TAILIEUCHUNG - Women’s Health and Pregnancy Outcomes: Do Services Make a Difference?*

The view that a midwife is the expert in normal pregnancy is not new but the context within which midwifery is practised has changed over the years. From the early 1960s the most usual place to give birth moved from being a woman’s home to hospital settings and the majority of women now give birth in hospital. In recent years larger tertiary maternity units have been developed, housing a range of specialised services, and there has also been an increase in the number of midwife-led units. Most midwives work in a hospital environment and have maintained their skills as the lead professional for healthy women with straightforward pregnancies while. | Women s Health and Pregnancy Outcomes Do Services Make a Difference March 2001 Elizabeth Frankenberg Duncan Thomas Elizabeth Frankenberg RAND 1700 Main Street Santa Monica CA 90407 E-mail efranken@. Duncan Thomas RAND and University of California at Los Angeles Email dt@. This work was supported by NICHD grants P50HD12639 R29HD32627 and P01HD28372 by NIA grant P30AG12815 and by the POLICY Project. We gratefully acknowledge the comments of Bondan Sikoki Wayan Suriastini and participants at seminars at the University of California at Los Angeles the Gadjah Mada University the University of Maryland the University of Michigan the University of Pennsylvania and the University of Washington. ABSTRACT We use data from the Indonesia Family Life Survey to investigate the impact of a major expansion in access to midwifery services on health and pregnancy outcomes for women of reproductive age. Between 1990 and 1998 Indonesia trained some 50 000 midwives. Between 1993 and 1997 these midwives tended to be placed in relatively poor communities that were relatively distant from health centers. We show that additions of village midwives to communities between 1993 and 1997 are associated with a significant increase in body mass index in 1997 relative to 1993 for women of reproductive age but not for men or for older women. The presence of a village midwife during pregnancy is also associated with increased birthweight. Both results are robust to the inclusion of community-level fixed effects a strategy that addresses many of the concerns about biases because of nonrandom program placement. Decline in mortality is among the most fundamental demographic changes experienced by developing countries over the past half-century. Today individuals are leading longer and healthier lives than did their parents and grandparents. In part these changes reflect investments in human resources by both individuals and governments. In virtually every developing country governments

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