Gender and Development
Paper Session
Friday, Jan. 3, 2025 8:00 AM - 10:00 AM (PST)
- Chair: Tom Vogl, University of California-San Diego
Family Planning, Now and Later: Infertility Fears and Contraceptive Take-Up
Abstract
Early fertility is thought to be one of the key barriers to female human capital attainment in sub-Saharan Africa, yet contraceptive take-up remains puzzlingly low, even among highly-educated populations with healthcare access. We study a barrier to hormonal contraceptive uptake that has not yet been examined in the economic literature: the persistent (incorrect) belief that these contraceptives may cause later infertility. This belief creates a perceived tradeoff between current and future reproductive control. We use a randomized controlled trial with female undergraduates at the flagship university in Zambia -- a highly-skilled population where education is likely to have particularly high returns -- to test two potential interventions to increase contraceptive use. Despite high rates of sexual activity and low rates of condom-use, only 5% of this population uses hormonal contraceptives at baseline. Providing a non-coercive conditional cash transfer to visit a local clinic temporarily increases contraceptive use. However, pairing this transfer with information addressing fears that contraceptives cause infertility persistently increases take-up over 6 months. The latter treatment moves beliefs about the infertility effects of contraceptives and leads to the take-up of longer-lasting contraceptives like injections. Compliers are more likely to cite fear of infertility as the reason for not using contraceptives at baseline. IV estimates indicate that eliminating the belief that contraceptives cause infertility would triple contraceptive use.When Pure Access Does Not Breed Use
Abstract
Sub-Saharan Africa has the highest adolescent birth rates globally, alongside some of the highest rates of unmet need for modern contraception. This paper evaluates the impact of a randomized controlled trial that offers adolescent females free modern contraceptives (implants, intrauterine devices, injectables, pills, condoms, female condom) on contraceptive use and pregnancy among adolescent females. Contraceptives were distributed by nurses at pre-existing adolescent clubs every other month between April 2017 and January 2018. We estimate a null treatment effect from this supply side treatment. We explore dimensions of heterogeneity in treatment effects according to dimensions cited in the literature and find little evidence of heterogeneous treatment effects. We conclude that providing access to contraceptives alone is not sufficient to increase adolescent contraceptive use; instead, programs should combine supply-side interventions with programming that targets knowledge and norms.The Mental Health Effects of Access to Contraception
Abstract
Depression and anxiety constitute leading contributors to the global burden of disease.1 Depression has substantial economic consequences, resulting in work absence, lower pro- ductivity, and worse outcomes for children of depressed individuals (Baingana et al., 2006; Dole, 2003; Nasreen et al., 2010). Economic development can also impact mental health, although this direction of the relationship is less understood (e.g. Cohen et al., eds, 2002). In particular, the economic factors able to decrease depression or anxiety may vary by gender, as women suffer disproportionately from depression even after accounting for differences in diagnosis rates (Nolen-Hoeksema, 2001; Piccinelli and Wilkinson, 2000). Explanations for this disparity usually focus on consequences of women’s lower social status, including domestic violence, discrimination, and excessive responsibilities within the household (Baingana et al., 2006; Gomel, 1997; Nolen-Hoeksema, 2001). This study, however, considers a largely unexplored determinant: a woman’s control over her own fertility outcomes. Women in developing countries face significant challenges in accessing family planning services and, more generally, controlling their own fertility. We posit that this inability to reliably manage fertility may constitute an important source of mental stress and anxiety.Discussant(s)
Rachel Heath
,
University of Washington
Anne Karing
,
University of Chicago
Simone Gabrielle Schaner
,
University of Southern California
Bilge Erten
,
Northeastern University
JEL Classifications
- O1 - Economic Development
- J1 - Demographic Economics