Reproductive Health and Social Development in Developing Countries: A Latent Growth Curve Analysis
The health of women in developing countries still remains vulnerable than their male counterparts, owing to persistent gender imbalances in decision making power. Although current strategies for improving reproductive health have focused on social development, research on the inter-relationships between them remains overwhelmingly cross-sectional with less attention given to changes over time. The purpose of this study is to examine the inter-relationship between reproductive health and social development over time, imperative for the development of broad-based social programs targeted towards improving reproductive health. We hypothesize that (1) the associations between social development and reproductive health are likely to be reciprocal in nature, and (2) growth in social development is expected to improve reproductive health over time.
Methods:
Using data from the World Bank for a period of forty years (1980-2010), we used Latent Growth Curve approach to examine the inter-relationship between reproductive health (RH) and social development with a sample of 143 developing countries. We used the United Nations Human Development Index (HDI) to measure social development. The latent construct of RH were measured by five indicators- maternal mortality ratio, teen fertility, age at marriage, and under five mortality rates. We used confirmatory factor analysis to develop a measure of RH. Both latent growth curve (LGC) and latent difference score (LDS) modeling methods were used to estimate the reciprocal nature of the relationship between social development and RH.
Results:
Results showed that reproductive health gains over time were accompanied by strong and significant advances in social development. The LGC models for RH (CFI=.984, TLI =.981, and NFI=.983) and HDI (CFI=.984, TLI=.981 and NFI=.933) yielded good fit. Estimated LGC models indicated that although the mean RH intercept and the mean RH slope were not statistically significant, the variances associated with the intercept and slope were significant. In the RH LGC model, the intercept and the slope were negatively associated (covariance= -.040). The results showed that countries with high levels of reproductive health tended to change slower than those at low levels of reproductive health over time. Unlike the RH intercept, the HDI intercept was significant. In addition, the HDI slope was also significant, indicating considerable inter- country variability in HDI slopes. We found no significant co-variation between intercept and slope for the HDI model (covariance=.001).
Results from LDS suggest that reproductive health scores have a positive effect on HDI. High levels of HDI were significantly correlated with high levels of RH (r=.786, P<.001, R2=.617). The rate of change in HDI was positively correlated with the rate of change in RH levels (r=.646, p<.001, R2 =.417). Both our hypotheses were supported.
Implications:
Our study extends the literature by adding an over time relationship between social development and RH. It provides an empirical basis for prioritizing investment of resources to address women’s reproductive health needs in conjunction with social development programs. Programs and policies geared towards improving women’s reproductive health not only can result in individual level advances in well-being and health, but contribute to increases in social development and community well-being.