The demand for reproductive health services: frameworks of analysis

Abstract

The paper reviews a unified model of demand for health care inputs and health production, first proposed by Rosenzweig and Schultz (1982), and shows how the model can be applied to design and implement policies to improve reproductive health of the population. Although the focus of the applications is sub-Saharan Africa, the illustrative examples presented are of general interest. The key feature of the model is the link between demand for reproductive health services and the production of health by households and individuals. The demand for reproductive health services together with the associated health production technology is first analyzed in the context of a unitary model of the household, before positioning the analysis in a more general collective model. In one of the several illustrations presented, the control function approach is used on Kenyan data to estimate the effect of tetanus immunization on birth weight in a unitary-household setting. Vaccinating mothers against tetanus during pregnancy is found to increase birth weight but indirectly through complementary behaviors and health care consumption patterns that are induced by vaccination. The effects of unobserved variables on birth weight, such as the knowledge gaps among mothers about health care, are also found to be substantial. An investigation is required on how to extend information to mothers about essential health care during pregnancy. It is argued that if mothers do not possess such information, tetanus vaccination may never induce them to invest in activities that improve birth weight in line with the complementarity hypothesis. More generally, we find a need to implement what we term immunization plus interventions to empower women to use reproductive health services effectively. The types of data needed to estimate other models presented in the paper are briefly discussed.