Large families can be a drain on household resources, with school fees being the largest cash expenditure in many households. With smaller families, women can stay healthier, become more economically productive, and have more opportunities for education, training, and employment. At the country level, women’s increased working outside the home also leads to an expanding labor force, which produces substantial economic benefits. Health-Wealth Relationship, a recent study conducted by the Harvard School of Public Health and the University of Ghana, Legon, examined the associations between reproductive health, fertility, and economic outcomes for women living in the urban area of Accra, Ghana. The study investigated this “health-wealth relationship” by analyzing the effects of fertility and family size on:

• Women’s reproductive health status.
• Female labor force participation.
• Employment status of mothers.
• Women’s wages and earnings.

The results provide new and rich information on the impact of high fertility and increasing family size for individuals, households, and communities. The analysis also addressed the specific challenges faced by urban women in Accra, where overall economic growth is fast, fertility is relatively low, and women’s economic independence is considerable. The study brought together several years of empirical research on women’s health and reproduction in Accra. Drawing on the 2003 Women’s Health Study of Accra 2003 and interviewing new participants, researchers gathered quantitative and qualitative data on health, time use, sexual behavior, pregnancies, childrearing, and labor force participation.