Sex, Drug, and Births: How Changes in International Provision of Contraceptive Supply Affect Fertility in Zambia
*Names in bold indicate Presenter
Supply-side policies therefore still have the potential to significantly reduce unmet need and total fertility rate. I focus this paper on mechanisms that international aid agencies and donors use to reduce unplanned pregnancy and fertility in low-income countries, which largely involves increasing contraceptive access through free or heavily subsidized commodities. This paper will explore whether improvements to contraceptive access, in the form of contraceptive supply, leads to reductions in pregnancies. I chose Zambia as a case study because it is a large recipient of aid, and thus vulnerable to many external factors that could disrupt the total supply of contraceptive methods in the country. Specifically, I will measure the effect of contraceptive quantities, frequency of shipments, and shipment timing on number of pregnancies.
The Reproductive Health Interchange (RHI), a website managed by UNFPA, provides open access to shipment data on over 80% of contraceptive supplies provided by donors for developing nations. Data on shipments to Zambia as reported by RHI show that the amount and frequency of shipments between 2008 and 2014 are substantially higher than between 2000 and 2008 (Figure 1). Furthermore, shipments of longer-term methods including Depo, IUD, and implants increased after 2007 (Figure 2).
Sudden increases in shipment quantity and frequency is an opportunity to test the impact of increases in contraceptive access on pregnancy outcomes in Zambia. This analysis will contribute to our understanding of whether increased contraceptive supply helped reduce TFR between 2007 and 2013. Using data reported from the RHI, I will estimate the impact of the increase in contraceptive shipment on probability of pregnancy for each reproductive age woman.
This study will be the first to examine the exogeneity of a sudden increase in contraceptive supply to Zambia after 2007, and estimate how much the increase in supply affected likelihood of pregnancy in Zambia. A significant decrease in likelihood of pregnancy will support the continued use of supply-side policy mechanisms to support population control activities in Zambia, and encourages U.S. policymakers and administrators to continue consistent financial and logistical support of contraceptive delivery for low-income, high-fertility countries.