Association for Public Policy Analysis & Management

How do we increase family planning usage and thus reduce unplanned pregnancies in Zambia? Three possible mechanisms are increasing knowledge of family planning, reducing husband disapproval of family planning, and increasing contraceptive access. According to the Zambia DHS in 2007, family planning knowledge is at 97 percent and 99 percent for men. Knowledge of family planning is therefore high, and room for improvement is minimal. While most husbands know about family planning, husband disapproval of modern family planning methods may be a large hindrance to women seeking contraception (Ashraf et al. 2014). Regardless of within-household dynamics between husband and wife, husband ideal numbers of children in Zambia, while higher than their wives, has been consistently lower than TFR in the past 15 years. There is still an opportunity to reduce number of unwanted and unplanned births in Zambia without the need to change husband behavior.

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.