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Globalization and Health
Published in: Globalization and Health 1/2021

Open Access 01-12-2021 | Research

For the children? A mixed methods analysis of World Bank structural adjustment loans, health projects, and infant mortality in Latin America

Author: Shiri Noy

Published in: Globalization and Health | Issue 1/2021

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Abstract

Background

The World Bank wields immense financial and normative power in health in the developing world. During the 1980s and 1990s, in the face of intense criticism of its structural adjustment policies, the World Bank purportedly turned its attention to “pro-growth and pro-poor” policies and new lending instruments. One focus has been an investment in maternal and infant health. My analysis uses a mixed methods approach to examine the relationship between traditional structural adjustment and health loans and projects and infant mortality in Latin America and the Caribbean from 2000 to 2015.

Results

My answer to whether the World Bank’s projects in Latin America worked “for the children” is: somewhat. The results are heartening in that quantitatively, health projects are associated with lower infant mortality rates, net of controls, whereas traditional structural adjustment loans do not appear to be negatively associated with infant mortality, though examined across a short time horizon. Qualitative data suggest that infants, children, and mothers are considered in World Bank loans and projects in the context of an economic logic: focusing on productivity, economic growth, and human capital, rather than human rights.

Conclusion

Taken together, my results suggest that the World Bank appears to, at least partially, have amended its approach and its recent work in the region is associated with reductions in infant mortality. However, the World Bank’s economistic approach risks compartmentalizing healthcare and reducing people to their economic potential. As such, there remains work to do, in Latin America and beyond, if health interventions are to be effective at sustainably and holistically protecting vulnerable groups.
Footnotes
1
The countries included in the analysis are: Argentina, 2000–2015; Bolivia, 2000–2015; Brazil, 2000–2015; Colombia, 2000–2015; Costa Rica, 2000–2015; Dominican Republic, 2000–2015; Ecuador, 2000–2015; El Salvador, 2000–2015; Guatemala, 2000–2015; Guyana, 2000–2015; Haiti, 2000–2015; Honduras, 2000–2015; Jamaica, 2000–2015; Mexico, 2003–2015; Nicaragua, 2000–2015; Paraguay, 2000–2015; Peru, 2000–2015; Venezuela, 2005–2011.
 
2
The most recent general structural adjustment loan in this data ended in 2009, and the World Bank has since utilized development policy loans (for information on these see http://​www1.​worldbank.​org/​publicsector/​pe/​befa05/​OP860.​htm and https://​ieg.​worldbankgroup.​org/​topic/​development-policy-financing-dpf) which include adjustment instruments. In order to examine the robustness of these findings, I also ran the models presented below for the time period ending in 2009. With this limited sample, the coefficients vary in magnitude but the results are consistent with those presented here where in the model including all controls the presence of a SAL does not have a significant association with infant mortality while health projects are associated with lower rates of infant mortality, but only net of controls. Further, I ran the same models after combining structural adjustment with adjustment development policy loans, which yield conclusions that mirror those discussed here.
 
3
Including country and year fixed effects in the models yield results consistent with those reported here.
 
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Metadata
Title
For the children? A mixed methods analysis of World Bank structural adjustment loans, health projects, and infant mortality in Latin America
Author
Shiri Noy
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Globalization and Health / Issue 1/2021
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/s12992-020-00649-1

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