Simultaneity in maternal-child health care utilization and contraceptive use: Evidence from developing countries

This study examines the synergistic relationship between the utilization of maternal-child health (MCH) care and contraceptive use, and the causal mechanism that operates at individual and household levels facilitating joint determination of these interventions. Although conceptualizing a relationship between contraceptive use and utilization of health services is easy, testing statistically the simultaneity in the relationship is difficult. The high correlation between the use of contraceptives and MCH interventions may be due to the independent effect of one on the other or it may be due to an association of both with the same or similar background factors. Latent class structural equation models are used to examine the relationship between these two interventions, controlling for endogeneity. The study addresses some methodological issues in analyzing binary outcome variables with endogeneity. The data for this study are derived from six Demographic and Health Surveys (DHS): Zimbabwe from Sub-Saharan Africa, Thailand from Asia, Egypt and Tunisia from North Africa, and Guatemala and Colombia from Latin America. Result shows that in all the six study countries contraceptive use and MCH care utilization are directly and significantly associated, independent of intervening factors, suggesting that families develop a joint demand for quality of health and for fewer children and translate these demands into action by utilizing health services for mothers and for children, and by voluntary fertility regulation. These findings provide evidence of the importance of integrating family planning and MCH services and address important programmatic issues. Acknowledgment : This study received financial support from World Health Organization (WHO), Geneva, as a research training grant. The authors acknowledge the assistance of Human Reproduction Program (HRP) Division of WHO for their financial support, and to Stanley Backer, Laura Caulfield and Mei-Cheng Wang for their contribution in this study.