Fauveau, and Wojtyniak 1991. The measles vaccination rate for children younger than the age of fi ve was less than 2 percent nationally in 1986 Kahn and Yoder 1998, and
was below 40 percent in the comparison area in 1990 Fauveau 1994. As the national vaccination program scaled up, the difference in vaccination rates between the treat-
ment and comparison area narrowed substantially but not completely. For example, by 1988 in the treatment area, vaccination rates for children aged 12–23 months were
88 percent for measles, 93 percent for tuberculosis, 83 percent for all three doses of DPT and polio, and 77 percent for all three major immunizations HDSS 2007. In the
comparison area, according to data from the 1996 Matlab Health and Socioeconomic Survey, the vaccination rates for children born in 1991 reached 78 percent for measles
and 60 percent for the third dose of DPT.
C. Potential Effect of the MCH- FP Program on Migration
Whether a program alters short- term migration patterns depends on a number of fac- tors. These include how much the benefi ciaries value the program, specifi cs of the
program including whether or not it requires the recipient to be physically present to receive benefi ts, and the mechanisms that drive migration. Based on the description
of the program interventions in Section IIA, the individuals or families most likely to value or benefi t from the MCH- FP program are: those who are married since premari-
tal sexual activity is rare among Bangladeshi women, those in need of ongoing family planning services or maternal care, and those with children younger than the age of
fi ve.
7
With the exception of a few contraceptive methods, program services were al-
7. It is possible that the program affected the marriage market, but marriage migration is not the topic of this paper and data on internal migration between treatment and comparison areas were not available until
mid- 1982. Peters 2011 studied marriage not marriage migration and observed that rates of inter-area mar- riages with one partner from treatment area and one from comparison area rose from 7 percent to 16 percent
between preprogram and postprogram periods signifi cant at 1 percent level.
Figure 2 Trends in Contraceptive Prevalence Rate CPR and Measles Vaccination Rates
MVR for Children 12–59 Months by Calendar Year
Source: Contraceptive use data from van Ginniken et al. 1998; Measles vaccination data from “CCDR,B Record Keeping System.
most exclusively intended for women or children younger than age fi ve. Consequently, adult males did not themselves receive many services although they indirectly ben-
efi tted from their spouse’s use of the services. Unmarried adult males were even less likely to benefi t from the services so would value them less.
8
As noted above, those who benefi tted from the program as young children could have achieved higher lev-
els of human capital, potentially altering migration behavior. These effects, however, would have occurred mainly after our study period and are not the focus of this paper.
Program services were place- based, so to receive the interventions benefi ciaries needed to be at their house during the monthly visit. If a family was only interested in,
or in need of, preventive services, the individual could conceivably migrate and return roughly four times a year to receive the services in their original treatment household
assuming the household still existed. This is because contraceptive options included injectables and pill supplies that provided three to six months of protection. The vac-
cine schedule for children older than the age of one required vaccination at most once a year, and Vitamin A supplementation was recommended every four to six months
Fauveau 1994; Rahman et al. 1980. Those who returned within a six- month period or returned at least monthly would still be considered a resident of Matlab.
Standard models of migration provide insight into the possible effects of the MCH-FP program on migration. These models suggest that migration occurs when
the expected income in the destination area is higher than that expected from staying at the point of origin plus the cost of migration Sjaastad 1962; Harris and Todaro
1970. Expected income depends on many individual characteristics including age and skill. The model can be generalized to consider expected utility or welfare, rather than
income alone, which in the context of this paper would include access to certain types of healthcare services. Therefore, given that benefi ciaries need to be physically present
to receive program benefi ts, families or individuals who value the MCH- FP program will have an incentive to stay rather than migrate.
More recent literature recognizes that migration may be a joint family decision, whereby family members may strategically migrate in order to diversify earnings risk
for the whole family Stark and Bloom 1985; Stark and Levhari 1982, thus allowing temporary and return migration. In societies where families do not have to migrate
as a unit, a household may share the costs and benefi ts of migration of individual family members. In Bangladesh, solo migration has become more common over the
years since dependence on subsistence agriculture in Matlab is increasingly problem- atic. This is because land reform, rapid population growth, and an Islamic system of
partible inheritance have contributed to relatively high rates of land ownership but declining and small plot sizes.
9
While day- labor jobs are available in Matlab during peak seasons, migration out of Matlab for work is typically by males and is seen as
important for livelihood support, insurance against crop failure, and accumulation of additional land. Rural- rural migrants often move for seasonal agricultural jobs. Rural-
urban migrants work in informal jobs such as pulling rickshaws or construction, in
8. Unmarried men may still have some value for the program. For example, they may value the future ben- efi ts when they do marry, it may enable them to marry a higher quality bride if they live in the treatment area,
or if they lived in a household with benefi ciaries they may value living in a healthier household with perhaps less children or longer birth spaces between children.
9. According to the 1982 census, 50 percent of households were at or below the level of “functional landless- ness”—0.5 acres—required to produce enough rice for an average family.
small business, and in semiformal or formal employment in public or private service and in manufacturing or textile processing Kuhn 2003, 2011. Although rural- urban
migration may be of long duration, many migrants will make regular visits to the ori- gin village, including for extended stays during peak agricultural seasons, and histori-
cally many have returned to their village Kuhn 2003, 2011. The possibility of solo migration means that program effects may differ for men and women. The possibility
of return migration means that program effects on out- migrant stock may diminish as migrants return to the place of origin.
D. Potential Confounder: The Meghna- Dhonnogoda Embankment
