Study: “Experimental Approaches to Assessing the Economic Determinants and Consequences of Contraceptive Adoption in Zambia”
PI(s): Lee, Jean Nahrae
Affiliation(s): Harvard University
Institutional Partner(s): PRB Dissertation Fellowship
Project Dates:
Start: 2007
End: 2009
Data Source(s): Prospective Data Collection
Methods: Field Experiment
Geographic Location(s): Zambia

Description:
There is not enough rigorous empirical evidence to support claims that access to reproductive health services and technologies affect the economic lives of women and children, or that decisions about contraceptive use and fertility respond to improvements in economic opportunities.

This study focuses on the effects of contraceptive availability on economic outcomes, male involvement and bargaining effects, and peer effects on adoption, with the goal to influence policy by providing evidence on whether and how to promote access to and use of modern contraceptives, especially in Africa where male involvement in family planning is actively debated. The researchers use survey and experimental data to establish these causal relationships in urban Zambia. They assess the impact of increases in access to family planning services on reported fertility desires, contraceptive use, and fertility and economic outcomes. The baseline survey and intervention were implemented in Lusaka, Zambia, in 2007, and a follow-up survey examines the broader impact of contraceptive adoption on outcomes for women and children, a more thorough analysis of household decisionmaking about fertility and contraceptive adoption, and an investigation of the importance of peer effects. The study finds that providing family planning counseling in the presence of the husband inhibits contraceptive choices. Those women provided access to contraception without their husband being present reported lower subjective well-being (felt less happy) than other women in the experiment. This suggests that there are psychological and social costs to making contraceptives more concealable. While these less-happy women did not report more marital dissolutions or domestic violence than other women in the study, this finding suggests a longer-term psychosocial cost to concealable contraceptives that may be addressed by involving husbands.

The finding that male involvement potentially reduces use of contraceptives among couples with conflicting fertility preferences helps explain why results from previous studies on male involvement in family planning have been mixed and why concealable contraceptives, such as injectables, have proven to be so popular in cultural contexts where men dominate family planning decisions. In reality, giving women access to injectables privately improves her set of choices but also may have detrimental consequences for her marriage. For this reason, it is important for practitioners to ask whether policies that reduce further investments in the marital relationship are the right path to take. Based on these results, the researchers suggest that some women would be better off by having more opportunities to make contraception decisions in private, and by gaining access to concealable, long-term contraceptive methods.

Research Outputs:
Ashraf, Nava, Erica Field, and Jean Lee. (2014). “Household Bargaining and Excess Fertility: An Experimental Study in Zambia.” American Economic Review, 104(7): 2210-37. DOI: 10.1257/aer.104.7.2210

Belohlav, Kate & Karra, Mahesh. (2013). “Household Decisionmaking and Contraceptive Use in Zambia.” Washington, DC: Population Reference Bureau. DOI: 10.6084/m9.figshare.1196996

Field, Erica M, Nava Ashraf, and Jean N Lee. (2007). “Gender, Intrahousehold Decisionmaking, and the Demand for Children.” (Harvard University Weatherhead Center for International Affairs Working Paper No. 2008-0028).