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The health and nutrition of young children is of importance not only for the immediate improvement in their well-being but also because of the longer-term impacts on children's physical and cognitive development. It is believed that improvements in cognitive development may lead to improved educational achievements, productivity, and labor market opportunities which in turn can break the chain of intergenerational transmission of poverty. This project seeks to evaluate the effect of early childhood health interventions and a family planning program typical of developing countries on the cognitive functioning of those same children when they are 6-19 years old. Rigorous empirical estimates of these types of programs are difficult because community selection into child health programs and household use of health services are often not random. In addition, estimating long-term effects of early childhood health programs is challenging owing to a lack of detailed, longitudinal data from well-designed programs that took place 10 or more years ago. Furthermore, inclusion of cognitive functioning outcomes was not common in survey data in developing countries in the past. The above mentioned challenges have meant that few studies have rigorously examined the role of early childhood health and family planning programs on later cognitive development. To contribute to this needed body of research, we propose to take advantage of the quasi-random placement of the Matlab Maternal and Child Health and Family Planning Program (MCH-FP) in Bangladesh which began in the late 1970s to overcome some of the methodological problems previous studies have faced. In addition, the interventions were phased-in over time with the family planning activities introduced first and the child health interventions five or more years later. This phasing-in allows a comparison of the effect of the program on children affected by the family planning and maternal health interventions as young children to those also eligible for the child health interventions. The analysis will benefit greatly from the unique and rich secondary data sources which are available in the Matlab area. In particular, the Matlab Health and Demographic Surveillance System has collected monthly demographic data (e.g., births, vaccinations, death, migration) since 1966 and will aid in the analysis of attrition due to mortality and migration. Census data for the Matlab area are also available for the years prior to the program 1974. Using these data we show that the treatment and comparison were similar in many respects prior to the introduction of the MCH-FP program. Finally, the 1996 Matlab Health and Socio-Economic Survey collected data, including a measure of cognitive functioning, from a random sample of children who were part of the experiment in the 1970s and 1980s. This research will provide critical analysis on the medium-term benefits of the MCH-FP program for an R01 grant that the University of Colorado at Boulder team along with other plan to resubmit in 2009. PUBLIC HEALTH RELEVANCE: The health and nutrition of young children is of importance not only for the immediate improvement in their well-being but also because of the longer-term impacts on children's physical and cognitive development. It is believed that improvements in cognitive development may lead to improved educational achievements and labor market opportunities which in turn can break the chain of intergenerational transmission of poverty. Empirical estimates of the long-term effects of early child health interventions on cognitive functioning later in life are not well established. The proposed research overcomes methodological issues that have hampered pervious research by examining the cognitive functioning of 6-19 year olds who were part of a quasi-randomly placed experiment.

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