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Reducing the Cost of Remoteness: Community-Based Health Interventions and Fertility Choices

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  • Herrera-Almanza, Catalina
  • Rosales-Rueda, Maria F.

Abstract

Distance to health centers can represent a significant healthcare cost for poor households. Community-based health interventions and community health workers can be an alternative to deficient formal health care provision among remote populations. We analyze the effects on fertility outcomes of a large-scale community-based health worker program that aims to reach remote areas distant from health facilities in Madagascar. We use a triple difference model that exploits time and geographic variation in the program rollout and the geocoded household distance to the closest health facility. Our findings indicate that the program decreased the probability of conception among women in treated areas but did not have a differential effect among women living in remote areas. A potential mechanism underlying this fertility reduction is that the program increased women’s modern contraceptive use.

Suggested Citation

  • Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2020. "Reducing the Cost of Remoteness: Community-Based Health Interventions and Fertility Choices," Journal of Health Economics, Elsevier, vol. 73(C).
  • Handle: RePEc:eee:jhecon:v:73:y:2020:i:c:s0167629619309452
    DOI: 10.1016/j.jhealeco.2020.102365
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 5th October 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-10-05 11:00:05

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    1. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2023. "Community-based health programs and child vaccinations: Evidence from Madagascar," World Development, Elsevier, vol. 170(C).
    2. Bancalari, Antonella & Berlinski, Samuel & Buitrago, Giancarlo & García, María Fernanda & de la Mata, Dolores & Vera-Hernandez, Marcos, 2023. "Health inequalities in Latin American and the Caribbean: child, adolescent, reproductive, metabolic syndrome and mental health," LSE Research Online Documents on Economics 120559, London School of Economics and Political Science, LSE Library.
    3. Bancalari, Antonella & Bernal, Pedro & Celhay, Pablo & Martinez, Sebastian & Sánchez, Maria Deni, 2023. "An Ounce of Prevention for a Pound of Cure: Efficiency of Community-Based Healthcare," IZA Discussion Papers 16350, Institute of Labor Economics (IZA).
    4. Bancalari, Antonella & Bernal, Pedro & Celhay, Pablo & Martinez, Sebastian & Sánchez, María Deni, 2024. "An Ounce of Prevention for a Pound of Cure: Basic Health Care and Efficiency in Health Systems," IDB Publications (Working Papers) 13433, Inter-American Development Bank.

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    More about this item

    Keywords

    Community Health Workers; Cost of Remoteness; Fertility; Africa;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I - Health, Education, and Welfare
    • J13 - Labor and Demographic Economics - - Demographic Economics - - - Fertility; Family Planning; Child Care; Children; Youth
    • O15 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Economic Development: Human Resources; Human Development; Income Distribution; Migration

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