研究将为增加或维持此类服务获取机会的努力提供决策信息。这项研究的广泛影响将是为捐助者和服务提供者提供必要的信息，以准确地比较RHS的好处与提供服务的成本。目前对这些益处的认识往往相互矛盾，并存在方法上的缺陷。试图量化生殖保健服务益处的研究通常被重要的未观察到的因素所混淆，例如家庭在接受此类服务时的选择。如果不从方法上处理这些不可观察的因素，就不可能确定RHS对结果的真正因果影响。除了上文讨论的本研究的广泛影响外，本项目还将在用于应对这些重大挑战的方法中展示知识价值。研究人员将利用美国政策的外生变化来规避通常阻碍这一性质研究的内生问题。2001年墨西哥城政策的实施影响了美国的发展援助，并减少了对大约10个非洲国家的主要生殖健康服务提供者的资助。该政策有效地减少了这些国家社区的生殖健康服务供应。首先，将评估该政策对受影响社区提供服务的影响。分析将把联合收割机现有的住户调查数据与研究人员收集的机构调查数据结合起来。这一初步分析将涉及基于政策时机和组织削减位置的外生性的差异化方法。在评估了政策对服务提供的影响之后，政策变化将被用作一种工具，以确定RHS对相关结果的影响。该项目将通过审查外部可获得性对结果的影响，从家庭选择接受服务的角度抽象出来，否则这些服务会使结果产生偏差。关注的结果将是：产妇产后健康指标;出生时健康指标，如早产率和出生体重不足率;儿童健康指标，如身高体重和6岁以下儿童年龄身高;以及人力资本发展指标，如小学入学率。

Reproductive health services such as family planning, pregnancy care, and HIV prevention services are readily accessible in the developed world. Yet in poor countries, even basic reproductive health services are often unavailable. Though governments and non-governmental organizations struggle to increase coverage of these services, the benefits accruing from increased access are relatively unknown. The purpose of this study is to assess the impacts of reproductive health services (RHS) in the context of poor countries in Africa. Primary benefits resulting from increased access to RHS may include improvements in maternal health, especially post-partum, increased satisfaction with family size, and lower incidence of HIV infections. However, the secondary benefits have longer-term impacts on the wellbeing of individuals and the development of the country economically. Such secondary impacts include improvements to the health of the children of recipients, increases in education, and the resulting benefits to future labor markets. By correctly estimating the benefits of RHS in terms of maternal and child health, child education, and HIV infection, this study will inform decisions regarding efforts to increase or sustain access to such services. The broad impact of this study will be to provide donors and service providers with the information necessary to accurately compare the benefits of RHS with the cost of providing the services. Current knowledge of such benefits is often contradictory and is plagued with methodological shortcomings. Studies that have attempted to quantify the benefits of RHS have been generally confounded by important unobserved factors, such as family choice in receiving such services. Without methodologically dealing with these unobservables, it is impossible to identify the true causal effect of RHS on outcomes. In addition to the broader impacts of this study discussed above, this project will also exhibit intellectual merit in the methods used to address these substantial challenges. The researcher will make use of an exogenous change in U.S. policy to circumvent endogeneity issues that typically hamper research of this ature. The 2001 implementation of the Mexico City Policy affected U.S. development assistance and reduced funding to major RHS service providers in around 10 African countries. The policy effectively reduced availability of RHS to vrying degrees in communities throughout these countries. First, the impact of the policy on service provision in affected communities will be assessed. The analysis will combine existing household survey data with institutional survey data to be collected by the researcher. This preliminary analysis will involve differencing methods based on the exogeneity of policy timing and location of organizational cut-backs. After assessing the impact of the policy on service provision, the policy change will be used as an instrument to identify the impact of RHS on outcomes of interest. By examining the impact of exogenous availability on outcomes, the project will abstract from the family choice to receive services that would otherwise bias the results. Outcomes of interest will be: indicators of maternal post-partum health, indicators of health-at-birth such as prevalence of pre-term births and prevalence of low birth weight;indicators of child health such as weight-for-height and height-for-age of children under age six; and indicators of human capital development such as percent enrolled in primary school.