Effects of the World Bank's maternal and child health intervention on Indonesia's poor: Evaluating the Safe Motherhood Project

Poverty and human rights are inextricably related; yet few studies have evaluated the effects of development programs focused on the maternal and child health (MCH) of the poor. We analyzed the impact of the World Bank's Safe Motherhood Project (SMP) on the MCH outcomes of Indonesia's poor before and after the intervention, comparing membership and non-membership in SMP. Main outcomes were infant mortality, under-five mortality, and percentage deliveries overseen by trained health personnel. Provincial level data from 1990 to 2005 was analyzed using a difference-in-difference approach with OLS multivariate regression. East and Central Java were compared to seven reference provinces. The SMP was associated with a net beneficial change in under-five mortality (P=0.03), but was not associated with a beneficial change in other MCH outcomes. Unemployment and pupil-teacher ratio were significantly associated with infant mortality (P=0.005 and P=0.02, respectively) and deliveries overseen by trained personnel (P=0.001 and P<0.001, respectively). Pupil-teacher ratio and female education level were significantly associated with under-five mortality (P=0.01 and P=0.04, respectively). Poor Indonesians living in provinces that were targeted by the SMP had no greater beneficial changes in MCH outcomes as compared to non-members. This study illustrates the connection between unemployment and education to health access and outcomes. While this MCH intervention may not have produced sustainable results in the context of nationwide changes in education and employment among the poor, further research is needed to build the evidence base for future development policy.