Use of modern medical care for pregnancy and childbirth care : does female schooling matter ?
AbstractControversy exists over whether the estimated effects of schooling on health care use reflect the influence of unobserved factors. Existing estimates may overstate the schooling effect because of the failure to control for unobserved variables or may be downwardly biased due to measurement error. This paper contributes to the resolution of this debate by adopting an instrumental variable approach to estimate the impact of female schooling on maternal health care use. A school construction program in Indonesia in the 1970s is used to construct an instrumental variable for education. The choice between use and non-use of maternal health services is estimated as a function of schooling and other variables. Data from the Indonesia Family Life Survey are used for this paper. Standard regression models estimated in the paper indicate that each additional year of schooling does indeed have a significant, positive effect on maternal health care use. Instrumental variable estimates of the schooling effect are larger. The results suggest that schooling has a positive impact on maternal health care use even after eliminating the effect of unobserved variables and measurement error. This paper moves beyond previous work on the impact of education on health care use by adopting an IV approach to address the problem of endogeneity and measurement error. IV methods have been used widely in the labour economics literature to examine the impact of schooling on wages and other labour market outcomes but rarely to estimate the effect of schooling on health outcomes.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
Bibliographic InfoPaper provided by The World Bank in its series Policy Research Working Paper Series with number 4625.
Date of creation: 01 May 2008
Date of revision:
Health Monitoring&Evaluation; Population Policies; Health Systems Development&Reform; Gender and Health; Primary Education;
This paper has been announced in the following NEP Reports:
- NEP-ALL-2008-09-13 (All new papers)
- NEP-DEV-2008-09-13 (Development)
- NEP-HEA-2008-09-13 (Health Economics)
- NEP-SEA-2008-09-13 (South East Asia)
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Panis, Constantijn W. A. & Lillard, Lee A., 1994.
"Health inputs and child mortality: Malaysia,"
Journal of Health Economics,
Elsevier, vol. 13(4), pages 455-489.
- Akin, John S, et al, 1986. "The Demand for Primary Health Care Services in the Bicol Region of the Philippines," Economic Development and Cultural Change, University of Chicago Press, vol. 34(4), pages 755-82, July.
- Cleland, John G. & van Ginneken, Jerome K., 1988. "Maternal education and child survival in developing countries: The search for pathways of influence," Social Science & Medicine, Elsevier, vol. 27(12), pages 1357-1368, January.
- Lucia Breierova & Esther Duflo, 2003.
"The Impact of Education on Fertility and Child Mortality: Do Fathers Really Matter Less Than Mothers?,"
OECD Development Centre Working Papers
217, OECD Publishing.
- Lucia Breierova & Esther Duflo, 2004. "The Impact of Education on Fertility and Child Mortality: Do Fathers Really Matter Less Than Mothers?," NBER Working Papers 10513, National Bureau of Economic Research, Inc.
- Behrman, Jere R. & Wolfe, Barbara L., 1987. "How does mother's schooling affect family health, nutrition, medical care usage, and household sanitation?," Journal of Econometrics, Elsevier, vol. 36(1-2), pages 185-204.
- Mwabu, Germano M., 1986. "Health care decisions at the household level: Results of a rural health survey in Kenya," Social Science & Medicine, Elsevier, vol. 22(3), pages 315-319, January.
- Strauss, John, 1990. "Households, Communities, and Preschool Children's Nutrition Outcomes: Evidence from Rural Cote d'Ivoire," Economic Development and Cultural Change, University of Chicago Press, vol. 38(2), pages 231-61, January.
- Sonalde Desai & Soumya Alva, 1998. "Maternal education and child health: Is there a strong causal relationship?," Demography, Springer, vol. 35(1), pages 71-81, February.
- Lavy, V & Strauss, J & Thomas, D & de Vreyer, P, 1996.
"Quality of Health Care, Survivial and Health Outcomes in Ghana,"
96-20, RAND - Reprint Series.
- Lavy, Victor & Strauss, John & Thomas, Duncan & de Vreyer, Philippe, 1996. "Quality of health care, survival and health outcomes in Ghana," Journal of Health Economics, Elsevier, vol. 15(3), pages 333-357, June.
- Schwartz, J Brad & Akin, John S & Popkin, Barry M, 1988. "Price and Income Elasticities of Demand for Modern Health Care: The Case of Infant Delivery in the Philippines," World Bank Economic Review, World Bank Group, vol. 2(1), pages 49-76, January.
- Hossain, Shaikh I., 1989. "Effect of public programs on family size, child education and health," Journal of Development Economics, Elsevier, vol. 30(1), pages 145-158, January.
- Michael Grossman, 1972. "The Demand for Health: A Theoretical and Empirical Investigation," NBER Books, National Bureau of Economic Research, Inc, number gros72-1, December.
- Gertler, Paul & Locay, Luis & Sanderson, Warren, 1987.
"Are user fees regressive? : The welfare implications of health care financing proposals in Peru,"
Journal of Econometrics,
Elsevier, vol. 36(1-2), pages 67-88.
- Paul J. Gertler & Luis Locay & Warren C. Sanderson, 1987. "Are User Fees Regressive? The Welfare Implications of Health Care Financing Proposals in Peru," NBER Working Papers 2299, National Bureau of Economic Research, Inc.
- Rosenzweig, Mark R. & Wolpin, Kenneth I., 1984.
"Migration Selectivity and the Effects of Public Programs,"
8442, University of Minnesota, Economic Development Center.
- Rosenzweig, Mark R. & Wolpin, Kenneth I., 1988. "Migration selectivity and the effects of public programs," Journal of Public Economics, Elsevier, vol. 37(3), pages 265-289, December.
- Strauss, John & Thomas, Duncan, 1995. "Human resources: Empirical modeling of household and family decisions," Handbook of Development Economics, in: Hollis Chenery & T.N. Srinivasan (ed.), Handbook of Development Economics, edition 1, volume 3, chapter 34, pages 1883-2023 Elsevier.
- Bicego, George T. & Ties Boerma, J., 1993. "Maternal education and child survival: A comparative study of survey data from 17 countries," Social Science & Medicine, Elsevier, vol. 36(9), pages 1207-1227, May.
- Gertler, Paul & Rahman, Omar & Feifer, Chris & Ashley, Deanna, 1993. "Determinants of pregnancy outcomes and targeting of maternal health services in Jamaica," Social Science & Medicine, Elsevier, vol. 37(2), pages 199-211, July.
- Barrera, Albino, 1990. "The role of maternal schooling and its interaction with public health programs in child health production," Journal of Development Economics, Elsevier, vol. 32(1), pages 69-91, January.
- Wolfe, Barbara L. & Behrman, Jere R., 1982. "Determinants of child mortality, health, and nutrition in a developing country," Journal of Development Economics, Elsevier, vol. 11(2), pages 163-193, October.
- Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-55, March-Apr.
- Guilkey, David K. & Riphahn, Regina T., 1998. "The determinants of child mortality in the Philippines: estimation of a structural model," Journal of Development Economics, Elsevier, vol. 56(2), pages 281-305, August.
- Wong, Emelita L. & Popkin, Barry M. & Guilkey, David K. & Akin, John S., 1987. "Accessibility, quality of care and prenatal care use in the Philippines," Social Science & Medicine, Elsevier, vol. 24(11), pages 927-944, January.
- Wolfe, Barbara L & Behrman, Jere R, 1984. "Determinants of Women's Health Status and Health-Care Utilization in a Developing Country: A Latent Variable Approach," The Review of Economics and Statistics, MIT Press, vol. 66(4), pages 696-703, November.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Roula I. Yazigi).
If references are entirely missing, you can add them using this form.