Population Research and Policy Review

, Volume 24, Issue 6, pp 543–571 | Cite as

Is Maternal and Child Health Service use a Causal Gateway to Subsequent Contraceptive use?: A Multi-Country Study

  • David R. Hotchkiss
  • Jeffrey J. Rous
  • Eric E. Seiber
  • Andrés A. Berruti


The purpose of this study is to examine the relationship between MCH service utilization and contraceptive use in five countries: Bolivia, Guatemala, Indonesia, Morocco, and Tanzania. The analysis is carried out at the level of the individual woman, with contraceptive-use status modeled as a function of: (1) the availability, quality, and packaging of MCH and family planning services; (2) community- and individual-level determinants of health service and contraceptive use; and (3) intensity of prior MCH service use. Data for the analysis comes from DHS data on women of reproductive age linked with data from service-availability surveys. We use full-information, maximum-likelihood regression techniques to control for the effects of unobserved heterogeneity that might otherwise bias our estimates. In three of the five countries (Morocco, Guatemala, and Indonesia) the results of the analysis suggest that the intensity of MCH service use is positively associated with subsequent contraceptive use among women, even after controlling for observed and unobserved individual- and community-level factors. This result lends support to the proposition that, at least in the context of these three countries, the intensity of MCH service per se use does have a “causal” impact on subsequent contraceptive use, even after controlling for factors that “predispose” sample women to use health care services.


Contraceptive use Maternal and child health services Service integration 


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Copyright information

© Springer 2006

Authors and Affiliations

  • David R. Hotchkiss
    • 1
  • Jeffrey J. Rous
    • 2
  • Eric E. Seiber
    • 3
  • Andrés A. Berruti
    • 4
  1. 1.Department of International Health and DevelopmentTulane UniversityNew OrleansUSA
  2. 2.University of North TexasUSA
  3. 3.Clemson UniversityUSA
  4. 4.Tulane UniversityUSA

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