Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. Christine Moser

Second Advisor

Dr. Jean Kimmel

Third Advisor

Dr. Paul Clements


This dissertation is intended to evaluate the effects of economic and risk factors on three aspects of sexual and reproductive health: maternal mortality, prenatal care demand, and contraceptive use. The first study of this dissertation discusses the effects of risk factors and socioeconomic determinants on maternal mortality. This research uses a unique, nationwide panel of counties to analyze maternal mortality in Madagascar. Factors like health environment and access to health services were controlled for. The results indicate that female literacy and wages decrease maternal mortality. Other factors related to health infrastructure, and diseases can represent a burden to women's health.

The second study of this dissertation examines the effects of shocks and other economic determinants on prenatal healthcare provider choices. Shocks are unanticipated events that reduce household income, consumption, and/or the accumulation of productive assets. Two types of shocks are evaluated in this research: idiosyncratic and covariate. Idiosyncratic shocks affect only the household, while covariate shocks involve the entire community. The findings suggest that covariate shocks increase the likelihood of using formal prenatal care. Shocks that affect the entire community can affect the community support, cause food uncertainty, and result in a lack of other health resources to women. Other important factors in prenatal health care choices are education and income.

The third study of this dissertation examines the effects of shocks and other economic determinants on the choice of contraceptive method. Because shocks may increase the health risks to infants and reduce resources that can be devoted to children, women may want to use contraception as a strategy to prevent these negative outcomes. This research looks at four types of shocks: economic, environmental, health, and crime. The findings suggest that when a woman faces an economic shock, she is more likely to choose formal contraceptives use. Other factors like death of an offspring, maternal mortality, and education also are important in a woman's contraceptive use. The results in this dissertation can help identify some factors that threaten women's health and can help Madagascar accomplish the fifth goal of the Millennium Development Goals which aims to reduce maternal mortality and improve maternal health in developing countries.

Access Setting

Dissertation-Open Access