The Effects of Expanding Access to Health Services on Adult Health Status

This paper documents the impact on adult health status of expansion in access to midwifery services. In the early 1990s the Government of Indonesia began the Village Midwife (Bidan Desa) program to train midwives and place them in villages and townships throughout Indonesia. We use data from the 1993 and 1997 rounds of the Indonesia Family Life Survey. Between 1993 and 1997, the fraction of IFLS communities with a Village Midwife more than quadrupled, increasing from 10% to almost 45%. The statistical models that we estimate address the issue of non-random placement of midwives by examining change in health status as a function of whether the community gained (or lost) a Village Midwife. We measure health status as Body Mass Index (BMI), which is a standard measure of adult nutritional status. Our results show that for women under 50, increases in BMI were significantly more likely among those who lived in communities that gained a Village Midwife. Gaining a village midwife appears to have had no impact on men’s health status or on the health status women over 50. Among women under 50, the largest effects of gaining a Village Midwife on BMI are observed for women in the lower quartile of the BMI distribution in 1993, for relatively younger women, and for women with relatively more education. In combination the results suggest that efforts of the Ministry of Health to rapidly expand access to midwifery services has had a pay off in terms of the health status of women of reproductive age.[]

*Klik untuk mengunduh makalah: Seminar Bulanan S.288 – Elizabeth Frankenberg, Duncan Thomas | 19 Februari 2000