Household Bargaining and Excess Fertility: An Experimental Study in Zambia
Enabling a woman to make her own decision about having children -- independently from her husband -- can reduce unwanted pregnancies.
Modern contraception is one of the most important technological developments of the 20th century that has broad social and economic consequences for women and societies. Contraceptive use often leads to improvements in women’s education and workforce participation. Additionally, contraceptives enable women to space their births; women who conceive less than 15 months after a birth are at a higher risk of maternal mortality, third trimester bleeding, high blood pressure, as well as other poor maternal health outcomes. Children that result from closely spaced pregnancies often have increased under-nutrition and child mortality. Many developing countries still face high rates of unwanted births, even in areas where birth control is readily and cheaply available. If access to contraceptives is not a barrier, why do unwanted births persist? This study explores how bargaining between women and men affects family planning, contraceptive use and unwanted pregnancies.
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.