Maternal Mortality Risk and Spousal Differences in the Demand for Children

Abstract

Fertility decisions are often made by partners who may disagree. We develop a model in which conflicting interests prevent effective communication between spouses about the costs of childbearing incurred by women. This mechanism is likely to further widen the spousal disagreement over fertility in environments where maternal health risk is high and imperfectly observed. We design an intervention to experimentally vary exposure to information about maternal health costs to either the husband or the wife among approximately 500 couples in Lusaka, Zambia. At baseline, husbands exhibit lower knowledge of maternal health risk compared to their wives. One year after the intervention, husbands significantly update their beliefs about maternal risk but only if the information is delivered directly to them, whereas wives update their beliefs about risk regardless of who in the household is treated. The intra-household asymmetry in information spillovers is strongest among men with more urgent demand for children. Households treated with information on maternal risk experience a sizable reduction in the probability of pregnancy -an effect which is strongest when the woman faces a higher risk of complications -but only when the information is delivered to wives rather than husbands is this decline in fertility accompanied by a significant reduction in transfers to the wife. These patterns are consistent with differences in initial beliefs and demand for children generating a barrier to credible communication between spouses.

Women's Political Representation and Intimate Partner Violence

“…Moreover, our work relates to a limited literature showing that women's improved access to family planning services may lead to intrahousehold conflict and IPV (Ashraf et al 2014;Anukriti 2020). More generally, we contribute to an emerging literature on how misaligned fertility preferences can prevent efficient information sharing between spouses, leading to suboptimal outcomes for women (Ashraf et al 2020). Finally, our paper also contributes to the extensive literature on the drivers of IPV (Aizer 2010;Anderberg et al 2016;Erten and Keskin 2018;Bhalotra et al 2021).…”

“…20 Intrahousehold misalignment of fertility preferences. Previous studies show that household decision-making about childbearing and contraceptive use may be characterized by inefficiency and noncooperative behavior (Ashraf et al 2014;Anukriti 2020;Ashraf et al 2020). As women's use of contraceptives may not be perfectly observable to the male partner, moral hazard can arise due to hidden action and asymmetric information.…”

Maternal Mortality and Women’s Political Power

“…Women in politics appear to be more intrinsically moti vated and less prone to the policy distortions created by electoral incentives (Baskaran et al, 2018; Brollo andTroiano, 2016). If women have more information on MMR (Ashraf et al, 2020), they may also be better able to target resources. Finally, our measures of reproductive health coverage are not purely supplyside measures, they also reflect uptake.…”

“…Women may achieve larger reductions in MMR because they have different preferences (Baskaran and Hessami, 2019; Baskaran et al, 2018; Lippmann, 2020; Clayton et al, 2017; Okuyama, 2018, different information sets (Ashraf et al, 2020), are less corrupt, or have greater intrinsic motivation (Folbre, 2012; Brollo and Troiano, 2016; Baskaran et al, 2018, or because women citizens feel more able to raise their concerns with women rep resentatives (Parthasarathy et al, 2019). In section 7, we discuss evidence that is broadly consistent with leaders being able to move the outcomes they prioritize by influencing building consensus, provoking legislation and improving policy design and delivery, including better targeting and greater outreach.…”

Shared Decision-Making: Can Improved Counseling Increase Willingness to Pay for Modern Contraceptives?

“…Our study is also related to a growing literature in the U.S. on counseling interventions -such as peer counseling, a waiting room app for contraceptive counseling, and motivational interviewing techniques allowing the client to articulate goals and discuss plans -that showed promise in leading to higher levels of knowledge of contraceptive effectiveness, increased interest in adopting the implant, and higher rates of LARC uptake (Gilliam et al, 2014;Church et al, 2017;Wilson et al, 2014). It is also related to the literature in economics on providing sexual and reproductive health information to adolescents, young women, and to their spouses/partners (Dupas, 2011;Dupas et al, 2018;Duflo et al, 2015;Ashraf et al, 2020).…”