Development Projects to Improve Maternal and Child Health: Assessing the Impact

D emographic and social conditions in Ethiopia pose serious challenges to human survival. These challenges are particularly relevant to women, who often have the prime responsibility for the welfare of children and the family at large. Women's status in Ethiopia, as in other developing countries, is low, and their daily workload is often enormous [1]. Women have the dual responsibility of both reproducing and ensuring the survival of their children. Leisure time for women is declining due to increasing economic diffi culties; even the period of confi nement following childbirth has declined [1]. There have been many initiatives to improve the life of people living in rural Ethiopia over the last few decades, but many of these initiatives were not systematically evaluated. Thus, the short-term and long-term impacts of development interventions in Ethiopia remain largely unknown or unreported. In a new study in PLoS Medicine, Mhairi Gibson and Ruth Mace attempted to evaluate the effect of improved water access in rural Ethiopia—a development initiative that reduces women's workloads since they no longer have to collect water from distant sites—on birthrate and child malnutrition [2]. As such, this study is a very important step forward in making developmental interventions evidenced based and contextual. Gibson and Mace collected retrospective demographic data over a four-year period in eight rural villages in Arsi zone, Ethiopia. These included villages with and without the water development scheme. Villages with and without tapped water were comparable with respect to size, altitude, ethnicity, and religion. Using logistic hazards models and general linear modeling techniques, the authors found an association between the development initiative and a decline in infant mortality. However, the initiative was also associated with an increase in birthrate. And the initiative was not associated with any improvement in maternal or child health or in nutritional status. In fact, after controlling for any effects of age, sex, birth order, socioeconomic status, and family size, children living in villages with water access were at a signifi cantly greater risk of being malnourished and stunted. In summary, the study showed that developmental interventions may have deleterious effects on overall societal well-being in the long run if they are not implemented and monitored carefully. In this case, the increased birthrate could potentially exacerbate the population pressure on the already scarce farming land. Although the study has many strong methodological aspects, including the use of a local event calendar to obtain …