Maternal mortality risk and gender gap in desired fertility

High rates of urbanisation generate both positive and negative externalities in developing countries. While urbanisation is linked to productivity and economic growth, it places a strain on the already meager public infrastructure, leaving the housing, health, and education needs of the urban poor largely unmet. In Zambia, 36% of the population resides in urban cities and, as of the last national census, population growth in the capital of Lusaka was 4.9% per year—among the highest in the world. High fertility rates in Lusaka coupled with rapid rural-urban migration has led to the establishment of overcrowded and inadequately serviced informal settlements (or “compounds”), in which a growing proportion of Lusakans reside.

Despite critical implications for development and growth, the determinants of fertility remain poorly understood. While women’s demand for children has decreased in Sub-Saharan Africa over the past decade, male demand has remained constant and, as such, ideal male family size currently exceeds the ideal family size of women. This gender difference in desired fertility has a measurable effect on both realised fertility and unmet need for family planning.

This study documents a large gender information gap regarding maternal mortality in households in Lusaka’s urban slums. Given this gap, informing men on maternal health risk could significantly affect their support for family planning, better aligning fertility preferences between husbands and wives and lowering realised fertility rates. Through a field experiment in Lusaka, this study aims at providing accurate information about maternal mortality risk to both women and men separately. Using an innovative design that targets information to different members of the household, this study tests the extent to which such information affects desired fertility and contraceptive use depending on which member of the household receives it.

In the next 50 years, 56% of the population in African countries is expected to reside in cities. Innovative, low cost approaches for both managing excess fertility and lowering maternal risk may help reduce the negative externalities associated with urban overcrowding and enable states to better meet the needs of their most vulnerable citizens.