Socioeconomic inequalities in fertility in three rural districts of Tanzania. New evidence from a longitudinal study in rural Tanzania

Researchers have intensively demonstrated the socioeconomic inequalities in fertility everywhere in the World. There are however limited researches on the causal effects of distance to facilities on fertility. This paper uses unique longitudinal data collected in three rural districts of Tanzania to test whether enhanced proximity to health services can reduce inequalities in fertility between rich and poor. Data on births, deaths, migrations, SES and geographic data on households and facilities have been recorded every 120 days since 1999 (n≈200,000). We will use multivariate analysis to measure the causal effects of distance to health facilities on fertility and to test interactions between distance to health facilities and maternal education and households’ SES. Initial results indicate that, from 2000 to 2010, TFR remains high around 5.3 births per woman with significant differences between poor (6.4) and rich (3.4) and between educated (2.9) and not educated (5.9). The distance to the closest health facility remained a strong determinant of fertility, even after adjusting for endogeneity biases. The development of community-based primary health care can improve health outcomes and can increase equity by offsetting the detrimental effects of low maternal education, household poverty and distance to health facilities.