il Systematic review The impact of aid on maternal and reproductive health A systematic review to evaluate the effect of aid on the outcomes of Millennium Development Goal 5 by Rachel Hayman Emma Michelle Taylor Fay Crawford Patricia Jeffery James Smith October 2011 The EPPI-Centre reference number for this report is 1916. This report should be cited as: Hayman R, Taylor EM, Crawford F, Jeffery P, Smith J (2011) The impact of aid on maternal and reproductive health: A systematic review to evaluate the effect of aid on the outcomes of Millennium Development Goal 5. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London. ISBN: 978-1-907345-23-4 © Copyright Authors of the systematic reviews on the EPPI-Centre website (http://eppi.ioe.ac.uk/) hold the copyright for the text of their reviews. 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Background .................................................................................. 8 1.1 Aims and rationale for review ........................................................ 8 1.2 Objectives ............................................................................. 10 1.3 Definitional and conceptual issues ................................................. 10 1.4 Research and policy background………………………………………………………………….. 16 2. Methods used in the review ............................................................. 18 2.1 User involvement ..................................................................... 18 2.2 Identifying and describing studies ................................................. 18 3. Search Results ............................................................................. 25 3.1 Studies included from searching and screening .................................. 25 3.2 Details of included studies .......................................................... 26 4. Synthesis Results .......................................................................... 30 4.1 Further details of studies included in the synthesis ............................. 30 4.2 Synthesis of evidence ................................................................ 30 4.3 Synthesis: Quality Assessment Results ............................................ 33 5. Strengths and limitations ................................................................ 35 5.1 Methodology ........................................................................... 35 5.2 Data on maternal and reproductive health ....................................... 36 5.3 Aid intervention and health outcomes ............................................ 39 6. Conclusions and Recommendations .................................................... 41 7. References ................................................................................. 45 7.1 Studies included in the in-depth review .......................................... 45 7.2 References included (Round 3) ..................................................... 48 7.3 References excluded in Round 3 ................................................... 51 7.4 Additional references ................................................................ 66 Appendices .................................................................................... 70 Appendix 1.1: Authorship of this report ............................................... 70 Appendix 2.1: Search strategy and results ............................................ 71 Appendix 2.2: Coding tool ............................................................... 77 Appendix 2.3: Quality Assessment Checklist .......................................... 81 Appendix 3.1: Details of studies included in the review ............................ 83 Appendix 3.2: Aid Pools .................................................................. 99 Appendix 4.1: Details of studies included in the sythesis ......................... 102 Appendix 4.3: Synthesis of evidence .................................................. 157 Appendix 4.4: Quality Assessment Results ........................................... 164 ii List of abbreviations ANC Ante-natal Care ASRH Adolescent Sexual and Reproductive Health Ausaid Australian Government‟s Overseas Development Aid Programme AYA African Youth Alliance BCC Behaviour Change Communication BMI Bono Materno Infantil BMJF Bono Mujer Jefe de Familia CARE Cooperative for Assistance and Relief Anywhere CAS Country Assistance Strategy CI Confidence Interval CIDA Canadian International Development Agency CmSS Community Support Systems CPE Country Programme Evaluation CPR Contraceptive Prevalence Rate DFID Department for International Development DHMT District Health Management Team DSI Dinajpur Safe Mother Initiative EAP Equity and Access Programme EmOC Emergency Obstetric Care FCI Family Care International FHP Family Health Project FP Family Planning FPHP Fourth Population and Health Project GFATM Global Fund for AIDS, TB and Malaria GHI Global Health Initiatives GoB Government of Bangladesh GTZ German Technical Cooperation Program HAART Highly Active Antiretroviral Therapy HAI Health Alliance International HIV Human Immunodeficiency Virus HPP Health and Population Project HSSP Health Sector Support Project IDA International Development Association IEC Information Education Communication IEG Independent Evaluation Group IEGWB Independent Evaluation Group of the World Bank IP Implementing Partner IUD Intrauterine Device JICA Japan International Cooperation Agency JOICFP Japanese Organization for International Cooperation in Family Planning JSI John Snow International KAP Knowledge Attitudes Practice KPC Knowledge Practice Coverage LDP Leadership Development Programme LIP Low-Intensity Partnership MCDI Medical Care Development International MCH Maternal Child Health MDG Millennium Development Goal iii MOFCOM Chinese Ministry of Trade and Commerce MoH Ministry of Health MOHFW Ministry of Health and Family Welfare MMR Maternal Mortality Ratio NGO Non-Governmental Organisation NMMS National Maternal Mortality Survey ODA Official Development Assistance ODI Overseas Development Institute OECD Organisation for Economic Cooperation and Development PAHO Pan American Health Organisation PAMI Programe de Almentacion Materno Infantil PATH Program for Appropriate Technology in Health PHC Primary Health Centre POPTECH Population Technical Assistance Project PPAR Project Performance Assessment Report PRISMA Preferred Reporting Items for Systematic Reviews and Meta- Analyses PSA Public Service Agreement R.s Rupees RCTs Randomized control trials SBAs Skilled Birth Assistants SCI Skilled Care Initiative SD Standard Deviation SMP Safe Motherhood Project/Programme SPSS Statistical Package for the Social Sciences SRHC Sexual Reproductive Health Care SSMP Support to Safe Motherhood Programme STI Sexually Transmitted Infection SWAp Sector-wide approach TBAs Traditional Birth Assistants TPCSP Toliara Province Child Survival Project UN United Nations UNDG United Nations Development Group UNDP United Nations Development Programme UNFPA United Nations Population Fund UNICEF United Nations Children Fund USAID United States Agency for International Development WB World Bank WHO World Health Organisation YFS Youth-Friendly Services iv Abstract Background The Millennium Development Goal 5 (MDG 5) aims to improve maternal and reproductive health outcomes by: a) reducing the maternal mortality ratio by 75%; and b) achieving universal access to reproductive healthcare, by 2015. Current estimates suggest that only 23 countries out of 181 are likely to reduce maternal mortality by 75%. The adoption of the Paris Declaration on Aid Effectiveness in 2005 represented a global agenda to improve aid management and delivery, partly in order to address the slow progress towards the MDGs. In 2008, the Principles set out in the Paris Declaration to guide changes in international aid were re-affirmed in the Accra Agenda for Action. This review assesses available evidence of how aid delivered under the Principles adopted in the Paris Declaration is impacting upon development outcomes, focusing specifically on maternal and reproductive health (MDG 5). The review question is: What is the evidence of the impact on MDG 5 outcomes of delivering aid in line with Paris and Accra aid effectiveness principles? How does this compare to the evidence of the impact of aid in general on MDG 5 outcomes? Methods and Results The review involved a comprehensive search of the literature to identify studies that met specific criteria. The studies had to address maternal and reproductive health in developing countries, had to concern activities funded by international aid, and had to provide