PURPOSIVE PROGRAM PLACEMENT AND THE ESTIMATION OF FAMILY-PLANNING PROGRAM EFFECTS IN TANZANIA

Most studies evaluating the impact of family planning on fertility tre at the presence of family planning clinics as being ''randomly'' assig ned among the areas included in the study. They tend to ignore the pos sibility that the distribution of services may be related to the ferti lity level observed ina particular area. In some cases the distributio n of services may respond to a conscious effort by public authorities or funding agencies to target areas with observed higher fertility. Ev en in absence of program planning, the factors determining service pla cement might be related to the determinants of high, or low,fertility in a particular area. If that is the case, and one fails to account fo r the endogeneity of family planning services, then the estimated impa ct of family planning programs will be biased. This article presents a modeling approach to address this issue. The model extends the simult aneous equation framework by integrating an individual-level model of timing and spacing of children with the dynamic process of program pla cement. Individual-level data from the 1991/1992 Tanzania Demographic and Health Survey are augmented with data on the timing or and factors influencing, family planning service placement to demonstrate the app roach. The empirical results show that standard methods yield misleadi ng results on the impact of different components of the family plannin g program on fertility. In particular, the effect of access to family planning hospitals on births is overstated, and the impact of access t o health centers that offer family planning is understated significant ly. We quantify the size of these effects through simulations.