Maternal Mortality Risk and the Gender Gap in Desired Fertility

Policy Context

Maternal mortality remains high in many low- and middle-income countries, especially in sub-Saharan Africa. Limited awareness of risk factors for maternal mortality such as maternal age and birth spacing may contribute to persistently high rates. Evidence from Zambia also shows that men’s desire to have more children than their wives hinders contraception use.

Study Design

This study took place in two government-run facilities serving low-income areas in Lusaka and randomized information sharing to couples of childbearing age to better understand gendered household fertility preferences. Upon arrival at the clinics, couples were randomly assigned and then split into gender specific meetings in which either the husband or wife received information about maternal mortality risk, in addition to both spouses receiving information about family planning. In the control group, husbands and wives only received family planning information.

Researchers measured the impact of providing this targeted information by tracking outcomes such as changes in knowledge and beliefs about the prevalence and risk of maternal mortality, intra-household dynamics, household demand for family planning, take-up of contraception, and realized fertility. An endline survey examined longer term fertility outcomes, including number of children and birth spacing, as well as maternal and child health.

Results and Policy Lessons

At baseline, husbands had lower knowledge of maternal mortality and morbidity compared to their wives. At endline, women whose husbands had directly received maternal mortality information experienced a 43% reduction in the probability of being pregnant. Consistent with preliminary hypotheses, men who directly received maternal mortality information reported lower desired fertility and had more accurate beliefs about their wife’s desired fertility than the husbands of women who received maternal mortality information. Couples in which the husband directly learned about maternal mortality also reported increased communication about family planning, and greater marital satisfaction.

Results suggest that improving men’s knowledge of maternal mortality risk could help reduce the gender gap in demand for children, but only if this information is targeted directly to men. Researchers noted that the reduction in fertility was of the same order of magnitude of other household-level interventions shown to reduce pregnancy (Ashraf, Field and Lee, 2014), but was accompanied by reports of greater marital satisfaction, communication, and closeness, which has important policy implications for family planning and reproductive health strategies.