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

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.

The sociology of global health: Inequality, disease‐related stigma, and the rise of nongovernmental organizations

“…Like Chorev (2020), scholars also discuss issues with access to medications in resource‐poor settings (Roy, 2023), perhaps related to the lack of global regulatory bodies (Nilsson, 2017). When working toward better health outcomes, organizations must weigh issues of cost effectiveness (Noy, 2015, 2021; Zhou, 2021) with moral considerations (Noy, 2015) or widening global inequality (Stubbs et al., 2022). Yet, moral considerations and well‐being may play a bigger role for agencies like the International Monetary Fund, that demonstrate a financial commitment to sustainability in development of poorer nations (Kentikelenis et al., 2022).…”