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Experimental Approaches to Assessing the Economic Determinants and Consequences of Contraceptive Adoption in Zambia

  • 2008-2010
  • Project
Ashraf, Nava, Harvard University, University of Zambia School of Humanities and Social Science

Study: “Experimental Approaches to Assessing the Economic Determinants and Consequences of Contraceptive Adoption in Zambia”
PI(s): Ashraf, Nava
Co-PI(s): Field, Erica
Affiliation(s): Harvard University, University of Zambia School of Humanities and Social Sciences
Institutional Partner(s): PRB Center
Project Dates:
Start: May 2008
End: October 2010
Data Source(s): Panel Data
Methods: Randomized Controlled Trial
Geographic Location(s): Zambia

In Lusaka, Zambia, family planning services are readily available, yet unmet need for contraception remains high, with one in four women reporting a desire to prevent childbearing, but not doing anything to prevent it. Contraceptives and family planning services promote a wide range of health and socioeconomic benefits. Allowing women to time their births increases women’s investments in education and participation in the labor market at childbearing ages. High levels of unmet need, therefore, are a cause for both social and economic concern in Zambia.

Ashraf, Field, and Lee explored how the husband’s presence in the fertility clinic affected uptake of contraception among women. The research team implemented a field experiment in Zambia, a country that experiences high excess fertility despite availability of contraceptives through both public and private providers. The experiment provided a voucher that guaranteed a short wait time and free access to concealable forms of contraception, with the treatment arms being split into two groups: one where women received the voucher in private, and another where the couple received the voucher together. Wives receiving vouchers without having their husbands present redeemed their vouchers and used concealable contraceptives at a higher rate than the couples who received the voucher together. 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, Field, Erica & Lee, Jean. (2007). Gender, Intrahousehold Decisionmaking, and the Demand for Children (Harvard University Weatherhead Center for International Affairs Working Paper No. 2008-0028).

Ashraf, Nava, Field, Erica and Lee, Jean. (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

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