ESSAYS ON BIRTH SPACING AND FERTILITY IN SOUTH ASIA
Open Access
- Author:
- Naz, Syeda
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- October 11, 2021
- Committee Members:
- Mary Shenk, Outside Field Member
Jeannette Rogowski, Major Field Member
Nancy Luke, Outside Unit Member
Yubraj Acharya, Chair & Dissertation Advisor
Chris Hollenbeak, Program Head/Chair - Keywords:
- Fertility
Birth Spacing
Birth Interval
Family Planning
Reproductive Health
Demographic Methods
Causal Inference - Abstract:
- This dissertation consists of three chapters. In the first chapter, I fill an important gap in the existing literature about the impact of family planning in reducing the incidence of short birth intervals. I estimate the effect of contraceptives on birth intervals by comparing the risk of pregnancy in multiple birth intervals with and without contraceptive use for the same mother using mother fixed effects. The analysis is based on 12,540 birth intervals from the reproductive calendar data provided by the Pakistan Demographic and Health Survey 2017-18. Using an event-history analysis, I find that every additional month of contraceptive use within a birth interval reduced the risk of pregnancy by 25%. The findings of this study strengthen the existing literature on the impact of contraceptives on birth spacing. I also find suggestive evidence that, in this context, a traditional family planning method withdrawal may be more effective in lengthening birth intervals than two modern contraceptives: birth control pills and condoms. While these findings need to be further investigated, the results highlight the need to focus on the optimal use of modern contraceptives to help reduce the incidence of short birth intervals which can be attained through the quality of care in family planning services. The second chapter evaluates the impact of a large five-year-long family planning project also in Pakistan. This chapter addresses an important policy question in Pakistan where the contraceptive prevalence rate has remained stagnant for almost two decades and the government’s efforts to reduce fertility—one of the highest in the South Asian region—have not been successful. The resulting high population growth has impacted various aspects of the economic, social, environmental, and political well-being of the country. I evaluate if repositioning the family planning program as a health intervention—rather than one intended to reduce family size—was effective in reducing the prevalence of short birth intervals. In a significant methodological improvement from previous studies, I generate estimates of the effect by comparing birth intervals of the same women before and after the project was implemented. I find that this intervention increased birth intervals by 2.4 months, which translates to an approximately 9.3 percent increase in birth intervals from the average. As such, the proportion of birth intervals deemed “too short” by the World Health Organization fell by approximately 7.1 percentage points. These findings, which are robust to a range of checks, suggest that birth spacing as a goal of contraceptive use resonates better with Pakistani couples than limiting family size. In third chapter, I examine fertility differentials among minority and majority religious groups in three South Asian countries: India, Bangladesh, and Nepal using the latest rounds of the Demographic and Health Surveys. I examine the question of whether minority religious groups have different fertility and reproductive health outcomes than majority religious groups by testing three key hypotheses: the particularistic theology hypothesis, the characteristics hypothesis, and the minority status hypothesis. I test the characteristics hypothesis by using a propensity score matching approach. I test the particularistic theology hypothesis by multi-country comparison of fertility and reproductive health outcomes among different minority and majority religious groups. Finally, I test the minority status hypothesis by examining the impact of the degree of minority status within a country on fertility and reproductive health outcomes measured at the district level. The results do not support the characteristics hypothesis that members of religious minorities have high fertility due to low education and low socioeconomic status. The results do, however, support the particularistic theology hypothesis that Muslims in South Asia have higher fertility than Hindus at the aggregate level, yet I also find that these results differ at the regional level. Finally, the results also support the minority status hypothesis by showing that minority status within a country or region matters for fertility and reproductive health outcomes—though the direction of the results vary across countries. Findings of higher fertility among minority religions when they are residing in districts with more than 90% of the majority religion in India; and lower fertility among minority religions in Bangladesh and Nepal when they reside in a similar setting are consistent with predictions of two different models of fertility motivations among minority groups in different sociopolitical contexts.