The trade-off of spousal secrets in family planning: Guest post by Aine McCarthy


This page in:

This is the eleventh in our series of posts by students on the job market this year.

When men desire nearly three times as many additional children as their wives and possess most of the decision-making power in the household, the stark difference in fertility preferences leads to excess fertility and welfare losses for wives.

Fertility rates remain high in rural Sub-Saharan Africa, where in Tanzania in 2010, the total fertility rate was 8.1 births per woman. Yet, the benefits of planned and spaced births include positive outcomes for children, including better nutrition and more years of schooling (Do and Phung, 2010), and better maternal health (Winikoff, 1983; Norton, 2005). In my study district in north-central Tanzania, 89% of women report wanting to wait two years before their next child (or stop having children altogether) and yet only 12% taking contraceptives. In my job market paper, I argue that this gap is explained by both a lack of information and by imposing husbands (more specifically, by their imposing preferences).


Most women in this district report knowledge and use of folkloric methods of birth control (e.g. luck charms). And most women don’t know that modern contraceptives are actually free at their local (or neighboring) dispensary.


Husbands (and their pro-natalist preferences), on the other hand, are very well known to wives and to the community. In the Meatu household survey, women, on average, report desiring an additional 1.4 children and men report desiring an additional 4.5 children. Women also report avoiding contraception due to their husbands’ desires.


This predicament leads me to explore intra-household bargaining and fertility decisions through a randomized control trial in northern Tanzania. I collaborated with local health officials to evaluate the effect of a community family planning program designed to improve education about contraceptive options. The family planning program included household consultations by a trained community health worker who is a resident of each village. The design of the study allows me to measure the effect of the inclusion of husbands in these household consultations about family planning after a fifteen month intervention. In half the treatment villages, the consultations between women and the health worker included husbands (couples’ treatment), while in the other half, husbands were excluded (women-only treatment).


Previous work on intra-household behavior indicates that, given private information, family members behave strategically to improve individual welfare (Ashraf et al., 2014; Castilla and Walker, 2013; Ambler, 2014). However, the demography literature has demonstrated the need for spousal communication and joint education as a vehicle for family planning (Ezeh, Seroussi and Raggers 1996; Lasee and Becker, 1997; El-Khoury, Thornton, Chatterji, Kamhawi, Sloane and Halassa, 2015). I bridge these two groups of literature by demonstrating the benefits of private information (for women) in family planning (women-only treatment), but by also showing the improvements in couples’ cooperation through the joint intervention (couples treatment).


The main findings provide evidence of a trade-off of asymmetric information about family planning. Women who consulted with the community health worker alone (without their husbands) reduced their pregnancies by 16 percentage points (relative to the control group), while women in the couples treatment group did not significantly reduce pregnancies. These women are likely taking advantage of the private information about contraceptive options and, without their husbands’ outright ability to veto, they may be using contraception discretely.


Yet, the joint conversation about family planning as part of the couples’ consultation also had an effect, reducing men's (relatively large) fertility desires. The number of spousal conversations about family size not taking place in the presence of the community health worker also increased in the couples’ treatment group. So while the private family planning information in the individual treatment group has a more immediate effect on reducing women’s excess fertility, the joint consultations had an effect in aligning preferences and improving spousal communication. Given the low baseline levels of communication about planning family sizes in this context, improved communication about preferences may lead to better spousal cooperation and a more equalized balance of intra-household bargaining power.


This study brings to light additional questions in intra-household bargaining over fertility. While this study examines a medium-term intervention (fifteen months) that allows for a spousal bargaining process, the long-term effects of asymmetric family planning information on total family size are yet to be measured. And although husbands’ reported fertility preferences were reduced by the intervention, a further exploration on the duration and impact of these preferences is needed to better understand the effect of of asymmetric information in family planning.


In the unresolved question on whether husbands should be included in family planning education, my results provide evidence of the positive cooperation effects of inclusion while also supporting private welfare gains for women in individual consultations.


Aine McCarthy is a Ph.D. candidate in Applied Economics at the University of Minnesota. She is on the job market this year; more details about her research can be found here.

December 18, 2015

I think the TFR in rural Tanzania is 6.1 and not 8.1: