Population Dynamics and Economic Development: An Assessment of Recent Research

1. Population Dynamics and EconomicDevelopment: An Assessment of Recent Research Shareen Joshi

2. In 2005, the Population and Development Working Group outlined three major research questions: • Given the projected trends in fertility and mortality changes, what are the implications for economic growth and income distribution and the incidence of poverty? • How does investment in reproductive health affect economic conditions at the household level? • How do different types of investments in reproductive health affect the health of women and their children?

3. They also outlined four priorities for data-collection • Collection of new cross-sectional data • Development of panel datasets • Collection of sub-national data for large countries with significant internal variation • Use of random assignment evaluation methods

4. Questions for today • How far along are we in answering the three questions? • To what extent have we succeeded in collecting new and innovative datasets? • What gaps remain?

5. Theme 1: The relationship between fertility change and economic growth, the distribution of income and the incidence of poverty • Foster and Weil (Brown University) • Relationship between health improvements, fertility, reduction and GDP growth • Ruben and Kamazima (Radboud University) • Using data from 32 sub-Saharan African countries to find out whether investments in such services generate wealth and economic growth at the household and district level. • Health improvements have at best only modest positive effects on economic growth • Main reason: Health improvements are usually not accompanied by a fall in fertility • Fertility stays high because (a) more children survive; (b) more women reach child bearing age • These improvements take a long time to materialize • The impacts can be heterogeneous across not only regions, but also countries and districts

6. Theme 2: The impact of reproductive health programs on the health of women and their children • Dow (Berkeley) • Vera-Hernandez (Institute of Fiscal Studies) • Hallman (Population Council) • Ashraf and Fields (Harvard University) • Thomas and Frankenburg (Duke University) • Lam and Liebbrandt (University of Michigan and Capetown) • Ruben and Kamazima (Radboud University) • The piloted programs have a variety of features: • Health services: • Family planning • Reproductive health services • Safe delivery support • Cost reductions: • Cash incentives • Free or subsidized care • Educational supports: • Health education • HIV risk information • Financial literacy • Other types of basic education • Some pay attention to the needs of distinct sub- populations (for example, adolescents)

7. Theme 3: The impact of reproductive health programs on the economic status of households • Many of the previously listed studies also look at this issue • Hill and Aryeetey (Harvard University) • Hooimeijer (Utrecht University) and Musahara (National University of Rwanda) • Lam and Liebbrandt (Univ of Michigan and Capetown) • Thomas and Frankenberg (Duke Univ) • Improved reproductive health and lower fertility is associated with benefits for the household: • Higher savings • Higher asset holdings • More expenditures on human capital investments in children • Reproductive health shocks can generate short and long-term economic shocks for a household • The effects of a reproductive health program may be heterogeneous across a population • Lowering of teen fertility different from birth spacing at older ages

8. Questions for today • How far along are we in answering the three questions? • To what extent have we succeeded in collecting new and innovative datasets? • What gaps remain?

9. Progress in gathering data • New cross-sectional data • Development of panel datasets • Collection of sub-national data for large countries with significant internal variation • Use of random assignment evaluation methods • Randomized trials: • Dow (Southern Tanzania) • Vera-Hernandez (Malawi) • Hallman (South Africa) • Ashraf and Field (Zambia) • Thomas and Frankenburg (Bangladesh) • Panel datasets: • Filippe (Burkina Faso) • Baschieri (Malawi) • Foster and Weil (India and others) • Hill and Aryeetey (Ghana) • Thomas and Frankenburg (Indonesia) • Ruben and Kamazima (Sub-Saharan Africa) • Lam and Liebbrandt (South Africa) • Hooimeijer and Musahara (Rwanda)

10. Questions for today • How far along are we in answering the three questions? • To what extent have we succeeded in collecting new and innovative datasets? • What gaps remain? What new questions have emerged? • Macro • Micro

11. Additional questions from macro-studies • What is “different” about fertility decline in Sub-Saharan Africa (as compared to East Asia)? • Is it driven by lower levels of education and/or information dissemination? • Is high fertility a response to perceived risks of new epidemics, famines, wars, and other risks of mortality in this region? • To what extent does the structure and composition of the household affect the preferences of women who are being targeted by family planning programs? What, if any, role does “culture” play here? • Are there mechanisms other than fertility that could drive the relationship between health improvements and economic growth? • Examples: Technological innovation and adoption • What is the source of bias in the policy-literature (based on the use of cross-country regressions) on this issue?

12. Additional questions from the micro-studies • What specifically do we mean by “reproductive health”? • How do you define and measure women’s empowerment? • What are the core constituents of a “reproductive health program”? • How, and in what cases, do we generalize the results of small randomized experiments? • What is the role of “contextual factors”? • Can successful randomized experiments be “scaled up”? • What is the appropriate time-frame to measure the impact of an intervention that is aimed at fertility decline?

13. 1. What specifically do we mean by “reproductive health”? • The Hewlett studies have included the following: • Family planning • Birth spacing • Prevention of unwanted births • Provision of various technologies and follow-up supports • Access to adequate nutrition, particularly during pregnancy and while breast-feeding • Maternal morbidity • Maternal mortality reduction • Post-partum health issues • Health services for young children • HIV treatment, awareness and counseling • Prevention and treatment of other sexually transmitted diseases

14. 2. How do you define and measure female “empowerment”? • The 2005 Working Group hoped that new research would estimate the impact of improved reproductive health and fertility decline on “female empowerment” • A challenge to this: measuring female empowerment • What it may include: • Greater decision-making authority within the household • Greater control over resources within the household • Greater contribution to household resources (higher incomes, more assets) • Expanded social networks • More access to information • Greater participation in community activities • Greater access to community/social supports • Freedom from violence • How do you measure these?

15. 3. What (if any) are the “core” elements of a reproductive health program? • Services featured in the Hewlett studies: • Family planning and follow-up? • HIV counseling, risk-reduction and treatment? • Maternal morbidity and mortality? • Nutritional supplements? • General health education? • Other supports (financial literacy, other education)? • General counseling and support • Special interventions for adolescents and/or older women? • Which of these are “high priority”?

16. 4. How do you generalize the results of small randomized experiments? • The new research provides a variety of perspectives on “best practices” in the area of reproductive health programs • Can these be generalized? Can the observed relationships be assumed to hold in other settings? • Examples: • Does the presence of a husband at the time of offering family-planning services always affect impact? In South Asia, should we worry about the presence of a mother-in-law? (Ashraf and Field) • Does the provision of basic financial literacy and other supports to women always impact their decision-making authority in the household (Dow)?

17. 5. How do we systematize the study of “contextual” factors? • Some the new results suggest that it is important for policy-makers to consider the context in which reproductive decisions are made (Ashraf and Field) • How do we define and quantify these additional variables? • How should we conceptualize the control structure of a household? • How do we measure the power of a woman to make her own reproductive decisions? • How do we address variations in fertility preferences of men and women? older and younger household members? • Main challenges in doing this: • Structure of control within a household is typically quite complex • There is variation across geographies, cultures, religions, economic systems, socio-economic groups

18. 6. How do you “scale up” a successful randomized experiment? • Some of the new research features interventions that are labor-intensive and expensive. Examples: • Cash incentives to participate in programs • The provision of basic financial literacy, employment skills, and encouragement of greater decision making • Use of separate strategies for heterogeneous populations • Where shown to be successful, can these be efficiently “scaled up”? • Is it possible for policy-makers to identify some “core drivers” of success? • Can the management challenges of implementing such programs over large populations be reasonably overcome?

19. 7. What is the best time-frame for evaluating reproductive health programs? • Many of the interventions have been implemented on a relatively short horizon • On average, these are 1—4 years, with some exceptions • Existing research suggests that full impact may take up 20 years to have their strongest effects (Thomas and Frankenberg; Joshi and Schultz, 2007). • Long-time frames may be essential to observe some effects: • Improvements in female decision-making authority • Household savings and asset holdings • Investments in children • How do we deal with this issue from the standpoint of research? Policy?