Demography

, Volume 44, Issue 4, pp 747–770 | Cite as

The spread of health services and fertility Transition

  • Sarah R. Brauner-Otto
  • William G. Axinn
  • Dirgha J. Ghimire
Article

Abstract

We use detailed measures of social change over time, increased availability of various health services, and couples’ fertility behaviors to document the independent effects of health services on fertility limitation. Our investigation focuses on a setting in rural Nepal that experienced a transition from virtually no use of birth control in 1945 to the widespread use of birth control by 1995 to limit fertility. Changes in the availability of many different dimensions of health services provide the means to evaluate their independent influences on contraceptive use to limit childbearing. Findings show that family planning as well as maternal and child health services have independent effects on the rate of ending childbearing. For example, the provision of child immunization services increases the rate of contraceptive use to limit fertility independently of family planning services. Additionally, new Geographic Information System (GIS)-based measures also allow us to test many alternative models of the spatial distribution of services. These tests reveal that complex, geographically defined measures of all health service providers outperform more simple measures. These results provide new information about the consequences of maternal and child health services and the importance of these services in shaping fertility transitions.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Acharya, M. and L. Bennett. 1981. Rural Women of Nepal: An Aggregate Analysis and Summary of Eight Village Studies. Kathmandu: Tribhuvan University.Google Scholar
  2. Allison, P.D. 1982. “Discrete-Time Methods for the Analysis of Event Histories.” Sociological Methodology 13:61–98.CrossRefGoogle Scholar
  3. —. 1984. Event History Analysis. Newbury Park, CA: Sage Publishing.Google Scholar
  4. Angeles, G., D.K. Guilkey, and T.A. Mroz. 1998. “Purposive Program Placement and the Estimation of Family Planning Program Effects in Tanzania.” Journal of the American Statistical Association 93(443):884–99.CrossRefGoogle Scholar
  5. Arends-Kuenning, M. 2001. “How Do Family Planning Workers’ Visits Affect Women’s Contraceptive Behavior in Bangladesh?” Demography 38:481–96.CrossRefGoogle Scholar
  6. Axinn, W.G. 1992a. “Family Organization and Fertility Limitation in Nepal.” Demography 29:503–21.CrossRefGoogle Scholar
  7. —. 1992b. “Rural Income-Generating Programs and Fertility Limitation: Evidence From a Microdemographic Study in Nepal.” Rural Sociology 57:396–413.CrossRefGoogle Scholar
  8. Axinn, W.G. and J.S. Barber. 2001. “Mass Education and Fertility Transition.” American Sociological Review 66:481–505.CrossRefGoogle Scholar
  9. Axinn, W.G., J.S. Barber, and D.J. Ghimire. 1997. “The Neighborhood History Calendar: A Data Collection Method Designed for Dynamic Multilevel Modeling.” Sociological Methodology 27:355–92.CrossRefGoogle Scholar
  10. Axinn, W.G., L.D. Pearce, and D.J. Ghimire. 1999. “Innovations in Life History Calendar Applications.” Social Science Research 28:243–64.CrossRefGoogle Scholar
  11. Axinn, W.G. and S.T. Yabiku. 2001. “Social Change, the Social Organization of Families, and Fertility Limitation.” American Journal of Sociology 106:1219–61.CrossRefGoogle Scholar
  12. Barber, J.S. and W.G. Axinn. 2004. “New Ideas and Fertility Limitation: The Role of Mass Media.” Journal of Marriage and Family 66:1180–200.CrossRefGoogle Scholar
  13. Barber, J.S., S.A. Murphy, W.G. Axinn, and J. Maples. 2000. “Discrete-Time Multilevel Hazard Analysis.” Sociological Methodology 30:201–35.CrossRefGoogle Scholar
  14. Barber, J.S., S.A. Murphy, and N. Verbitsky. 2004. “Adjusting for Time-Varying Confounding in Survival Analysis.” Sociological Methodology 34:163–92.CrossRefGoogle Scholar
  15. Becker, G.S. 1981. A Treaties on the Family. Cambridge, MA: Harvard University Press.Google Scholar
  16. Billy, J.O.G., K.L. Brewster, and W.R. Grady. 1994. “Contextual Effects on the Sexual Behavior of Adolescent Women.” Journal of Marriage and the Family 56:387–404.CrossRefGoogle Scholar
  17. Bista, D.B. 1972. People of Nepal. Kathmandu: Ratna Pustak Bhandar.Google Scholar
  18. Boardman, J.D. and S.H. Field. 2002. “Spatial Mismatch and Race Differentials in Male Joblessness: Cleveland and Milwaukee, 1990.” Sociological Quarterly 43:237–55.CrossRefGoogle Scholar
  19. Bongaarts, J. and J. Menken. 1983. “The Supply of Children: A Critical Essay.” Pp. 27–60 in Determinants of Fertility in Developing Countries, Vol. 1, edited by R.A. Bulatao and R.D. Lee. New York: Academic Press.Google Scholar
  20. Brewster, K.L., J.O.G. Billy, and W.R. Grady. 1993. “Social Context and Adolescent Behavior: The Impact of Community on the Transition to Sexual Activity.” Social Forces 71:713–40.CrossRefGoogle Scholar
  21. Brooks-Gunn, J., G.J. Duncan, P.K. Klebanov, and N. Sealand. 1993. “Do Neighborhoods In uence Child and Adolescent Development?” American Journal of Sociology 99:353–95.CrossRefGoogle Scholar
  22. Browning, C.R., T. Leventhal, and J. Brooks-Gunn. 2004. “Neighborhood Context and Racial Differences in Early Adolescent Sexual Activity.” Demography 41:697–720.CrossRefGoogle Scholar
  23. Bulatao, R.A. and R.D. Lee. 1983. Determinants of Fertility in Developing Countries. New York: Academic Press.Google Scholar
  24. Buor, D. 2002. “Distance As a Predominant Factor in the Utilization of Health Services in the Kumasi Metropolis, Ghana.” GeoJournal 56:145–57.CrossRefGoogle Scholar
  25. —. 2003. “Analysing the Primacy of Distance in the Utilization of Health Services in the Ahafo-Ano South District, Ghana.” International Journal of Health Planning and Management 18:293–311.CrossRefGoogle Scholar
  26. Caldwell, J.C. 1982. Theory of Fertility Decline. New York: Academic Press.Google Scholar
  27. —. 1986. “Routes to Low Mortality in Poor Countries.” Population and Development Review 12:171–220.CrossRefGoogle Scholar
  28. Caldwell, J.C., P.H. Reddy, and P. Caldwell. 1988. The Causes of Demographic Change: Experimental Evidence Research in South India. Madison: University of Wisconsin Press.Google Scholar
  29. Casterline, J.B. 1985. The Collection and Analysis of Community Data. Voorburg, Netherlands: International Statistics Institute.Google Scholar
  30. —. 2001. “Diffusion Processes and Fertility Transition: Introduction.” Pp. 1–16 in Diffusion Processes and Fertility Transition, edited by J.B. Casterline. Washington, DC: National Academy Press.Google Scholar
  31. Casterline, J.B. and S.W. Sinding. 2000. “Unmet Need for Family Planning in Developing Countries and Implications for Population Policy.” Population and Development Review 26:691–723.CrossRefGoogle Scholar
  32. Chen, L.C. 1983. “Child Survival: Levels, Trends, and Determinants.” Pp. 199–232 in Determinants of Fertility in Developing Countries, Vol. 1, edited by R.A. Bulatao and R.D. Lee. New York: Academic Press.Google Scholar
  33. Cleland, J. and J. Hobcraft. 1985. Reproductive Change in Developing Countries: Insights From the World Fertility Survey. Oxford: Oxford University Press.Google Scholar
  34. Coale, A.J. 1973. “The Demographic Transition.” International Union for the Scientific Study of Population, International Population Conference 1:53–72.Google Scholar
  35. Coale, A.J. and S.C. Watkins, eds. 1986. The Decline of Fertility in Europe. Princeton, NJ: Princeton University Press.Google Scholar
  36. Downey, L. 2006. “Using Geographic Information Systems to Reconceptualize Spatial Relationships and Ecological Context.” American Journal of Sociology 112:567–612.CrossRefGoogle Scholar
  37. Easterlin, R. and E. Crimmins. 1985. “Theoretical Framework.” Pp. 12–31 in The Fertility Revolution: A Supply-Demand Analysis, edited by R.A. Easterlin and E.M. Crimmins. Chicago: University of Chicago Press.Google Scholar
  38. Entwisle, B. and W.M. Mason. 1985. “Multilevel Effects of Socioeconomic Development and Family Planning Programs on Children Ever Born.” American Journal of Sociology 91:616–49.CrossRefGoogle Scholar
  39. Entwisle, B., R.R. Rindfuss, D.K. Guilkey, A. Chamratrithirong, S.R. Curran, and Y. Sawangdee. 1996. “Community and Contraceptive Choice in Rural Thailand: A Case Study of Nang Rong.” Demography 33:1–11.CrossRefGoogle Scholar
  40. Entwisle, B., R.R. Rindfuss, S.J. Walsh, T.P. Evans, and S.R. Curran. 1997. “Geographic Information Systems, Spatial Network Analysis, and Contraceptive Choice.” Demography 34:171–87.CrossRefGoogle Scholar
  41. Foster, S.O. 1984. “Immunizable and Respiratory Diseases and Child Mortality.” Population and Development Review 10(Suppl.: Child Survival: Strategies for Research):119–40.CrossRefGoogle Scholar
  42. Frankenberg, E. and D. Thomas. 2001. “Women’s Health and Pregnancy Outcomes: Do Services Make a Difference?” Demography 38:253–365.CrossRefGoogle Scholar
  43. Freedman, R. 1979. “Theories of Fertility Decline: A Reappraisal.” Social Forces 58:1–17.CrossRefGoogle Scholar
  44. —. 1997. “Do Family Planning Programs Affect Fertility Preferences? A Literature Review.” Studies in Family Planning 28(1):1–13.CrossRefGoogle Scholar
  45. Freedman, R. and J.Y. Takeshita. 1969. Family Planning in Taiwan: An Experiment in Social Change. Princeton, NJ: Princeton University Press.Google Scholar
  46. Fricke, T.E. 1986. Himalayan Households: Tamang Demography and Domestic Processes. Ann Arbor, MI: UMI Research Press.Google Scholar
  47. Gertler, P.J. and J.W. Molyneaux. 1994. “How Economic-Development and Family-Planning Programs Combined to Reduce Indonesian Fertility.” Demography 31:33–63.CrossRefGoogle Scholar
  48. Gurung, H.B. 1980. Vignettes of Nepal. Kathmandu: Sajha Prakashan.Google Scholar
  49. Hermalin, A. and B. Entwisle. 1987. “The Availability and Accessibility of Contraceptive Services.” Pp. 583–96 in Organizing for Effective Family Planning Programs, edited by R. Lapham and G.B. Simmons. Washington, DC: National Academy Press.Google Scholar
  50. Hernandez, D.J. 1981. “A Note on Measuring the Independent Impact of Family Planning Programs on Fertility Declines.” Demography 18:627–34.CrossRefGoogle Scholar
  51. Hogan, D.P. and E.M. Kitagawa. 1985. “The Impact of Social Status, Family Structure, and Neighborhood on the Fertility of Black Adolescents.” American Journal of Sociology 90: 825–55.CrossRefGoogle Scholar
  52. Justice, J. 1986. Polices, Plans and People: Culture and Health Development in Nepal. Berkeley: University of California Press.Google Scholar
  53. Knodel, J., A. Chamratrithirong, and N. Debavalya. 1987. Thailand’s Reproductive Revolution: Rapid Fertility Decline in a Third-World Setting. Madison: University of Wisconsin Press.Google Scholar
  54. Koenig, M.A., J.F. Phillips, R.S. Simmons, and M.A. Khan. 1987. “Trends in Family-Size Preferences and Contraceptive Use in Matlab, Bangladesh.” Studies in Family Planning 18(3):117–27.CrossRefGoogle Scholar
  55. Lesthaeghe, R. and J. Surkyn. 1988. “Cultural Dynamics and Economic Theories of Fertility Change.” Population and Development Review 14(1):1–45.CrossRefGoogle Scholar
  56. Lloyd, C.B. and S. Ivanov. 1988. “The Effects of Improved Child Survival on Family Planning Practice and Fertility.” Studies in Family Planning 19(3):141–61.CrossRefGoogle Scholar
  57. Mason, K.O. 1987. “The Impact of Women’s Social Position on Fertility in Developing Countries.” Sociological Forum 2:718–45.CrossRefGoogle Scholar
  58. —. 1997. “Explaining Fertility Transitions.” Demography 34:443–54.CrossRefGoogle Scholar
  59. —. 2001. “Gender and Family Systems in the Fertility Transition.” Population and Development Review 27(Global Fertility Transition supplement):160–76.Google Scholar
  60. Massey, D.S. and K.E. Espinosa. 1997. “What’s Driving Mexico-U.S. Migration? A Theoretical, Empirical, and Policy Analysis.” American Journal of Sociology 102:939–99.CrossRefGoogle Scholar
  61. Ministry of Health. 1977. Nepal Fertility Survey 1976. Kathmandu: His Majesty’s Government and World Fertility Survey/Nepal Project.Google Scholar
  62. —. 2004. Annual Report. Kathmandu: His Majesty’s Government, Ministry of Health, Department of Health Services.Google Scholar
  63. Montgomery, M.R. 2000. “Perceiving Mortality Decline.” Population and Development Review 26:795–819.CrossRefGoogle Scholar
  64. Morenoff, J.D., R.J. Sampson, and S.W. Raudenbush. 2001. “Neighborhood Inequality, Collective Efficacy, and the Spatial Dynamics of Urban Violence.” Criminology 39:517–59.CrossRefGoogle Scholar
  65. Muhuri, P.K. 1995. “Health Programs, Maternal Education, and Differential Child Mortality in Mat-lab, Bangladesh.” Population and Development Review 21:813–34.CrossRefGoogle Scholar
  66. Nepal South Asia Center. 1998. Nepal Human Development Report 1998. Kathmandu, Nepal: Nepal South Asia Center.Google Scholar
  67. Palmore, J. and R. Freedman. 1969. “Perceptions of Contraceptive Practice By Others: Effects on Acceptance.” Pp. 224–40 in Family Planning in Taiwan: An Experiment in Social Change, edited by R. Freedman and J.Y. Takeshita. Princeton, NJ: Princeton University Press.Google Scholar
  68. Pebley, A.R. 1984. “Intervention Projects and the Study of Socioeconomic Determinants of Mortality.” Population and Development Review 10(Suppl.: Child Survival: Strategies for Research): 281–305.CrossRefGoogle Scholar
  69. Petersen, T. 1986. “Estimating Fully Parametric Hazard Rate Models With Time-Dependent Covariates: Use of Maximum Likelihood.” Sociological Methods and Research 14:219–46.CrossRefGoogle Scholar
  70. —. 1991. “The Statistical Analysis of Event Histories.” Sociological Methods and Research 19:270–323.CrossRefGoogle Scholar
  71. Phillips, J.F., W.S. Stinson, S. Bhatia, M. Rahman, and J. Chakraborty. 1982. “The Demographic Impact of the Family Planning—Health Services Project in Matlab, Bangladesh.” Studies in Family Planning 13(5):131–40.CrossRefGoogle Scholar
  72. Raudenbush, S.W. 1988. “Educational Applications of Hierarchical Linear Models: A Review.” Journal of Educational Statistics 13:85–116.CrossRefGoogle Scholar
  73. Sandberg, J. 2002. “Child Mortality, Family Building and Social Learning in a Nepalese Mountain Community.” Ph.D. dissertation. Department of Sociology, The University of Michigan, Ann Arbor, MI.Google Scholar
  74. —. 2006. “Infant Mortality, Social Networks, and Subsequent Fertility.” American Sociological Review 71:288–309.CrossRefGoogle Scholar
  75. Sastry, N. 1996. “Community Characteristics, Individual and Household Attributes, and Child Survival in Brazil.” Demography 33:211–29.CrossRefGoogle Scholar
  76. South, S.J. and K.D. Crowder. 1997. “Escaping Distressed Neighborhoods: Individual, Community, and Metropolitan In uences.” American Journal of Sociology 102:1040–84.CrossRefGoogle Scholar
  77. Stash, S. 1999. “Explanations of Unmet Need for Contraception in Chitwan, Nepal.” Studies in Family Planning 30:267–87.CrossRefGoogle Scholar
  78. Suvedi, B.K. 2003. “Immunization Programme of Nepal: An Update.” Kathmandu University Medical Journal 2(3):238–43.Google Scholar
  79. Thornton, A. 2005. Reading History Sideways: The Fallacy and Enduring Impact of the Developmental Paradigm on Family Life. Chicago: University of Chicago Press.Google Scholar
  80. Thornton, A. and H.-S. Lin. 1994. Social Change and the Family in Taiwan. Chicago: University of Chicago Press.Google Scholar
  81. Tuladhar, J.M. 1989. The Persistence of High Fertility in Nepal. New Dehli: Inter-India Publications.Google Scholar
  82. United Nations Population Fund. 1989. South Asia Study on Population Policies and Programmes: Nepal. United Nations.Google Scholar
  83. Whyte, M.K. and W.L. Parish. 1984. Urban Life in Contemporary China. Chicago: University of Chicago Press.Google Scholar
  84. Yabiku, S.T. 2004. “Marriage Timing in Nepal: Organizational Effects and Individual Mechanisms.” Social Forces 83:559–86.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2007

Authors and Affiliations

  • Sarah R. Brauner-Otto
    • 1
  • William G. Axinn
    • 2
  • Dirgha J. Ghimire
    • 2
  1. 1.Carolina Population CenterUniversity of North Carolina at Chapel Hill, CB# 8120, University SquareChapel Hill
  2. 2.Institute for Social ResearchUniversity of MichiganUSA

Personalised recommendations