Maternal mortality risk and the gender gap in desired fertility

  • There is strong evidence that high fertility rates are due, in part, to misaligned preferences between husbands and wives, with male preference for a higher number of children resulting in lower contraceptive adoption.

  • While such a gap may originate because women directly bear the cost of childbearing, there is also an information gap between men and women on maternal risk which is borne of traditional gender roles.

  • Using a randomised controlled trial (RCT) design, the study targets information on maternal mortality to different members of households to measure the extent to which learning about maternal health risk affects both spouses’ beliefs about maternal mortality, household demand for family planning, and, ultimately, realised fertility.

Reducing unplanned or unwanted pregnancies is important for economic growth, children’s outcomes, and women’s wellbeing. Despite its crucial implications for development and growth, the determinants of fertility remain poorly understood. Excess fertility is generally attributed to barriers to access to modern contraception such as cost, distance to providers, inconsistent and uncertain availability due to stockouts at clinics, and misinformation about the efficacy or risks of available methods. Yet, high rates of unwanted births are reported around the world in many settings where birth control is readily and cheaply available. Part of this may be attributed to misaligned preferences between husbands and wives: men’s higher demand for children can significantly reduce contraceptive adoption and lead to higher realised fertility.

According to Zambian DHS statistics, married men report an ideal number of children of 5.7 compared to 5.1 for married women. In Sub-Saharan Africa, the gap between desired and completed family size among men is very small, and has remained relatively stagnant despite increases in education and reductions in child mortality. Although the primary gender difference from which such a gap is likely to originate is the fact that women directly bear the cost of childbearing, there has been surprisingly little research regarding the determinants of men’s fertility preferences, both in general and relative to women. In countries like Zambia, which currently has one of the world’s highest maternal mortality ratios, the physical cost of childbearing, and hence the gender difference in total costs of childbearing, is particularly high.

This study will test the extent to which beliefs about maternal mortality and morbidity risk influence fertility demand, for men and for women, using a field experiment. The experiment will take place in Lusaka and involve 738 married couples. As part of the intervention, either husband or wife will be invited to attend a community workshop on maternal mortality while the other spouse will be invited to a similar workshop on family planning. Behavioral responses to the intervention will be measured through a variety of questions and tests posed to the participants of the workshops.

The study will be being implemented jointly with the Ministry of Health and the Ministry of Community Development, Maternal and Child Health, where our co-PI, Dr. Angel Mwiche, serves as the Director of Reproductive Health and Family Planning. This research has important implications for our policy partners in designing their fertility and maternal health strategy going forward.

The ultimate goal of this study is to encourage the adoption of modern contraceptives.  The study identifies a mechanism that can ensure, in an inexpensive and easily scalable fashion, that male involvement in family planning does not lead to unintended declines in contraceptive adoption, and actually increases the use of contraceptives. Therefore, the research can significantly contribute to the policy dialogue surrounding the Zambian government’s comprehensive strategy on smart and sustainable urbanisation.


  • Research in progress.

    Project last updated on: 11 January 2016.


Project information



Start date / End date

1 January 2013 - 1 July 2016



Research Theme

Inclusive Growth