Access to Family Planning Services Improves Child Growth Patterns and Cognitive Development: Findings from the Malawi Family Planning Study

Each year, 14 million unplanned pregnancies occur in Sub-Saharan Africa. Given the costs involved in raising a child, the high rate of unplanned pregnancy may influence how limited household resources are allocated among children, with potentially detrimental effects on children’s growth and development. While family planning and reproductive health services allow couples to plan births, there has been little empirical evidence to date linking such services to long-term outcomes like child health.

In a new policy brief, Mahesh Karra, Daniel Maggio and David Canning share results from a randomized controlled trial wherein new and expecting mothers in Lilongwe, Malawi were provided with access to a range of postpartum family planning services. Women assigned to the intervention arm of the trial were offered a multi-component family planning package consisting of free home visits from a family planning counselor, transportation to a family planning clinic and financial reimbursement for family planning services. The policy brief focuses on observing how improved access to family planning services affected children conceived directly prior to the trial.

Main findings:

• Children who were conceived just prior to the intervention were less likely to be stunted in height near their first birthday.
• Children born to women in the intervention arm performed better on cognitive measures than children born to women in the control arm.
• Women assigned to the intervention arm were 10.4 percentage points more likely to have attended a medical clinic within the last year. The results suggest that this increase can explain roughly 30 percent of the changes in child growth and development.

The study demonstrates there are large gains to be made in child health by helping couples exert greater control over and reduce their fertility. Based on the findings, the authors recommend countries improve access to high quality postpartum family planning services to encourage greater childhood growth, cognitive development and school preparedness.