Short Abstract:

This research aims to determine if the maternal health care package of services in Peru has been successful or not in providing adequate health outcomes for women and children, based on the evaluative framework of the Capabilities Approach. This study understands maternal and child health as a joint fertile functioning through the relationship between maternal anemia and child malnutrition.

Long Abstract:

In Peru, the rate of chronic childhood malnutrition affected 11.7 percent of children until 5 years old. If the data is analyzed at the regional level, the rate increases by 18.2 percent points in places like Huancavelica*. However, in the last 10 years, the trend has decreased due to different factors, like the emphasis on care explained through the intergenerational health transmission channel between the mother and the child.

Various efforts have been made by the health public institutions in Peru to address the problems surrounding the health and well-being of individuals. One of them is the creation of a set of health services in favor of pregnant women to improve their quality of life and their children. The integrated package consists of providing auxiliary examinations, prenatal care, ferrous sulfate supplements, and institutional child deliveries. As part of the results of the package, the care for mothers would contribute to improving the health of children, perceived as a reduction in rates of chronic malnutrition.

This research aims to determine to what extent the maternal health care package of services for pregnant women in Peru has been successful or not in providing adequate health outcomes for women and children, based on the evaluative framework of the Capabilities Approach. In both health economics and economic development studies, the mother is generally positioned as a means of development to obtain a level of well-being for her children. This research takes into account the achievement of results in both mother and child, due to the commitment of the Capabilities Approach to the principle of “each individual as an end.” The study proposes to understand maternal and child health as a joint fertile functioning through the relationship between maternal anemia and child malnutrition.

The literature on “Joint Capabilities” is limited as it is a new concept proposed by Hall in 2016. The author draws on the literature on collective capabilities and proposes that joint capabilities are understood as a category of existing capabilities between individuals and broader impersonal collectivities, where such

capabilities incorporate groups that act as a unit and relate with each other based on interpersonal relationships. The second concept that will be used in this research is that of “Fertile Functionings”. Broady (2014) defines them as functionings that help individuals achieve other important functionings in other dimensions of life. From both terms, the concept of joint fertile functionings is proposed to refer to maternal and child health at early ages. In this case, fertility is not understood in the sense of biological reproduction of the mother, but rather in the sense proposed by Wolff and de-Shalit (2007) as opposed to corrosive disadvantage. From this, the duo (mother-child) must be evaluated jointly due to the special association existing between the functionings of the mother and the functionings of the child. These types of operations are so special that they must be studied jointly, without losing sight of the fact that the subjects of moral concern are both the mother and the son, two different individuals. But also, the joint term refers to the health functionings of the mother and child as a whole, because it is in them where the duo manifests itself.

A quasi-experimental model is estimated with the methodology of “Propensity Score Matching”, using the Demographic and Family Health Survey 2016-2017 (ENDES) to determine if the mentioned package has been successful in improving both the health of mothers and children (anemia and malnutrition, respectively. The matching method seeks to estimate the effect of a treatment or a public policy using different variables that estimate the probability of receiving treatment. To take into account the differences between treated and untreated mothers (controls), a set of covariates associated with the use of the package of services are the following: age, maternal tongue, level of education, chief of the household, area, sanitary, electric light at home, and wealth index.

The results suggest that the integrated package has been successful in jointly reducing maternal anemia and childhood chronic malnutrition. This result would raise the discussion that, by obtaining a significant effect of the maternal and child health success package, the inclusion of the mother as an end of development, would demonstrate that the medium and long-term impacts on the health of children would be even more powerful. When the evaluation takes both the mother and the child as units of study, the success in reducing maternal anemia and child malnutrition is greater than when only the evaluation of the child is the ultimate end of the package. The analysis will allow better indicators, the same ones that can be captured in health policies for better understanding.

*Rates from year 2022

Note: The work was supported by the grant SVV 260 596 - Charles University