Abstract

This study examined the relationship between the use of maternal-child health (MCH) care and the use of contraceptives. The high correlation between the two may be due to the independent effect of one on the other or to an association of both with the same or similar background factors. We used structural equation models to examine the relationship between these two interventions. The data were derived from six Demographic and Health Surveys: Zimbabwe from Sub-Saharan Africa, Thailand from Asia, Egypt and Tunisia from North Africa, and Guatemala and Colombia from Latin America. The results show that in all six countries, the use of contraceptives and MCH care are significantly associated, independent of intervening factors; this finding suggests that families develop a joint demand for better-quality health and limited family size and translate these demands into action by using health services for mothers and for children and by voluntarily regulating fertility.

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References

Agarwal, K.K. (
1994
).
Determinants of Health and Family Planning Service Utilization: A Case Study of Tunisia
.
Baltimore, MD
:
Johns Hopkins University School of Public Health
.
Ahmed, S. (
1996
).
Contraceptive Use and Maternal-Child Health Care Utilization: A Search for the Path of Joint Determination
.
Baltimore, MD
:
Johns Hopkins University School of Public Health
.
Andersen, R. 1968. “A Behavioral Model of Families’ Use of Health Services.” Research Series No. 25, Center for Health Administration Studies, University of Chicago.
Becker, G.S. (
1960
).
An Economic Analysis of Fertility
Demographic and Economic Change in Developed Countries—A Conference of the Universities-National Bureau Committee for Economic Research
(pp.
209
31
).
Princeton, NJ
:
Princeton University Press
.
Becker, G.S. (
1976
).
The Economic Approach to Human Behavior
.
Chicago
:
University of Chicago Press
.
Berry, W.D. (
1984
).
Nonrecursive Causal Models
.
Beverly Hills, CA
:
Sage
.
Bollen, K.A. (
1989
).
Structural Equations With Latent Variables
.
New York
:
John Wiley & Sons
.
Bollen, K.A., Guilkey, D.K., & Mroz, T.A. (
1995
).
Binary Outcomes and Explanatory Variables: Tests and Solutions With an Application to the Demand for Contraceptive Use in Tunisia
.
Demography
,
32
,
111
31
. 10.2307/2061900
Browne, M.W. (
1984
).
Asymptotic Distribution Free Methods in Analysis of Covariance Structures
.
British Journal of Mathematical and Statistical Psychology
,
37
,
62
83
.
Buekens, P., Tsui, A., Kotelchuck, M., & Degraft-Johnson, J. (
1995
).
Tetanus Immunization and Prenatal Care in Developing Countries
.
International Journal of Gynaecology and Obstetrics
,
48
(
1
),
91
94
. 10.1016/0020-7292(94)02265-8
Caldwell, J.C. (
1986
).
Routes to Low Mortality in Poor Countries
.
Population and Development Review
,
12
(
2
),
171
220
. 10.2307/1973108
Cleland, J., Phillips, J.F., Amin, S., & Kamal, G.M. (
1994
).
The Determinants of Reproductive Change in Bangladesh: Success in a Challenging Environment
.
Washington, DC
:
World Bank
.
Cleland, J., & Wilson, C. (
1987
).
Demand Theories of the Fertility Transition: An Iconoclastic View
.
Population Studies
,
41
(
1
),
5
30
. 10.1080/0032472031000142516
Coale, A.J. (
1973
).
The Demographic Transition
International Population Confer ence, Liege 1973
(pp.
53
72
).
Liege, Belgium
:
International Union for the Scientific Study of Population
.
Dhrymes, P.J. (
1994
).
Topics in Advanced Econometrics: Volume 2. Linear and Nonlinear Simultaneous Equations
.
New York
:
Springer-Verlag
.
Easterlin, R.A. (
1975
).
An Economic Framework for Fertility Analysis
.
Studies in Family Planning
,
6
,
54
63
. 10.2307/1964934
Easterlin, R.A., & Crimmins, E.M. (
1985
).
The Fertility Revolution: A Supply-Demand Analysis
.
Chicago
:
University of Chicago Press
.
Fisher, F.M. (
1961
).
On the Cost of Approximate Specification in Simultaneous Equations
.
Econometrica
,
29
,
139
70
. 10.2307/1909286
Fisher, F.M. (
1966
).
The Identification Problem in Econometrics
.
New York
:
McGraw-Hill
.
Geraci, V.J. (
1982
).
Simultaneous Equation Models With Measurement Error
.
New York
:
Garland
.
An Assessment of DHS-I Data Quality
. (
1990
).
Calverton, MD
:
IRD/Macro Systems
.
Jöreskog, K.G. (
1979
).
Structural Equation Models in the Social Sciences: Specification, Estimation and Testing
. In K.G. Jöreskog, & D. Sörbom (Eds.),
Advances in Factor Analysis and Structural Equation Models
(pp.
105
27
).
Cambridge, MA
:
Abt Books
.
Jöreskog, K.G. (
1986
).
Estimation of the Polyserial Correlation From Summary Statistics
.
Sweden
:
Mimeograph, Department of Statistics, University of Uppsala
.
Jöreskog, K.G., & Sörbom, D. (
1989
).
LISREL 7: A Guide to the Program and Application
.
Chicago
:
SPSS
.
McGuire, W.J. (
1981
).
The Theoretical Foundations of Campaigns
. In W. Rice, & W. Paisley (Eds.),
Public Communication Campaigns
(pp.
41
70
).
Beverly Hills, CA
:
Sage
.
Meijer, E. (
1998
).
Structural Equation Models for Nonnormal Data
.
Leiden, the Netherlands
:
DSWO Press
.
Monteith, R.S., Warren, C.W., Stanziole, E., Lopez, U.R., & Oberle, M.W. (
1987
).
Use of Maternal and Child Health Services and Immunization Coverage in Panama and Guatemala
.
Bulletin of the Pan American Health Organization
,
21
(
2
),
1
15
.
Mosley, W.H. and I. Sirageldin. 1987. “The Effects of Family Planning on Improving Efficiency and Effectiveness of Health Services.” Paper presented at the International Conference on Better Health for Women and Children Through Family Planning, Nairobi, Kenya, October 5–9.
Mosley, W.H., Wong, R., & Shah, F.K. (
1988
).
Child Survival, Fertility Control and Population Growth in Developing Countries: Implication for Health and Policy Programs
.
Baltimore, MD
:
Johns Hopkins University
.
Family Planning for Couples in Rural Areas—Tunisia
Operations Research Family Planning Database Project Summaries
. (
1993
).
New York
:
Population Council
.
Potter, J.E., Mojarro, O., & Nunez, L. (
1987
).
The Influence of Health Care on Contraceptive Acceptance in Rural Mexico
.
Studies in Family Planning
,
18
(
3
),
144
56
. 10.2307/1966809
Pullum, T.W. (
1991
).
The Relationship of Service Availability to Contraceptive Use in Rural Guatemala
.
Calverton, MD
:
IRD/Macro Systems
.
Rosenfield, A. 1984. “The Integration of Health, Nutrition and Family Planning Services.” Unpublished paper. Center for Population and Family Health, Columbia University.
Rosenstock, I.M. (
1974
).
The Health Belief Model and Preventive Health Model
.
Health Education Monograph
,
2
,
354
86
.
Simmons, G.B. (
1992
).
Supply and Demand, Not Supply vs. Demand: Appropriate Theory for the Study of Effects of Family Planning Programmes on Fertility
. In J.F. Phillips, & J.A. Ross (Eds.),
Family Planning Programmes and Fertility
(pp.
59
77
).
Oxford, England
:
Clarendon Press
.
Stewart, K., & Sommerfelt, A.E. (
1991
).
Utilization of Maternity Care Services: A Comparative Study Using DHS Data
Proceedings of the Demographic and Health Surveys World Conference
(pp.
1645
68
).
Calverton, MD
:
IRD/Macro Systems
.
Taylor, H.C., & Berelson, B. (
1971
).
Comprehensive Family Planning Based on Maternal/Child Health Services: A Feasibility Study for a World Program
.
Studies in Family Planning
,
2
(
2
),
22
54
. 10.2307/1964774
C.E. Taylor, R.S. Sarma, R.L. Parker, W.A. Reinke, & R. Faruqee (
1983
).
Child and Maternal Health Services in Rural India, The Narangwal Experiment: Integrated Family Planning and Health Care
.
Baltimore, MD
:
Johns Hopkins University Press
.
Verkuyl, D.A., Fawcus, S., Willis, J.A., & Mutusa, H. (
1990
).
Integration of FP Into Maternal and Child Health and Other Services at Harare Central Hospital
.
Central African Journal of Medicine
,
36
,
311
15
.
Wansbeek, T., & Meijer, E. (
2000
).
Measurement Error and Latent Variables in Econometrics
.
Amsterdam, North Holland
:
Elsevier Press
.
Warren, C.W., Monteith, R.S., Johnson, J.T., Santiso, R., Guerra, F., & Oberle, M.W. (
1987
).
Use of Maternal-Child Health Services and Contraception in Guatemala and Panama
.
Journal of Biosocial Science
,
19
,
229
43
. 10.1017/S0021932000016825
Wiley, D.E. (
1973
).
The Identification Problem for Structural Equation Models With Unmeasured Variables
. In A.S. Goldberger, & O.D. Duncan (Eds.),
Structural Equation Models in Social Sciences
(pp.
69
83
).
New York
:
Academic Press
.
Wilopo, S.A. and W.H. Mosley. 1992. “The Relationship of Child Survival Intervention Programs to the Practice of Contraception: A Case Study in Indonesia.” Unpublished manuscript, Johns Hopkins University School of Hygiene and Public Health.
Winikoff, B. (
1988
).
Womeńs Health: An Alternative Prospective for Choosing Interventions
.
Studies in Family Planning
,
19
,
197
214
. 10.2307/1966552
Wong, R., & Agarwal, K.K. (
1993
).
The Common Determinants of Utilization of Child Survival and Fertility-Control Interventions
Proceedings of the International Union for the Scientific Study of Population (IUSSP), Montreal
(pp.
81
96
).
Leige, Belgium
:
IUSSP
.
Zerai, A. and A.O. Tsui. 1995. “The Relationship Between Prenatal Care and Subsequent Modern Contraceptive Use in Bolivia, Botswana, Egypt and Thailand.” Paper presented at the Annual Meeting of the Population Association of America, San Francisco, April 6–8.