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Family planning programs are believed to have substantial long-term benefits for women’s health and well-being, yet few studies have established either extent or direction of long-term effects. The Matlab, Bangladesh, maternal and child health/family planning (MCH/FP) program afforded a 12-y period of well-documented differential access to services. We evaluate its impacts on women’s lifetime fertility, adult health, and economic outcomes 35 y after program initiation. We followed 1,820 women who were of reproductive age during the differential access period (born 1938–1973) from 1978 to 2012 using prospectively collected data from the Matlab Health and Demographic Surveillance System and the 1996 and 2012 Matlab Health and Socioeconomic Surveys. We estimated intent-to-treat single-difference models comparing treatment and comparison area women. MCH/FP significantly increased contraceptive use, reduced completed fertility, lengthened birth intervals, and reduced age at last birth, but had no significant positive impacts on health or economic outcomes. Treatment area women had modestly poorer overall health (+0.07 SD) and respiratory health (+0.12 SD), and those born 1950–1961 had significantly higher body mass index (BMI) in 1996 (0.76 kg/m(2)) and 2012 (0.57 kg/m(2)); fewer were underweight in 1996, but more were overweight or obese in 2012. Overall, there was a +2.5 kg/m(2) secular increase in BMI. We found substantial changes in lifetime contraceptive and fertility behavior but no long-term health or economic benefits of the program. We observed modest negative health impacts that likely result from an accelerated nutritional transition among treated women, a transition that would, in an earlier context, have been beneficial.

This paper describes the process of adapting an early childhood development programme, with proven effectiveness in Bangladesh, for integration into government health services in rural Bangladesh. Through a three-stage process, we adapted an evidence-based, home-visiting, programme (Reach-Up and Learn) for delivery in government health clinics by government health staff as part of their regular duties. Stage one involved preparing an initial draft of two parenting interventions for use with: (1) pairs of mother/child dyads, and (2) small groups of mother/child dyads. In stage two, we piloted the adapted interventions in nine clinics with a total of twenty-seven health staff and 357 mother/child dyads. We used data from mothers' attendance, feedback from participating mothers and health staff and observations of parenting sessions by the research team to revise the interventions. Stage three involved piloting the revised interventions in six clinics with eighteen health staff and 162 mother/child dyads. We gathered additional data on mothers' attendance and used observations by the research team to finalize the interventions. Through this three-stage process, adaptations were made to the intervention content, process of delivery, materials, and engagement strategies used. The largest challenges were related to incorporating the parenting programme into health staff's existing workload and promoting mothers' engagement in the programme. We also simplified the content and structure of the curriculum to make it easier for health staff to deliver and to ensure mothers understood the activities introduced. This iterative piloting was used prior to implementing and evaluating the interventions through an effectiveness trial.

Background Family planning programs are widely believed to have substantial long-term benefits for women’s health and well-being, yet longitudinal studies are rare and mechanisms of impact are complex. We evaluated the effects of an in-home maternal and child health / family planning (MCH/FP) program in Matlab, Bangladesh on women’s lifetime fertility, adult health, and economic production 35 years after program initiation. Methods In 1977, women were assigned to treatment and comparison areas that were similar across most baseline characteristics. Comparable services were added to the comparison area from 1989. We followed 1,820 women born 1938-1973 from a census in 1974 to surveys in 1996 hand 2012-14. We estimated single-difference models of program impact using an intent-to-treat design with controls for baseline characteristics and potential confounders. Findings We found significant impacts on contraception, completed fertility and birth timing in aggregate and cohort-stratified models. We observed no significant positive impacts on health or economic production. Aggregate models found modest effects on poorer overall health (+0.07 SD) and respiratory health (+0.12 SD). Among women born 1950-1961, we observed poorer overall health (+0.11 SD) and metabolic health (+0.15 SD). For the 1950-1961 cohort, we observed significant increases in BMI in 1996 (0 · 76 kg/m2) and 2012 (0 · 57 kg/m2), along with a +2.5 kg/m2 secular change in BMI. As a result, treated women had a lower risk of underweight in 1996, but a higher risk of being overweight or obese in 2012. Interpretation: We found no long-term health or economic benefits of an in-home MCH/FP program. We observed modest negative health impacts among treated women that likely reflected an accelerated nutritional transition among treated women. Our findings suggest that we should not expect significant secondary health benefits from programs aimed at fertility reduction. Funding: This study was funded and supported by the US National Institute on Aging, the International Initiative for Impact Evaluation (3ie) and the Population Reference Bureau. Declaration of Interests: The authors have no conflicts of interest to report. Ethics Approval Statement: Protection of human participants during fieldwork and data analysis was ensured under icddr,b Ethical Review Committee Protocol #PR-10005.