Researchers at the Yale School of Public Health conducted an independent analysis of a multimillion-dollar program funded by the World Bank to improve maternal and child health in rural Indonesia.
The Safe Motherhood Project (SMP) was launched in 1998 in the provinces of East and Central Java, where some 75 million residents live. Its goals included increasing the demand for and use of maternal and child health care through education and awareness, increasing the supply of health services at the village level, improving the quality of maternal and child health care through training and improving health services aimed at adolescent reproductive health.
The SMP project was rated as “satisfactory” by the World Bank in terms of overall health service impact. But few, if any, studies have evaluated the effects of such interventions on outcomes, particularly on child and maternal health outcomes. The $42.5 million aid program was discontinued in 2003.
The study led by Jennifer Prah Ruger, Ph.D., associate professor in the division of Health Policy and Administration, compared health outcomes in provinces with the SMP program to a control group of provinces with comparable size and baseline characteristics. The analysis found that, while the number of deliveries overseen by trained personnel increased by 52 percent to 68 percent and infant mortality and under-five mortality decreased by 25 percent to 33 percent and 8 percent to14 percent respectively over the study period, only the under-five mortality represented a statistically significant difference in health outcomes between the SMP and control groups.
“While the maternal and child health intervention evaluated in this study may not have produced statistically significant results across the board, we did see clinically relevant improvements in both groups within an environment of nationwide changes in education and employment among Indonesia’s poor,” said Prah Ruger. “Our study’s design of examining the SMP intervention in the context of other development projects demonstrates the complexity involved in assessing the independent effect of any given program above and beyond other growth strategies.”
The study was published recently in the journal Social Science & Medicine. Other authors on the study include Steven Ma, Ph.D., an associate professor in the division of Biostatistics at Yale, and John Baird, a student at the University of Pittsburgh.
Indonesia is the world’s fourth most populous country and is home to many of the world’s poorest people, with 18 percent of its population living below the poverty line. It also suffers from higher-than-average rates of maternal and child mortality. Approximately 80 percent of maternal deaths are avoidable, as are over half of infant and child deaths, prompting the United Nations to identify maternal and childhood health as one of its main priorities as part of its Millennium Development Goals.
“Indonesia’s female population is at the height of reproductive capacity. This coupled with concerning maternal and child mortality rates make Indonesia an important geographic focus for studying the impact of development projects,” Prah Ruger said.