Academic journal article American Economist

Do Changes in Condom Availability Affect Short-Term Fertility? Evidence from Rwanda

Academic journal article American Economist

Do Changes in Condom Availability Affect Short-Term Fertility? Evidence from Rwanda

Article excerpt

I. Introduction

Family planning programs with the goal of improving the availability of contraceptive methods have played a key role in development agendas since the mid-1900's. However, scholars and policymakers alike have frequently questioned the effectiveness of such programs as instruments for population control. Two high profile articles in particular, Dasgupta (1995) and Pritchett (1994), argue compellingly that in developing countries, demandside parental decisions, rather than access to contraceptives, determine actual fertility patterns. In other words, these researchers argue that actual changes in fertility rise only from shifts in "demand" for children, and that exogenous increases in family planning availability will have a limited, if any, effect on fertility behavior, holding demand constant. The same is argued by Banerjee and Duflo (2011), whose book Poor Economics draws on evidence from various randomized evaluations, to argue that fertility decisions generally are complex decisions driven by demand-side factors, rather than simply the availability of contraceptives.

Several recent articles, however, have shown that changes in the supply of various contraceptive methods have affected fertility rates in countries along the developmental spectrum, from Colombia (Miller 2010) and Romania (Pop-Eleches 2006, 2010) to the United States (Ananat and Hungerman 2008). The exogenous changes in contraceptive supply examined by these scholars take a variety of forms. Pop-Eleches (2006, 2010) and Ananat and Hungerman (2008) investigate changes in contraceptive access

resulting from stark alterations in national family planning policy. Miller (2010) analyzes the impact of the implementation and work of the well-known PROFAMILIA, a third-party aid program, geared toward improving the availability of family planning services in Colombia.

An opportunity to empirically test these conflicting theories in a developing country exists in the case of Rwanda. In 2002, the DELIVER Project, a USAID initiative, began working with the Rwandan Ministry of Health (MOH) to improve access to contraceptives in Rwanda. In particular, DELIVER's primary goal was to sharpen the contraceptive "supply chain," or improve the logistical systems by which contraceptives were made available. Demographic and Health Surveys (DHS) from 2000 and 2005 indicate that DELIVER activity and MOH cooperation resulted in large increases in contraceptive supply for certain regions or areas. I exploit this variation using several differences-indifferences regression estimates, which I will discuss further in Sections 5 and 6.

Though DELIVER's implementation was certainly in response to both high fertility rates and damage to the country's health systems during the genocide and civil strife of the 1990s, available evidence suggests that demand for contraception remained relatively constant over time. Moreover, increased access provided by DELIVER and MOH activity resulted from sources exogenous to individual fertility preferences. Thus, I treat the implementation of DELIVER as a shift in the supply of contraceptives and analyze the ensuing short-term effects.

The goal of this paper is to evaluate whether changes in contraceptive availability affected fertility rates and the distribution of births in Rwanda, with a secondary goal of comparing the validity of the opposing demand and supply-side theories of fertility mentioned above. Here I specifically examine changes in the availability of condoms because available data restricts my analysis of changes in availability over time to this particular contraceptive method. (1) This has some advantages. First, I hope to advance the strand of development literature focused on family planning, as prominent research in this field has not generally addressed condom availability specifically. Second, condoms are among the least costly contraceptive methods to obtain and distribute. …

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