Data + analysis = Policies that work
The development of Bangladesh's national family planning program, shaped by the Matlab maternal and child health extension project, was one of the first examples of evidence-based decisionmaking. In the 1970s, we collaborated closely with a major research organization, ICDDR,B, in the introduction of home-delivered family planning and maternal health services, providing technical assistance and project monitoring and evaluation. Unlike previous attempts to bring family planning to similarly rural and conservative areas, the designers of Matlab took the realities of women's lives into account.
A fact of life for women in Bangladesh is "purdah," or social seclusion, which restricts women's movement outside their homestead. Purdah prevented women from easily accessing clinic-based family planning services. The Matlab project overcame this barrier by designing a program that gave women access to services in their own homes. The program relied on locally recruited female workers who conducted home visits, tracked the health of women and children, and provided basic advice and services, such as immunizations.
Matlab proved hugely successful. Rates of fertility and maternal mortality in the program villages fell significantly, compared with rates in the control villages. Elements of family welfare—household assets, schooling of the women's children, and women's social participation—improved substantially. The rapid acceptance of contraception and health services in Matlab showed that purdah may have been a barrier to contraceptive access but not to its use. The project was central to convincing skeptical donors and policymakers, and doorstep delivery of family planning was eventually expanded nationally. Matlab continues to be widely cited as having provided important empirical evidence in support of the role of family planning in promoting health, reducing mortality, and enhancing women's status.
Evidence from Matlab—about record keeping, logistics, and managing a large and mobile workforce—has been used to shape other programs in Bangladesh affected by purdah, such as national campaigns to combat diarrhea, increase children's immunization, and introduce micro-credit. The education field in particular used research to demonstrate impact and then successfully change national policy and expand programs. In the late 1980s, a small study demonstrated how providing free schooling and scholarships boosted girls' enrollment in secondary schools. Later expanded to a national program, educational subsidies are now credited with boosting girls' enrollment to exceed that of boys. A similar approach led to the successful expansion of programs for adolescent girls to enhance their opportunities to learn livelihood skills and earn a living.
As a result of our work on Matlab and other important projects, the Population Council is a founding member of and strong influence on EXPANDNET, the World Health Organization's program for scaling up health innovations. Our leadership in translating research into widespread practice—gained from Matlab, the expansion of primary health care in Ghana, the introduction of emergency contraception nationally in Bangladesh, and our global work on expanding services for reproductive health, HIV, and AIDS—is recognized by governments and partners around the world.
Senior associate Sajeda Amin is affiliated with the Population Council's Poverty, Gender, and Youth program. She conducts research and data analysis related to gender, work, poverty, and the family in the developing world.