Maternal health intervention and sex ratios: evidence from the Village Midwife Program in Indonesia

Abstract

In about last three decades, many developing countries have experienced a large decline in maternal mortality rates. Global initiatives leading to better maternal health policies may have contributed to this decline. In this paper, we investigate whether maternal health intervention also improves the fetal survival rate. For this purpose, we consider the Village Midwife Program in Indonesia, which was launched in 1989 as a part of the safe motherhood strategy. Using the Indonesian Family Life Survey (IFLS), we investigate the impact of midwives on fetal survival rate in terms of a change in the likelihood of a live birth being male. Our results show that the provision of a midwife in a community increases the probability of a live birth being male by about 3 percentage points. Greater antenatal care, skilled birth-attendance, and an improvement in nutrition among reproductive-age women—in terms of greater BMI—are the likely pathways. We do not find the results to be driven by pre-treatment trends, and they remain robust to a number of checks.