State of World Population 2012 - UNFPA Haiti

childhood. It has increased in recent decades inpopulations where per capita national incomehas increased and public health activities havegrown. A study from the Laguna province ofthe Philippines that collected information onheights, weights and exposure to family planningprogrammes between 1975 and 1979 foundthat exposure to health programmes and familyplanning programmes improved children’sheight-for-age as well as weight-for-age. Theirestimates indicate that the height of a childfor whom no health clinic existed would be5 per cent below that for a child always exposedto a clinic, while exposure to a family planningclinic increases height by 7 per cent.Another important mechanism linkingimproved family planning services and earlychildhoodhealth is the improvement inmaternal nutrition that occurs as a result ofbetter-spaced and fewer overall pregnancies.A vast literature in medicine, public health andthe social sciences now argues that improvedmaternal nutrition plays a critical role in childdevelopment. Many studies show that maternalunder-nutrition—as measured by stunting,wasting, chronic energy deficiencies, essentialmicronutrient deficiencies and body massindexes below 18.5 are associated with increasedrisk of intrauterine growth retardation as well ascomplications at birth and birth defects (Bhuttaet al., 2008). Poor foetal growth can contributeindirectly to neonatal deaths, particularly thosedue to birth asphyxia and infections (sepsis,pneumonia, and diarrhoea), which togetheraccount for more than half of neonatal deathsin the world today.Declines in fertility and improvements inmaternal health are known to be associated withhealthier babies with higher birth weights andlower risks of neonatal death. This was seen incommunity-sampled prospective birth cohortsin Nepal, India, Pakistan and Brazil. The studyfound that infants born at term weighing 1500–1999 grams were 8.1 times more likely to die,while those weighing 2000–2499 grams were2.8 times more likely to die from all causesduring the neonatal period than were thoseweighing more than 2499 grams at birth(Bhutta et al., 2008).Children’s schoolingImproved reproductive health and access to familyplanning can also affect investment in humancapital in children. This occurs through severalchannels. Increases in life expectancy create newincentives and opportunities for investmentsin schooling. Moreover, improved reproductivehealth improves overall health of mothers duringpregnancy, which has favourable impacts on children’scognitive development. Finally, declinesin fertility free up women’s resources and allowthem to increase investments in schooling fortheir children.The best evidence for the relationship betweenfertility decline, improved reproductive healthand children’s schooling again comes fromMatlab, Bangladesh. Declines in fertility andimproved maternal health not only increasedinvestment in the schooling of children butalso impacted the trade-offs between children’sschooling and labour (Sinha, 2003; Joshi andSchultz, 2007; Schultz, 2010). There is alsoevidence that the programme also positivelyimpacted children’s test scores and cognitivedevelopment (Barham, 2009).Children’s future labour force participationDeclines in a mother’s fertility, improvements inher health and greater investments in children’shuman capital should ultimately impact theirparticipation in the labour force. While thislink is intuitive and appears to be obvious,78 CHAPTER 4: THE SOCIAL AND ECONOMIC IMPACT OF FAMILY PLANNING