Maternal Mortality Risk and the Gender Gap in Desired Fertility | Nava Ashraf, Harvard

The Challenge
High fertility rates and inadequate family planning undermine economic growth and contribute to infant and maternal mortality. While women’s fertility demand has steadily decreased throughout sub-Saharan Africa in recent years, men’s fertility demand has remained relatively constant. In cases where men have more intra-household bargaining power, this gap in fertility preferences results in lower contraceptive use and higher fertility.

The primary gender difference from which such a gap is likely to originate is the fact that women directly bear the cost of childbearing. In Zambia, cultural myths around maternal mortality are common and men are shielded from many of the complications and maternal risks during delivery. However, such lack of knowledge has never been linked to a gender gap in desired fertility.

The Approach
This study will evaluate whether and how increasing maternal mortality awareness changes men’s fertility demand. In Lusaka, 2,000 couples will be randomly assigned to a “husband focused” or “wife focused” group at a community workshop.

In the “husband focused” group, the wives will attend a neutral health meeting and in the “wife focused” group, the husband will attend a neutral health meeting. Husbands in the “husband-focused” group and wives in the “wife-focused” group will be randomized into either a treatment or comparison group. All participants will receive a voucher for free planning services at a local clinic.
Zambia maternal mortality2

Data collected from the local clinics will be used to compare voucher uptake among the different groups. Additionally, a panel survey will measure short and medium term outcomes. Outcomes to be measured include knowledge on maternal mortality, individual and household behaviors, superstitious beliefs about maternal mortality, and intra-household dynamics.  Health outcomes, which include use of family planning services, contraception adoption and pregnancy, will also be measured. Researchers will then determine the extent to which adding information on maternal mortality to family planning services changes men’s fertility demands.

The Lesson
Project ongoing, results forthcoming. The results will be incorporated into Zambia’s community health education program and could have important implications for other countries facing similar problems.


Photo Credit: Felix Clay, Women fetching water during dry season. 2012.

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