Reducing the Cost of Remoteness: Community-Based Health Interventions and Fertility Choices

Catalina Herrera-Almanza, Maria F. Rosales-Rueda

Research output: Contribution to journalArticlepeer-review


Distance to health centers can represent a significant healthcare cost for poor households. Community-based health interventions and community health workers can be an alternative to deficient formal health care provision among remote populations. We analyze the effects on fertility outcomes of a large-scale community-based health worker program that aims to reach remote areas distant from health facilities in Madagascar. We use a triple difference model that exploits time and geographic variation in the program rollout and the geocoded household distance to the closest health facility. Our findings indicate that the program decreased the probability of conception among women in treated areas but did not have a differential effect among women living in remote areas. A potential mechanism underlying this fertility reduction is that the program increased women's modern contraceptive use.

Original languageEnglish (US)
Article number102365
JournalJournal of Health Economics
StatePublished - Sep 2020
Externally publishedYes


  • Africa
  • Community Health Workers
  • Cost of Remoteness
  • Fertility

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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