Effects of the World Bank’s maternal and child health intervention on Indonesia’s poor: Evaluating the safe motherhood project

Abstract

This article examines the impact of the World Bank’s Safe Motherhood Project (SMP) on health outcomes for Indonesia’s poor. Provincial data from 1990 to 2005 was analyzed combining a difference-in-differences approach in multivariate regression analysis with matching of intervention (SMP) and control group provinces and adjusting for possible confounders. Our results indicated that, after taking into account the impact of two other concurrent development projects, SMP was statistically significantly associated with a net beneficial change in under-five mortality, but not with infant mortality, total fertility rate, teenage pregnancy, unmet contraceptive need or percentage of deliveries overseen by trained health personnel. Unemployment and the pupil–teacher ratio were statistically significantly associated with infant mortality and percentage deliveries overseen by trained personnel, while pupil–teacher ratio and female education level were statistically significantly associated with under-five mortality. Clinically relevant changes (52–68% increase in the percentage of deliveries overseen by trained personnel, 25–33% decrease in infant mortality rate, and 8–14% decrease in under-five mortality rate) were found in both the intervention (SMP) and control groups.