Impact of Oportunidades on Contraceptive Methods Use in Adolescent and Young Adult Women Living in Rural Areas, 1997-2000

This 41-page report explores Oportunidades ("Opportunities"), a social programme run by the Mexican government that seeks to improve education, health, nutrition, and living conditions of those living in extreme poverty. People supported by the programme attend monthly health talks, which include information on contraceptive methods. Reduction in fertility, especially among youth, is deemed crucial to accomplishing the programme's goals.

Researchers analysed information on contraceptive method use among young women from the Oportunidades evaluation surveys conducted in the years 1997 to 2000. The report presents intention-to-treat (ITT) effect estimates. While acknowledging that such estimates "are likely less interesting than average treatment effects on the treated[,]....This would require us to use data on actual enrollment rather than just eligibility to the program, with the difficulty being that enrollment would clearly be endogenous." The experimental design setting was implemented in rural areas.

In the study population, all subjects (both in treatment and control areas) have free access to contraceptives, particularly condoms. Thus, programme effects on contraceptive method use might arise primarily from the health information talks that adolescent women, their parents, or their partners attend rather than by improving access to contraceptives. Another possibility is that adolescents in treatment areas are more likely to stay in school than those in control areas, and this might provide them with some information on family planning or desire to use contraception to postpone pregnancy until they finish school. If the Oportunidades effect is mostly an "information" effect, then there could be spillover effects from people eligible for the programme to those not eligible in the treatment communities. Additionally, the increased purchasing power of the programme participants is likely to have a beneficial effect on non-participants if this increased income is spent locally.

Among women 20- to 24-years-old, the programme increased the prevalence of contraceptive methods use by 5 to 10 percentage points after 2 years of exposure to the programme. The impact appears to have occurred mostly to those with the lowest socio-economic level. The effect estimate in the 15- to 19-year-old group is very small (0.002), indicating that the effect of the programme in this age group after two years of exposure to the programme is negligible, and it is statistically indistinguishable from zero.

Over the time period of this study, adolescent women (15- to 19-year-olds) were not required to attend the health talks, and this could be a reason why the programme appeared to have no impact on them. The young adults, however, were required to attend these talks and the programme effects on contraceptive use were moderately sized and often statistically significant. An additional analysis in older women (25-29 year-olds, results not shown) also find a positive, albeit smaller (3 percentage points), impact of the programme. Women who have children of school age are more likely to benefit from the programme. This is due to the fact that they receive cash transfers for each child who attends school and are therefore more motivated to attend health talks. The programme might have a larger effect on this group of women. However, they might also be the group of women who have the strongest desires to control fertility.

The evaluators conclude that "[t]he effect of the program is likely to have operated through subjects' attendance to health talks, but at least part of this impact could reflect an overall improvement in access to contraceptive methods in the treatment communities."