(October 2010) Family planning is widely recognized as one of the most cost-effective health interventions.1 Decades of research have demonstrated that modest investments in family planning can save lives and dramatically improve maternal and child health. There is a growing push in the development community to reprioritize family planning because of the cross-cutting role it plays in achieving broader development goals, including the Millennium Development Goals (MDGs) and poverty reduction.2 Although it seems intuitive that helping women avoid unwanted pregnancies would improve their economic well-being, the data to adequately assess this relationship have been limited. Research results from Bangladesh are demonstrating that, in addition to contributing to better health, family planning is an essential component of sustainable development and poverty alleviation.
Recent research on the integrated Family Planning and Maternal Child Health (FPMCH) program in Matlab, Bangladesh, indicates that families in communities where the program was implemented became healthier and wealthier over time than families who lived in similar communities but received only the routine Ministry of Health services.3 Families who received FPMCH services through the program experienced health benefits in addition to larger incomes, greater accumulation of wealth, and higher levels of education.
After 20 years of FPMCH program implementation, study results revealed that women in the program area were more likely to use family planning and have fewer children than similar women in the comparison area. Women in the program area also had a better nutritional status with a higher average weight and body mass index. They were more likely to have had antenatal care and optimal spacing between births, and a lower risk of dying from pregnancy-related complications. Their daughters weighed more and their children were more likely to be immunized for diphtheria, pertussis, and tetanus (DPT); polio; and measles. Child mortality (deaths before age 5) decreased by at least 20 percent in the program area compared with the nonprogram area. These exciting health improvements and reductions in fertility support previous research demonstrating the positive impact of family planning on maternal and child health and mortality reduction.
The FPMCH program is unique because of the data available to measure improvements in community and household well-being. Over time, families in the program area were more likely than the comparison group to have higher incomes, increased home value, greater savings and assets, higher educational achievement, and improved access to water. Families attained a higher quality of life when they had the opportunity to prevent pregnancies and plan and space births as desired.
Women in the program area earned more money and lived in households with greater assets than women in the comparison group. Although income typically rises with educational level, women in the program group earned considerably more than those in the comparison group—an average of an additional 450 taka for each year of schooling representing an extra six months of typical salary. The total value of assets among families and households in the program area exceeded those in the comparison group by as much as 43 percent, depending on how assets were defined. Women with access to FPMCH services through the program—especially women with higher levels of education—were more likely to:
- Own more farm land.
- Have greater investments in ponds for aquaculture and orchards for perennial crops.
- Have other forms of savings and assets that may be more profitable than farmland because they require less manual labor.
Education helps to alleviate poverty by increasing literacy and preparing students for jobs with better salaries. Education was not part of the FPMCH program, but greater family income in the program area may have helped these families benefit more from educational opportunities. Although the educational benefits varied somewhat for boys and girls, according to age and whether a girl's mother had attended school, children in the program area were generally more likely to be enrolled in school and to have achieved a higher level of education than those in the comparison group.
Improved Access to Water
Households in the program area invested more in accessible well-water over time than those in the comparison groups. Since water was more convenient to collect, women and children in those households did not have to travel to rivers or other distant sources to fetch water and carry it back. Instead, these families could spend their time focusing on earning higher incomes, obtaining and preparing food, and improving family health. Improved water source in the program area may have also contributed to fewer child deaths from water-borne diseases.
Lessons From Bangladesh
The evidence from Bangladesh demonstrates how an integrated FPMCH program contributes to the achievement of the MDGs and improved economic security for women, families, and communities. When a range of family planning services are easy to obtain, women often choose to have fewer children and invest more in their families through the accumulation of greater wealth. Family planning enables women to be healthier and have more equal opportunities to pursue an education, a career, and financial security. With fewer children to support, families can accumulate greater assets and invest more in their children's health and well-being. The relationship between smaller families and greater wealth highlights the benefit of sustained investments in family planning and maternal and child health programs as an important poverty reduction strategy.
This global dissemination effort is the first of a series supported by PRB's IDEA project, funded by USAID's Bureau for Global Health.
James Gribble is vice president of International Programs at the Population Reference Bureau. Maura Graff is a policy analyst at PRB.
- Rhonda Smith et al., Family Planning Saves Lives, 4th ed. (Washington, DC: Population Reference Bureau, 2009); Population Action International, Voluntary Family Planning: An Investment in Our World's Future (Washington, DC: Population Action International, 2006); and Ruth Levine et al., "Contraception," in Disease Control Priorities in Developing Countries, 2nd ed., ed. Dean T. Jamison et al. (New York: The World Bank and Oxford University Press, 2006).
- United Nations, "We Can End Poverty: 2010 Millennium Development Goals," accessed at www.un.org/millenniumgoals, on Sept. 27, 2010; and Willard Cates Jr. et al., "Family Planning and the Millennium Development Goals," Science 329, no. 5999 (2010): 1603.
- Shareen Joshi and T. Paul Schultz, "Family Planning as an Investment in Development Evaluation of a Program's Consequences in Matlab, Bangladesh," working paper for the Yale University Economic Growth Center (2007); and James Gribble and Maj-Lis Voss, Family Planning and Economic Well-Being: New Evidence From Bangladesh (Washington, DC: Population Reference Bureau, 2009).