State of World Population 2012 - Country Page List - UNFPA

childhood. It has increased in recent decades in
populations where per capita national income
has increased and public health activities have
grown. A study from the Laguna province of
the Philippines that collected information on
heights, weights and exposure to family planning
programmes between 1975 and 1979 found
that exposure to health programmes and family
planning programmes improved children’s
height-for-age as well as weight-for-age. Their
estimates indicate that the height of a child
for whom no health clinic existed would be
5 per cent below that for a child always exposed
to a clinic, while exposure to a family planning
clinic increases height by 7 per cent.
Another important mechanism linking
improved family planning services and earlychildhood
health is the improvement in
maternal nutrition that occurs as a result of
better-spaced and fewer overall pregnancies.
A vast literature in medicine, public health and
the social sciences now argues that improved
maternal nutrition plays a critical role in child
development. Many studies show that maternal
under-nutrition—as measured by stunting,
wasting, chronic energy deficiencies, essential
micronutrient deficiencies and body mass
indexes below 18.5 are associated with increased
risk of intrauterine growth retardation as well as
complications at birth and birth defects (Bhutta
et al., 2008). Poor foetal growth can contribute
indirectly to neonatal deaths, particularly those
due to birth asphyxia and infections (sepsis,
pneumonia, and diarrhoea), which together
account for more than half of neonatal deaths
in the world today.
Declines in fertility and improvements in
maternal health are known to be associated with
healthier babies with higher birth weights and
lower risks of neonatal death. This was seen in
community-sampled prospective birth cohorts
in Nepal, India, Pakistan and Brazil. The study
found that infants born at term weighing 1500–
1999 grams were 8.1 times more likely to die,
while those weighing 2000–2499 grams were
2.8 times more likely to die from all causes
during the neonatal period than were those
weighing more than 2499 grams at birth
(Bhutta et al., 2008).
Children’s schooling
Improved reproductive health and access to family
planning can also affect investment in human
capital in children. This occurs through several
channels. Increases in life expectancy create new
incentives and opportunities for investments
in schooling. Moreover, improved reproductive
health improves overall health of mothers during
pregnancy, which has favourable impacts on children’s
cognitive development. Finally, declines
in fertility free up women’s resources and allow
them to increase investments in schooling for
their children.
The best evidence for the relationship between
fertility decline, improved reproductive health
and children’s schooling again comes from
Matlab, Bangladesh. Declines in fertility and
improved maternal health not only increased
investment in the schooling of children but
also impacted the trade-offs between children’s
schooling and labour (Sinha, 2003; Joshi and
Schultz, 2007; Schultz, 2010). There is also
evidence that the programme also positively
impacted children’s test scores and cognitive
development (Barham, 2009).
Children’s future labour force participation
Declines in a mother’s fertility, improvements in
her health and greater investments in children’s
human capital should ultimately impact their
participation in the labour force. While this
link is intuitive and appears to be obvious,
78 CHAPTER 4: THE SOCIAL AND ECONOMIC IMPACT OF FAMILY PLANNING