Thirty-Five Years Later: Long-Term Effects of the Matlab Maternal and Child Health / Family Planning Program on Older Women's Well-Being

Background Family planning programs are widely believed to have substantial long-term benefits for women’s health and well-being, yet longitudinal studies are rare and mechanisms of impact are complex. We evaluated the effects of an in-home maternal and child health / family planning (MCH/FP) program in Matlab, Bangladesh on women’s lifetime fertility, adult health, and economic production 35 years after program initiation. Methods In 1977, women were assigned to treatment and comparison areas that were similar across most baseline characteristics. Comparable services were added to the comparison area from 1989. We followed 1,820 women born 1938-1973 from a census in 1974 to surveys in 1996 hand 2012-14. We estimated single-difference models of program impact using an intent-to-treat design with controls for baseline characteristics and potential confounders. Findings We found significant impacts on contraception, completed fertility and birth timing in aggregate and cohort-stratified models. We observed no significant positive impacts on health or economic production. Aggregate models found modest effects on poorer overall health (+0.07 SD) and respiratory health (+0.12 SD). Among women born 1950-1961, we observed poorer overall health (+0.11 SD) and metabolic health (+0.15 SD). For the 1950-1961 cohort, we observed significant increases in BMI in 1996 (0 · 76 kg/m2) and 2012 (0 · 57 kg/m2), along with a +2.5 kg/m2 secular change in BMI. As a result, treated women had a lower risk of underweight in 1996, but a higher risk of being overweight or obese in 2012. Interpretation: We found no long-term health or economic benefits of an in-home MCH/FP program. We observed modest negative health impacts among treated women that likely reflected an accelerated nutritional transition among treated women. Our findings suggest that we should not expect significant secondary health benefits from programs aimed at fertility reduction. Funding: This study was funded and supported by the US National Institute on Aging, the International Initiative for Impact Evaluation (3ie) and the Population Reference Bureau. Declaration of Interests: The authors have no conflicts of interest to report. Ethics Approval Statement: Protection of human participants during fieldwork and data analysis was ensured under icddr,b Ethical Review Committee Protocol #PR-10005.