Household Bargaining and Excess Fertility: An Experimental Study in Zambia

The intervention was targeted to married women aged 18-40 who had given birth in the last two years and lived in compounds serviced by the Chipata Clinic in Lusaka, Zambia. Sample women were given a voucher guaranteeing free and immediate access to modern contraceptives through a private appointment with a family planning nurse. This included access to the most concealable and highly demanded method, which is often out of stock—injectables. In one condition, the voucher was provided to women alone (“Individual”) and required her signature only; in the other condition it was handed to the husband in the presence of his wife and required both of their signatures (“Couple”).

2007-03-01

2007-06-01

Contraceptive uptake through voucher use
Fertility
Well-being

Contraceptive uptake through voucher use: The nurse hired for the study kept daily visit logs of date and time of visit, name and National Registration Code (NRC) of the woman, ID number of the voucher and received family planning method. To ensure that vouchers were not used by individuals outside of the sample, the wife’s name and NRC numbers were written on the voucher by enumerators during the house visit, and women were instructed to bring their NRC cards to the clinic at the time of the visit for the nurse to verify.

Fertility: birth rates 9–13 months after a respondent received a voucher.

Well-being: measured by effect on separation, domestic violence, condom use, and self-reported well-being metrics: life satisfaction, happiness and peace of mind. Satisfaction is measured using the following question: All things considered, how satisfied are you with your life as a whole these days? Please tell me which number on this scale more adequately represents your level of satisfaction with your life as a whole: one means you are “completely dissatisfied” and five means you are “completely satisfied.” Health is measured using the following question: Compared to women in your community of the same age, how would you describe your overall health? Happiness is measured using the following question: Compared to women in your community of the same age, how would you describe your overall level of happiness and peace of mind? “very unhappy or discontent” is coded as one and “very happy and content” is coded as five. An individual was considered satisfied, healthy, or happy if they responded with a value greater than or equal to four for the above questions.

Sample women were recruited from the catchment area of Chipata Clinic, a large government clinic that serves low-income “compound” neighborhoods in Lusaka. Married women of childbearing age (18–40) were invited to participate in the study if they: (i) currently lived with their husband; (ii) had last given birth between January 2004 and December 2006; (iii) were not currently pregnant; (iv) had neither been sterilized nor had a hysterectomy; (v) were not known to have health conditions for which hormonal contraceptives are contraindicated; and (vi) agreed to participate in a survey and information session about family planning together with their husband. Although the voucher intervention only required the husband’s presence in the Couple condition, criteria (vi) was imposed on all subjects in order to prevent higher rates of attrition among those assigned to the Couple condition relative to those in the Individual condition.

The experiment consisted of a baseline survey in the first visit administered solely to the wife, during which an appointment was made for a second visit with both the wife and husband. Individual versus Couple condition was then randomly assigned. During the second visit, husband and wife were surveyed separately. In the Individual condition, the wife was given the voucher in private and in the Couple condition, the voucher was given to the husband in presence of the wife.

Two years later, researchers conducted a follow-up survey to study the impact of contraceptive access on fertility( birth rates 9–13 months after a respondent received the voucher) and well-being.

Done using the minmax t-statistic method

Individual women.

No

Study not clustered.

1031 sample women.

Couple treatment: 503
Wife involved treatment: 528

HOUSEHOLD BARGAINING AND EXCESS FERTILITY: AN EXPERIMENTAL STUDY IN ZAMBIA

We posit that household decision-making over fertility is characterized by moral hazard since most contraception can only be perfectly observed by the woman. Using an experiment in Zambia that varied whether women were given access to contraceptives alone or with their husbands, we find that women given access with their husbands were 19 percent less likely to seek family planning services, 25 percent less likely to use concealable contraception, and 27 percent more likely to give birth. However, women given access to contraception alone report a lower subjective well-being, suggesting a psychosocial cost of making contraceptives more concealable.

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.

https://www.povertyactionlab.org/sites/default/files/publications/204_334%20Household%20Fertility%20Zambia%20AEJ2014.pdf