BERI Framework: Executive Summary
Behavioral economics has begun to transform the design of public policies, particularly those related to health and economic development. Recent field experiments in the US and UK testing low-cost interventions inspired by psychology have demonstrated outsized impacts on human behavior and development outcomes. Can similar insights be employed to improve family planning and reproductive health? This paper summarizes existing evidence from the field and presents a framework for applying behavioral economics to reproductive outcomes.
Reproductive health remains one of the world’s most obstinate development challenges. Each year almost 300,000 women die from childbirth, and four million infants die within the first month of life. Most deaths and complications can be prevented with adequate health services or by avoiding early and unwanted pregnancy, yet use of contraceptives and maternal health services remains low.
We know that access to affordable services is a key determinant of take up, however it is not the only factor at play.
- The quality of health service delivery remains low across many areas. Health providers often lack the incentives to provide quality care, contributing to absenteeism, poor facility management, inappropriate care, and burdensome or unnecessary procedures.
- Nearly half of women in developing countries discontinue contraceptive use within a year, despite not wanting to become pregnant.
- Women’s education and employment affects desired family size, contraceptive use, and antenatal care take up, but in developing countries girls often lack access to quality education and face pressure to leave school.
- Cultural and social influences, including age at marriage, limit girls’ and women’s autonomy and intra-household bargaining power and can affect the take up of modern family planning and reproductive health services.
- Adolescents have higher risks of pregnancy complications than adult women but are less likely to seek adequate preventive care. They are also more likely to engage in risky behavior, which can contribute to early pregnancy and school dropout rates.
Among a host of other challenges, these factors can prevent women and families from achieving the healthy reproductive outcomes they desire.
Behavioral economics examines why individuals make decisions that potentially compromise their own future wellbeing and the welfare of others. It is a field of research that incorporates psychological insights to examine systematic behavioral biases in decision-making. We categorize these biases into four sets of opposing forces; individuals fall somewhere on a spectrum between these forces (often unknowingly) when making decisions about health
Illusion ↔Reality. People make decisions based on what they believe to be true, hinging on their own experiences, reference points, or estimates—rather than what is objectively or measurably true. Couples may choose not to use a modern method because they believe it causes infertility or disease, or because they underestimate the probability of becoming pregnant.
Self ↔Other. Individuals are sometimes influenced by others’ interests, or by social norms or expectations. For example, even when a woman prefers to deliver in a clinic or hospital, she may forego the opportunity due to the expectations of her partner, family, or community. Similarly, a couple may not desire a large family, but may have additional children to conform to social identities or norms.
Thinking Fast ↔ Thinking Slow. Cognition is a limited resource, and people living in poverty often exhibit a depletion of cognitive capacity due to the complexity and unpredictability of daily life. Sometimes individuals select choices that require the least mental energy or cognitive cost (often without realizing it). Busy providers may recommend a contraceptive method because they have prior experience with it, which could result in a different recommendation than processing all of the information available about different methods to make the best decision for their patient’s individual needs.
Today ↔ Tomorrow. Every day individuals face a trade-off between costs today and costs tomorrow. For example, a woman may delay the cost (or effort/time required) of going to a clinic today, perceiving the cost to be lower tomorrow. However, repeating this decision results in procrastination and it underweights the high costs of pregnancy complications in the future.
Evidence-based tools exist to help individuals make better decisions in the face of these forces. Yet few have been tested in the context of reproductive decision-making. We align the existing set of tools from behavioral economics with challenges in reproductive health, to incite new research at the nexus of these two disciplines.
Read the full BERI Review Paper here.