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Despite these numerous problems, some progress has been made in expanding health-care services. In their detailed study, Sunil and Pillai document improvements in reproductive health indicators in the 1990s. Contraceptive use increased, and fertility and infant mortality fell, and yet child marriage remains a deeply rooted custom: Most women marry by their mid-teens and start having children a year later, and the use of modern contraception and maternal and child health services is very low. On average, women continue to have nearly six children, half of whom below age 5 suffer from stunting. In 2005 barely one in five pregnancies was attended by skilled personnel, a factor that contributes to one of the highest maternal mortality rates in the world.
Sunil and Pillai further ground their study with the 1994 International Conference on Population and Development, at which 179 governments agreed on a landmark plan for achieving more sustainable population growth rates and for improving the reproductive health of the global population. This placed individual human rights and gender equality at the center of development efforts. Unfortunately, the realization of these goals has proved far more difficult than expected. Against this backdrop, they consider reproductive health as a process and present a theoretical model that suggests that reproductive health improves with gains in household economic conditions and women's autonomy.
Sunil and Pillai test their model by making innovative use of several latent (unobserved) variables for factors related to economics, gender, and reproductive health. They use the 1991 and 1997 Yemen Demographic and Health Surveys, which are nationally representative of Yemeni women of childbearing age and remain the only two quality data sets available for assessing the issues of interest in this fascinating country. Among other