Abstract

We use detailed measures of social change over time, increased availability of various health services, and couples’ fertility behaviors to document the independent effects of health services on fertility limitation. Our investigation focuses on a setting in rural Nepal that experienced a transition from virtually no use of birth control in 1945 to the widespread use of birth control by 1995 to limit fertility. Changes in the availability of many different dimensions of health services provide the means to evaluate their independent influences on contraceptive use to limit childbearing. Findings show that family planning as well as maternal and child health services have independent effects on the rate of ending childbearing. For example, the provision of child immunization services increases the rate of contraceptive use to limit fertility independently of family planning services. Additionally, new Geographic Information System (GIS)-based measures also allow us to test many alternative models of the spatial distribution of services. These tests reveal that complex, geographically defined measures of all health service providers outperform more simple measures. These results provide new information about the consequences of maternal and child health services and the importance of these services in shaping fertility transitions.

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References

Acharya, M., & Bennett, L. (
1981
).
Rural Women of Nepal: An Aggregate Analysis and Summary of Eight Village Studies
.
Kathmandu
:
Tribhuvan University
.
Allison, P.D. (
1982
).
Discrete-Time Methods for the Analysis of Event Histories
.
Sociological Methodology
,
13
,
61
98
. 10.2307/270718
Allison, P.D. (
1984
).
Event History Analysis
.
Newbury Park, CA
:
Sage Publishing
.
Angeles, G., Guilkey, D.K., & Mroz, T.A. (
1998
).
Purposive Program Placement and the Estimation of Family Planning Program Effects in Tanzania
.
Journal of the American Statistical Association
,
93
(
443
),
884
99
. 10.2307/2669827
Arends-Kuenning, M. (
2001
).
How Do Family Planning Workers’ Visits Affect Women’s Contraceptive Behavior in Bangladesh?
.
Demography
,
38
,
481
96
. 10.1353/dem.2001.0032
Axinn, W.G. (
1992
).
Family Organization and Fertility Limitation in Nepal
.
Demography
,
29
,
503
21
. 10.2307/2061849
Axinn, W.G. (
1992
).
Rural Income-Generating Programs and Fertility Limitation: Evidence From a Microdemographic Study in Nepal
.
Rural Sociology
,
57
,
396
413
. 10.1111/j.1549-0831.1992.tb00472.x
Axinn, W.G., & Barber, J.S. (
2001
).
Mass Education and Fertility Transition
.
American Sociological Review
,
66
,
481
505
. 10.2307/3088919
Axinn, W.G., Barber, J.S., & Ghimire, D.J. (
1997
).
The Neighborhood History Calendar: A Data Collection Method Designed for Dynamic Multilevel Modeling
.
Sociological Methodology
,
27
,
355
92
. 10.1111/1467-9531.271031
Axinn, W.G., Pearce, L.D., & Ghimire, D.J. (
1999
).
Innovations in Life History Calendar Applications
.
Social Science Research
,
28
,
243
64
. 10.1006/ssre.1998.0641
Axinn, W.G., & Yabiku, S.T. (
2001
).
Social Change, the Social Organization of Families, and Fertility Limitation
.
American Journal of Sociology
,
106
,
1219
61
. 10.1086/320818
Barber, J.S., & Axinn, W.G. (
2004
).
New Ideas and Fertility Limitation: The Role of Mass Media
.
Journal of Marriage and Family
,
66
,
1180
200
. 10.1111/j.0022-2445.2004.00086.x
Barber, J.S., Murphy, S.A., Axinn, W.G., & Maples, J. (
2000
).
Discrete-Time Multilevel Hazard Analysis
.
Sociological Methodology
,
30
,
201
35
. 10.1111/0081-1750.00079
Barber, J.S., Murphy, S.A., & Verbitsky, N. (
2004
).
Adjusting for Time-Varying Confounding in Survival Analysis
.
Sociological Methodology
,
34
,
163
92
. 10.1111/j.0081-1750.2004.00151.x
Becker, G.S. (
1981
).
A Treaties on the Family
.
Cambridge, MA
:
Harvard University Press
.
Billy, J.O.G., Brewster, K.L., & Grady, W.R. (
1994
).
Contextual Effects on the Sexual Behavior of Adolescent Women
.
Journal of Marriage and the Family
,
56
,
387
404
. 10.2307/353107
Bista, D.B. (
1972
).
People of Nepal
.
Kathmandu
:
Ratna Pustak Bhandar
.
Boardman, J.D., & Field, S.H. (
2002
).
Spatial Mismatch and Race Differentials in Male Joblessness: Cleveland and Milwaukee, 1990
.
Sociological Quarterly
,
43
,
237
55
. 10.1111/j.1533-8525.2002.tb00048.x
Bongaarts, J., & Menken, J. (
1983
).
The Supply of Children: A Critical Essay
. In Bulatao, R.A., & Lee., R.D. (Eds.),
Determinants of Fertility in Developing Countries
(pp.
27
60
).
New York
:
Academic Press
.
Brewster, K.L., Billy, J.O.G., & Grady, W.R. (
1993
).
Social Context and Adolescent Behavior: The Impact of Community on the Transition to Sexual Activity
.
Social Forces
,
71
,
713
40
. 10.2307/2579892
Brooks-Gunn, J., Duncan, G.J., Klebanov, P.K., & Sealand, N. (
1993
).
Do Neighborhoods In uence Child and Adolescent Development?
.
American Journal of Sociology
,
99
,
353
95
. 10.1086/230268
Browning, C.R., Leventhal, T., & Brooks-Gunn, J. (
2004
).
Neighborhood Context and Racial Differences in Early Adolescent Sexual Activity
.
Demography
,
41
,
697
720
. 10.1353/dem.2004.0029
Bulatao, R.A., & Lee, R.D. (
1983
).
Determinants of Fertility in Developing Countries
.
New York
:
Academic Press
.
Buor, D. (
2002
).
Distance As a Predominant Factor in the Utilization of Health Services in the Kumasi Metropolis, Ghana
.
GeoJournal
,
56
,
145
57
. 10.1023/A:1022452311911
Buor, D. (
2003
).
Analysing the Primacy of Distance in the Utilization of Health Services in the Ahafo-Ano South District, Ghana
.
International Journal of Health Planning and Management
,
18
,
293
311
. 10.1002/hpm.729
Caldwell, J.C. (
1982
).
Theory of Fertility Decline
.
New York
:
Academic Press
.
Caldwell, J.C. (
1986
).
Routes to Low Mortality in Poor Countries
.
Population and Development Review
,
12
,
171
220
. 10.2307/1973108
Caldwell, J.C., Reddy, P.H., & Caldwell, P. (
1988
).
The Causes of Demographic Change: Experimental Evidence Research in South India
.
Madison
:
University of Wisconsin Press
.
Casterline, J.B. (
1985
).
The Collection and Analysis of Community Data
.
Voorburg, Netherlands
:
International Statistics Institute
.
Casterline, J.B. (
2001
).
Diffusion Processes and Fertility Transition: Introduction
. In Casterline, J.B. (Ed.),
Diffusion Processes and Fertility Transition
(pp.
1
16
).
Washington, DC
:
National Academy Press
.
Casterline, J.B., & Sinding, S.W. (
2000
).
Unmet Need for Family Planning in Developing Countries and Implications for Population Policy
.
Population and Development Review
,
26
,
691
723
. 10.1111/j.1728-4457.2000.00691.x
Chen, L.C. (
1983
).
Child Survival: Levels, Trends, and Determinants
. In Bulatao, R.A., & Lee, R.D. (Eds.),
Determinants of Fertility in Developing Countries
(pp.
199
232
).
New York
:
Academic Press
.
Cleland, J., & Hobcraft, J. (
1985
).
Reproductive Change in Developing Countries: Insights From the World Fertility Survey
.
Oxford
:
Oxford University Press
.
Coale, A.J. (
1973
).
The Demographic Transition
.
International Union for the Scientific Study of Population, International Population Conference
,
1
,
53
72
.
Coale, A.J., & Watkins, S.C. (
1986
).
The Decline of Fertility in Europe
.
Princeton, NJ
:
Princeton University Press
.
Downey, L. (
2006
).
Using Geographic Information Systems to Reconceptualize Spatial Relationships and Ecological Context
.
American Journal of Sociology
,
112
,
567
612
. 10.1086/506418
Easterlin, R., & Crimmins, E. (
1985
).
Theoretical Framework
. In Easterlin, R.A., & Crimmins, E.M. (Eds.),
The Fertility Revolution: A Supply-Demand Analysis
(pp.
12
31
).
Chicago
:
University of Chicago Press
.
Entwisle, B., & Mason, W.M. (
1985
).
Multilevel Effects of Socioeconomic Development and Family Planning Programs on Children Ever Born
.
American Journal of Sociology
,
91
,
616
49
. 10.1086/228316
Entwisle, B., Rindfuss, R.R., Guilkey, D.K., Chamratrithirong, A., Curran, S.R., & Sawangdee, Y. (
1996
).
Community and Contraceptive Choice in Rural Thailand: A Case Study of Nang Rong
.
Demography
,
33
,
1
11
. 10.2307/2061709
Entwisle, B., Rindfuss, R.R., Walsh, S.J., Evans, T.P., & Curran, S.R. (
1997
).
Geographic Information Systems, Spatial Network Analysis, and Contraceptive Choice
.
Demography
,
34
,
171
87
. 10.2307/2061697
Foster, S.O. (
1984
).
Immunizable and Respiratory Diseases and Child Mortality
.
Population and Development Review
,
10
,
119
40
. 10.2307/2807958
Frankenberg, E., & Thomas, D. (
2001
).
Women’s Health and Pregnancy Outcomes: Do Services Make a Difference?
.
Demography
,
38
,
253
365
. 10.1353/dem.2001.0014
Freedman, R. (
1979
).
Theories of Fertility Decline: A Reappraisal
.
Social Forces
,
58
,
1
17
. 10.2307/2577781
Freedman, R. (
1997
).
Do Family Planning Programs Affect Fertility Preferences? A Literature Review
.
Studies in Family Planning
,
28
(
1
),
1
13
. 10.2307/2137966
Freedman, R., & Takeshita, J.Y. (
1969
).
Family Planning in Taiwan: An Experiment in Social Change
.
Princeton, NJ
:
Princeton University Press
.
Fricke, T.E. (
1986
).
Himalayan Households: Tamang Demography and Domestic Processes
.
Ann Arbor, MI
:
UMI Research Press
.
Gertler, P.J., & Molyneaux, J.W. (
1994
).
How Economic-Development and Family-Planning Programs Combined to Reduce Indonesian Fertility
.
Demography
,
31
,
33
63
. 10.2307/2061907
Gurung, H.B. (
1980
).
Vignettes of Nepal
.
Kathmandu
:
Sajha Prakashan
.
Hermalin, A., & Entwisle, B. (
1987
).
The Availability and Accessibility of Contraceptive Services
. In Lapham, R., & Simmons, G.B. (Eds.),
Organizing for Effective Family Planning Programs
(pp.
583
96
).
Washington, DC
:
National Academy Press
.
Hernandez, D.J. (
1981.
).
A Note on Measuring the Independent Impact of Family Planning Programs on Fertility Declines
.
Demography
,
18
,
627
34
. 10.2307/2060951
Hogan, D.P., & Kitagawa, E.M. (
1985
).
The Impact of Social Status, Family Structure, and Neighborhood on the Fertility of Black Adolescents
.
American Journal of Sociology
,
90
,
825
55
. 10.1086/228146
Justice, J. (
1986
).
Polices, Plans and People: Culture and Health Development in Nepal
.
Berkeley
:
University of California Press
.
Knodel, J., Chamratrithirong, A., & Debavalya, N. (
1987
).
Thailand’s Reproductive Revolution: Rapid Fertility Decline in a Third-World Setting
.
Madison
:
University of Wisconsin Press
.
Koenig, M.A., Phillips, J.F., Simmons, R.S., & Khan, M.A. (
1987
).
Trends in Family-Size Preferences and Contraceptive Use in Matlab, Bangladesh
.
Studies in Family Planning
,
18
(
3
),
117
27
. 10.2307/1966807
Lesthaeghe, R., & Surkyn, J. (
1988
).
Cultural Dynamics and Economic Theories of Fertility Change
.
Population and Development Review
,
14
(
1
),
1
45
. 10.2307/1972499
Lloyd, C.B., & Ivanov, S. (
1988
).
The Effects of Improved Child Survival on Family Planning Practice and Fertility
.
Studies in Family Planning
,
19
(
3
),
141
61
. 10.2307/1966750
Mason, K.O. (
1987
).
The Impact of Women’s Social Position on Fertility in Developing Countries
.
Sociological Forum
,
2
,
718
45
. 10.1007/BF01124382
Mason, K.O. (
1997
).
Explaining Fertility Transitions
.
Demography
,
34
,
443
54
. 10.2307/3038299
Mason, K.O. (
2001
).
Gender and Family Systems in the Fertility Transition
.
Population and Development Review
,
27
,
160
76
.
Massey, D.S., & Espinosa, K.E. (
1997
).
What’s Driving Mexico-U.S. Migration? A Theoretical, Empirical, and Policy Analysis
.
American Journal of Sociology
,
102
,
939
99
. 10.1086/231037
Nepal Fertility Survey 1976
. (
1977
).
Kathmandu
:
His Majesty’s Government and World Fertility Survey/Nepal Project
.
Annual Report
. (
2004
).
Kathmandu
:
His Majesty’s Government, Ministry of Health, Department of Health Services
.
Montgomery, M.R. (
2000
).
Perceiving Mortality Decline
.
Population and Development Review
,
26
,
795
819
. 10.1111/j.1728-4457.2000.00795.x
Morenoff, J.D., Sampson, R.J., & Raudenbush, S.W. (
2001
).
Neighborhood Inequality, Collective Efficacy, and the Spatial Dynamics of Urban Violence
.
Criminology
,
39
,
517
59
. 10.1111/j.1745-9125.2001.tb00932.x
Muhuri, P.K. (
1995
).
Health Programs, Maternal Education, and Differential Child Mortality in Mat-lab, Bangladesh
.
Population and Development Review
,
21
,
813
34
. 10.2307/2137775
Nepal Human Development Report 1998
. (
1998
).
Kathmandu, Nepal
:
Nepal South Asia Center
.
Palmore, J., & Freedman, R. (
1969
).
Perceptions of Contraceptive Practice By Others: Effects on Acceptance
. In Freedman, R., & Takeshita, J.Y. (Eds.),
Family Planning in Taiwan: An Experiment in Social Change
(pp.
224
40
).
Princeton, NJ
:
Princeton University Press
.
Pebley, A.R. (
1984
).
Population and Development Review
,
10
(
Intervention Projects and the Study of Socioeconomic Determinants of Mortality
),
281
305
. 10.2307/2807965
Petersen, T. (
1986
).
Estimating Fully Parametric Hazard Rate Models With Time-Dependent Covariates: Use of Maximum Likelihood
.
Sociological Methods and Research
,
14
,
219
46
. 10.1177/0049124186014003001
Petersen, T. (
1991
).
The Statistical Analysis of Event Histories
.
Sociological Methods and Research
,
19
,
270
323
. 10.1177/0049124191019003002
Phillips, J.F., Stinson, W.S., Bhatia, S., Rahman, M., & Chakraborty, J. (
1982
).
The Demographic Impact of the Family Planning—Health Services Project in Matlab, Bangladesh
.
Studies in Family Planning
,
13
(
5
),
131
40
. 10.2307/1966283
Raudenbush, S.W. (
1988
).
Educational Applications of Hierarchical Linear Models: A Review
.
Journal of Educational Statistics
,
13
,
85
116
. 10.2307/1164748
Sandberg, J. (
2002
).
Child Mortality, Family Building and Social Learning in a Nepalese Mountain Community
.
Department of Sociology, The University of Michigan, Ann Arbor
:
MI
.
Sandberg, J. (
2006
).
Infant Mortality, Social Networks, and Subsequent Fertility
.
American Sociological Review
,
71:
,
288
309
. 10.1177/000312240607100206
Sastry, N. (
1996
).
Community Characteristics, Individual and Household Attributes, and Child Survival in Brazil
.
Demography
,
33
,
211
29
. 10.2307/2061873
South, S.J., & Crowder, K.D. (
1997
).
Escaping Distressed Neighborhoods: Individual, Community, and Metropolitan In uences
.
American Journal of Sociology
,
102
,
1040
84
. 10.1086/231039
Stash, S. (
1999
).
Explanations of Unmet Need for Contraception in Chitwan, Nepal
.
Studies in Family Planning
,
30
,
267
87
. 10.1111/j.1728-4465.1999..x
Suvedi, B.K. (
2003
).
Immunization Programme of Nepal: An Update
.
Kathmandu University Medical Journal
,
2
(
3
),
238
43
.
Thornton, A. (
2005
).
Reading History Sideways: The Fallacy and Enduring Impact of the Developmental Paradigm on Family Life
.
Chicago
:
University of Chicago Press
.
Thornton, A., & Lin, H.-S. (
1994
).
Social Change and the Family in Taiwan
.
Chicago
:
University of Chicago Press
.
Tuladhar, J.M. (
1989
).
The Persistence of High Fertility in Nepal
.
New Dehli
:
Inter-India Publications
.
South Asia Study on Population Policies and Programmes
. (
1989
).
Nepal
:
United Nations
.
Whyte, M.K., & Parish, W.L. (
1984
).
Urban Life in Contemporary China
.
Chicago
:
University of Chicago Press
.
Yabiku, S.T. (
2004
).
Marriage Timing in Nepal: Organizational Effects and Individual Mechanisms
.
Social Forces
,
83
,
559
86
. 10.1353/sof.2005.0023