This Small Grant for Exploratory Research (SGER) supports an experimental study on fertility. The study uses a novel setting and experimental design, implemented with a family planning clinic in Lusaka, Zambia, to test whether women who desire to limit fertility but do not use contraception are constrained by spouses' preferences for children or unwillingness to use birth control. Although there is strong anecdotal evidence that spousal control over fertility can constrain women's choices, this is the first field experiment that can test the extent of this important factor in fertility decisions and outcomes, by randomizing husband's knowledge of his wife's access to contraception through providing family planning vouchers either to the wife alone (treatment group A), or the wife in the presence of her husband (treatment group B). Injectable contraception is available to women in Zambia but there is often a long wait; this experimental design increases access among all study subjects, in both treatment groups above, through the distribution of vouchers guaranteeing free and immediate access to this method at the local public health clinic. The increase in access created through this design allows the investigators, with sufficient sample size and a control group, to address other questions fundamental to fertility and development.
This study will contribute methodologically to the literature by generating the first experimental estimates of the impact on women and children of increasing women's control over birth number, timing and spacing, through access to long-term, commitment-oriented contraception. Most empirical studies of fertility choices and outcomes suffer from identification problems. Although the influence of contraception on female and family outcomes is a central question in the demography and economics literatures, there have been no experimental evaluations of contraceptive access, and quasi-experimental or retrospective studies suffer from the usual identification problems. Hence, this proposed methodology is a valuable application of a new approach to an established topic. In addition, the sub-component that randomizes husbands' knowledge will shed light on intra-household bargaining dynamics that inform fertility decisions.
Broader Impact: Better understanding of the intra-household determinants of contraceptive adoption and the impacts of contraception on family health and wellbeing has important implications for the design of family planning policies. In addition, by making use of the opportunity presented by the experiment to measure the importance of peer effects in contraceptive adoption, this study provides evidence on the extent to which contraceptive knowledge spreads through social networks to create changes in fertility norms. Improved understanding of both determinants and impact of contraceptive adoption is critical for deciding the amount and nature of resources that should be provided by governments for family planning in resource-constrained countries.
