Effects of the World Bank's Maternal and Child Health Intervention on Indonesia's Poor: Evaluating the Safe Motherhood Project

Abstract:     
This paper examines the impact of the World Bank’s Safe Motherhood Project (SMP) on health outcomes for Indonesia’s poor. Provincial data from 1990-2005 was analyzed using a difference-in-differences approach in multivariate regression analysis, with adjustment for possible confounders. Our results indicated that SMP was statistically significantly associated with a net beneficial change in under-five mortality, but not with infant mortality, total fertility rate, teenage pregnancy, unmet contraceptive need or percentage of deliveries overseen by trained health personnel. Unemployment and the pupil-teacher ratio were statistically significantly associated with infant mortality and percentage deliveries overseen by trained personnel, while pupil-teacher ratio and female education level were statistically significantly associated with under-five mortality. Unlike previous analyses of World Bank and other development programs, our study took into account other related projects to more accurately estimate the net effect of SMP. Our study shows that after taking into account the impact of two other concurrent development projects, the SMP provided no net benefits, with the exception of under-five mortality. Clinically relevant changes (50-68% increase in the percentage of deliveries overseen by trained personnel, 25-33% decrease in infant mortality rate, and 8-14% decrease in under-five mortality rate) were found in both study groups.

Keywords: poverty, healthcare, maternal care, Indonesia, World Bank, Safe Motherhood Project

JEL Classifications: I18, I12, H75, J13, O19

Working Paper Series