From Health Service Delivery to Family Planning: The Changing Impact of Health Clinics on Fertility in Rural Iran

After a decade of pronatal policies, in 1989 the Iranian government reversed itself and launched an ambitious program to control population growth. In the subsequent 15 years the average number of births per rural woman dropped from more than seven to the replacement level. We evaluate the impact of health clinics on rural fertility, distinguishing between their effect when they delivered only health services and when they also provided family planning. We use the exogenous variation in the timing of the construction of health clinics across rural Iran to identify their impact on the timing of birth for different parities. We also use the policy reversal in 1989 to delineate the function of the clinics in each year of their operation--that is, health versus health and family planning. Using individual birth histories, we estimate the impact of the clinics on the hazard of births during these different phases. Our findings indicate that, contrary to prevalent accounts that give the lion's share of the credit for rural fertility decline to government intervention, health clinics account for a relatively small part of the decline in fertility.