Long Term Effects of Infant Wantedness

描述(申请人提供)：意外怀孕和不合时宜的怀孕在世界各地仍然很常见，尽管现代计划生育已经帮助家庭控制了自己的生育能力。在低收入国家，获得计划生育的机会更为有限，在低收入国家，有1亿多妇女被归类为有未得到满足的需求，因为她们说她们不想怀孕，但又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计划。对于一些政策制定者来说，对计划生育是否只是一种生活方式的选择，或者是否确实对儿童和家庭的健康有重要影响的模棱两可，降低了对穷人计划生育服务支出的热情。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。目前还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防止意外怀孕来改善人口健康。之前关于这一主题的所有研究都存在偏见，因为要么是因为回顾了是否想要生孩子，要么是因为有更多意外生育的女性在生活中也容易出现更多无法测量的问题，这些问题也损害了她们家庭的健康。这项提案将回答被遗弃的儿童及其兄弟姐妹和母亲的健康状况和学业成就是否更差。1985年在孟加拉国的MatLab开始的计划生育和保健服务的准试验性分配使在提供比以往任何时候都更好的答案方面取得了巨大的进步。本研究的创新之处在于：1)意愿是产前测量的；2)打破了由于意愿与不可察觉的混淆而产生的偏差；3)通过人口监测系统对儿童和家庭的长期跟踪测量，直到意外出生后18年，打破了由于意愿与不可观察的混淆而产生的偏差。与实现妇幼保健千年发展目标的其他战略相比，这一项目将大大提高我们判断计划生育投资是否具有成本效益的能力。 与公共卫生相关：该项目将使用1990年至2008年孟加拉马特市儿童和母亲的健康和就学情况数据，以查明被遗弃的儿童是否健康状况和就学情况较差。这项研究的背景是在1985年经历了不同社区随机分配接受上门计划生育服务的地区，这种随机分配将帮助研究产生明确的结果，即是否可以通过帮助贫困家庭控制他们不想要的生育经历的措施来改善人口健康。

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. PUBLIC HEALTH RELEVANCE: This project will use data on the health and school attainment of children and mothers in Matlab, Bangladesh from 1990 to 2008 in order to find out if children who were unwanted have worse health and schooling. The study is set in an area that experienced the random assignment of different communities to receive door to door delivery of family planning services back in 1985 This random assignment will help the study produce definitive results on whether population health can be improved by measures that help poor families control their experience of unwanted fertility.