Household Bargaining and Excess Fertility: An Experimental Study in Zambia

The study gave women in Zambia information about and free access to contraceptives. Some of the women were given this information privately while others were given this information with their husband.

• Women who were given access to vouchers and contraceptive information with their husbands were 19% less likely to seek family planning services, 25% less likely to use injectable (concealable) contraceptives and 27% more likely to give birth, than those who received the same information alone.
• 11% of women who received the individual counseling condition reported concealing the voucher from their husbands, while another 5% admitted to misrepresenting the voucher so that their husband would let them use it.
• Among couples in which neither partner desires another pregnancy, women are twice as likely to redeem the voucher and three times as likely to choose long-acting hormonal methods when they are assigned to the individual treatment than when assigned to the couples condition.
• The use of family planning services through the intervention reduced the number of births over the next year by 27%.

Women who were given the information and contraceptives with their husbands reported being significantly happier and healthier than those who were given the information individually. This result suggests a psychosocial cost of concealable contraceptives.

In this study, women were first randomized to either the control or treatment group. Women in the control group received information on sexually transmitted infections, condoms, and injectable contraception. Women in the treatment group were then randomized again, after receiving the same information and services as well as the control group during their first visit, to either receive a voucher for family planning in a couples counseling session with their husbands or an individual session. For both individuals and couples counseling, the voucher guaranteed free, immediate access to an array of contraceptives as well as an appointment with a family planning nurse.

Women selected for the study were between the ages of 18 and 40, married, living with their husbands and not currently pregnant. In addition to comparisons among the three groups, the study also gathered information on fertility preferences, contraceptive use, birth history and other demographic information. The main outcome of interest, fertility, was measured 9-13 months after the receipt of the voucher.