Suchergebnisse

In the 1990s, the Indonesian government placed over 50,000 midwives in communities throughout the country. We examine how this expansion in health services affected children's height- for-age. To address the problem that midwives were not randomly allocated to communities, the estimation exploits the biology of childhood growth, the timing of the introduction of midwives to communities, and rich longitudinal data. The evidence indicates that the nutritional status of children fully exposed to a midwife during early childhood is significantly better than that of their peers of the same age and cohort in communities without a midwife. These children are also better off than children measured at the same age from the same communities, but who were born before the midwife arrived. Within communities, the improvement in nutritional status across cohorts is greater where midwives were introduced than where they were not. This result is robust to the inclusion of community fixed-effects.

In the late 1990s, most Southeast Asian countries experienced substantial economic downturns that reduced social‐sector spending and decreased individuals' spending power. Data from Indonesia were collected in 1997 (just before the crisis) and in 1998 (during the crisis) that are used in this study to examine changes in the contraceptive supply environment and in women's choices regarding contraceptive use. Despite substantial changes in providers' characteristics during the first year of the crisis, no statistically significant differences are found between 1997 and 1998 in overall levels of prevalence, in unmet need, or in method mix. Women's choices regarding source of contraceptive supplies, however, changed considerably over the period. Changes in the contraceptive supply environment are linked here to changes in women's choice of source of supply, and a number of providers' characteristics are found to be significantly associated with women's choices in this regard.

Data from the Indonesia Family Life Survey are used to investigate the impact of a major expansion in access to midwifery services on women's use of antenatal care and delivery assistance. Between 1991 and 1998, Indonesia trained some 50,000 midwives, placing them in poor communities that were distant from health‐care centers. We analyze information from pregnancy histories to relate changes in the choices that individual women make across pregnancies to the arrival of a trained midwife in the village. We show that regardless of a woman's educational level, the placement of village midwives in communities is associated with significant increases in women's receipt of iron tablets and in their choices about care during delivery—changes that reflect their moving away from reliance on traditional birth attendants. For women with relatively low levels of education, the presence of village midwives has the additional benefit of increasing use of antenatal care during the first trimester of pregnancy. The results of the study suggest that bringing services closer to women can change their patterns of use.