Essays on Maternal and Child Health, Fertility, and Economic Well-Being in Low- and Middle-Income Countries
CitationKarra, Mahesh. 2017. Essays on Maternal and Child Health, Fertility, and Economic Well-Being in Low- and Middle-Income Countries. Doctoral dissertation, Harvard T.H. Chan School of Public Health.
AbstractThis dissertation is comprised of three studies that, together, explore the links between: 1) access to and use of maternal and child health care, family planning, and reproductive health services; 2) fertility and maternal and child health outcomes; and 3) longer-term measures of well-being, in developing country contexts. I utilize both theoretical and empirical methods to explore these relationships of interest. In the first study, I use a large multi-country microeconomic data set to assess the associations between physical access to services and utilization of maternal and child health services as well as child mortality outcomes. I find that living close to a health facility is associated with increased utilization of maternal health services, namely receipt of antenatal care and in-facility delivery, as well as improved child survival, particularly in the neonatal period. In the second study, I adopt a macrosimulation approach to investigate the long-run health and economic effects of a decline in fertility. I construct a model that describes the interrelated evolution of economic and demographic outcomes under a “baseline” scenario, in which fertility declines slowly over time, and I compare these outcomes under a simulated “alternative” scenario in which fertility declines more rapidly. I calibrate the model parameters using findings from well-identified microeconomic studies, and I use baseline data from Nigeria to compare the model’s predictions for each of the key outcomes under the two fertility scenarios. Through this modeling exercise, I show that a decline in fertility creates the potential for a demographic dividend and a window of opportunity for economic growth; moreover, the magnitude of this growth factor may be substantially larger than what has been estimated to date. In the third study, I use population-based survey data to identify children growing up in healthy environments in low- and middle-income countries, and I compare the height distribution of these children to the height distribution of the international growth reference sample that was established by the World Health Organization. I find that observed differences in child height across populations are likely not due to innate or genetic differences, but are more likely to reflect children’s continued exposure to resource-poor environments, poor maternal education, and lack of access to health and sanitation.
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