(June 2015) Over the next 15 years, public and private funders are likely to invest trillions of dollars to make progress towards the proposed Sustainable Development Goals (SDGs). These efforts must be strategic and targeted to improve the health, well-being, and standard of living for millions of people. Current and future research can inform decisionmakers about what types of investments have the potential to yield returns—and to what extent.
For the past decade, the William and Flora Hewlett Foundation and its funding partners in the United States, Europe, and Africa have supported research on the relationships between population dynamics, reproductive health, and economic development. In June 2015, the Population and Poverty (PopPov) Conference on Population, Reproductive Health, and Economic Development hosted researchers to present results that have been supported through these partnerships, as well as through other sources. The conference highlighted evidence that contributes to a better understanding of the relationships among women’s and children’s health, access to health care, and economic well-being, including education and employment, providing insight relevant to achieving the SDGs.
Investing in Women Has Economic Benefits
Findings show that investments in women’s health improve economic well-being for individuals and households. Access to appropriate health care, including family planning services, can help women and girls complete more years of education and participate in the labor force. Women with more years of education are more likely to delay marriage and childbearing and to gain the skills necessary for gainful employment than women with fewer years of education.1 Delaying childbearing was shown to improve educational and health outcomes for mothers and children (see Table).2
Teen Mother Educational Attainment, Cape Town
|Teen Mother||Nonteen Mother|
|Years of education
completed by age 20
|Percent dropping out
completed high school
by age 20
Notes: A teen mother is defined as a woman who has her first child by age 20. A nonteen
mother is defined as a woman who has her first child after age 20.
Source: Vimal Ranchhod et al., “Estimating the Effect of Adolescent Fertility on Educational
Attainment in Cape Town Using a Propensity Score Weighted Regression,” Southern Africa
Labour and Development Research Unit Working Paper 59 (2011). Mean differences are
Researchers at the University of Cape Town in South Africa and Middlebury College in the United States are investigating the impact of the National Adolescent Friendly Clinic Initiative (NAFCI) in South Africa. NAFCI-accredited clinics provide health care and sex education services to adolescents without stigma from health care providers. The study found that girls who lived near a NAFCI clinic between ages 12 and 17 were substantially less likely to experience a birth before age 18 than their counterparts who lived further from a NAFCI clinic.3 Researchers estimate that clinic access also had a positive impact on years of schooling, which may influence employment and economic outcomes.
Similarly, a Cornell University study on the impact of early childbearing on educational attainment and cognitive skills among young women in Madagascar found that, after accounting for socioeconomic household and community characteristics, young women who lived in communities where condoms were accessible were less likely than those without access to have an early pregnancy. Women who experienced delays in childbearing were found to have greater educational attainment and better cognitive skills as indicated by math and French test scores than those who had children at an earlier age.4
Investing in Women Has Positive Effects for Children
Investments in health can also have intergenerational effects, leading to improved health and educational attainment of a woman’s children. Investing in nutrition is one example. Good nutrition before and during pregnancy affects the physical and mental well-being of both mother and child.5 These, in turn, influence the ability to learn and earn.
A collaboration between the International Centre for Diarrheal Disease Research in Bangladesh, the University of Colorado, and the University of Denver investigated outcomes of the Maternal and Child Health and Family Planning (MCH-FP) program implemented in Matlab, Bangladesh 19 years after its initiation. Findings showed that MCH-FP programs—which provided services such as family planning, vaccinations, and counseling on nutrition and hygiene—improved the cognitive function and educational attainment of children living in intervention areas in late childhood.6 Future research will examine whether these improvements in human capital continue into adulthood or fade. Results on migration, women’s economic empowerment, and employment are anticipated later this year.
An analysis of data from Burkina Faso found that children’s level of educational attainment is inversely associated with the number of biological siblings living in their household.7 Family units with fewer children may be more able to invest in those children’s human and social capital.
Human Capital Investments Yield Strong Returns
Social protection efforts can support school enrollment, educational attainment, and economic empowerment. Cash transfers and youth training, for example, are efforts that have been shown to promote economic empowerment and increase human capital.
A team of researchers from Norway and Tanzania conducted a field experiment in Tanzania to understand girls’ empowerment and fertility decisionmaking. When researchers compared entrepreneurship training alone, health training alone, or entrepreneurship and health training together, they found that entrepreneurship training alone and in combination with health training were more effective approaches for girls’ economic empowerment.8 Girls who completed the entrepreneurship training (alone or in combination with the health training) were more likely to be involved in business activities and be pleased with their economic situation a year later than those who only completed the health training.
Evidence on cash transfer programs demonstrate their potential to increase school attendance and influence sexual behavior and fertility decisionmaking, affecting both health and economic outcomes.9
Overall, studies across a variety of settings indicate that investing in women often spills over to their children and households, contributing to better health outcomes, increased human capital, and the economic growth of communities.10 Investing in human capital through women’s health and education contributes to sustainable development.
- David Canning and T. Paul Schultz, “The Economic Consequences of Reproductive Health and Family Planning,” Lancet 380, no. 9837 (2012): 165-71; and David Bloom et al., “Fertility, Female Labor Force Participation, and the Demographic Dividend,” Journal of Economic Growth 14, no. 2 (2009): 79-101.
- Mahesh Karra and Marlene Lee, “Human Capital Consequences of Teenage Childbearing in South Africa” (March 2012), accessed at www.prb.org/pdf12/poppov-teen-childbearing-southafrica.pdf, on June 16, 2015.
- Nicola Branson and Tanya Byker, “Impact of a Youth-Targeted Reproductive Health Initiative on Teen Childbearing in South Africa,” working paper submitted to Population and Poverty (PopPov) conference on Population, Reproductive Health, and Economic Development,” June 24-26, 2015.
- Catalina Herrera and David E. Sahn, “The Impact of Early Childbearing on Schooling and Cognitive Skills Among Young Women in Madagascar” (January 2015), Cornell University Food and Nutrition Policy Program working paper no. 247, accessed at http://ssrn.com/abstract=2369482 orhttp://dx.doi.org/10.2139/ssrn.2369482, on June 16, 2015.
- Plamen Nikolov, “The Cognitive Link Between in Utero Nutrition and Development: Micronutrient Deficiency, Schooling Attainment, and Economic Outcomes in Tanzania,” (2012), Harvard University, accessed at http://scholar.harvard.edu/files/pnikolov/files/folic_acid-education_project_draft_paper_march_2012.pdf, on June 17, 2015; and Muhammad Farhan Majid, “The Persistent Effects of in Utero Nutrition Shocks Over the Life Cycle: Evidence from Ramadan Fasting,” Grand Challenges Canada Working Paper series, University of Pennsylvania Scholarly Commons, accessed at http://repository.upenn.edu/cgi/viewcontent.cgi?article=1004&context=gcc_economic_returns, on June 16, 2015.
- Tania Barham, “Enhancing Cognitive Functioning: Medium-Term Effects of a Health and Family Planning Program in Matlab,” American Economic Journal: Applied Economics4, no. 1 (2014): 245-73, accessed at www.colorado.edu/ibs/hb/barham/PAPERS/Barham_AEJapplied_2012.pdf, on June 16, 2015.
- Moussa Bougma, Thomas K. LeGrand, and Jean-François Kobiané, “Fertility Decline and Child Schooling in Urban Settings of Burkina Faso,” Demography 52, no.1 (2015): 281-333.
- Bertil Tungodden, “Girls’ Economic Empowerment-The Best Contraceptive? A Randomized Controlled Trial in Zambia,”accessed at http://poppov.org/Projects/2014/Girls-Economic-Empowerment.aspx, on June 16, 2015.
- Sarah Baird, Craig McIntosh, Berk Özler, “Cash or Condition? Evidence From a Cash Transfer Experiment,” The Quarterly Journal of Economics 126, no. 4 (2011): 1709-53; Damien De Walque et al., “Incentivising Safe Sex: A Randomised Trial of Conditional Cash Transfers for HIV and Sexually Transmitted Infection Prevention in Rural Tanzania,” BMJ Open 2012;2:e000747. doi:10.1136/bmjopen-2011-000747, accessed at http://cega.berkeley.edu/assets/cega_research_projects/3/Incentivising_Safe_Sex.pdf, on June 16, 2015.
- Shireen Joshi and T. Paul Schultz “Family Planning and Women’s and Children’s Health: Long-Term Consequences of an Outreach Program in Matlab, Bangladesh,” Demography 50, no. 1 (2013): 149-80; Patrick G. C. Ilboudo, Steve Russell, and Ben D’Exelle, “The Long Term Economic Impact of Severe Obstetric Complications for Women and Their Children in Burkina Faso,” PLoS One 8, no. 11 (2013); and Lori Beaman et al., “Female Leadership Raises Aspirations and Educational Attainment for Girls: A Policy Experiment in India,” Science 335, no. 6068 (2012): 582-86.