Lifecycle Fertility and the Impact of Family Planning Programs: Evidence from Southern Africa

Abstract

The impact of family planning programs on fertility in developing countries is contested, with empirical evidence finding negative effects on completed fertility but no consistent effect on short-run fertility. Using a lifecycle model of fertility control choice, we theoretically and empirically show that differential responses of short-run and completed fertility are consistent with a single behavioral response to improved contraceptive access — a shifting of births earlier in the lifecycle due to improved control over fertility outcomes. Women without access to modern contraceptives use traditional methods to delay wanted births because of a precautionary motive to avoid exceeding their target fertility; improved contraceptive access relaxes this precautionary motive and can increase short-run, but not completed, fertility. Using a difference-in-difference design that exploits the legalization of injectables in Zambia, we show that an expansion of the type and availability of modern contraceptives increases use of injectables and modern contraceptives by 350% and 50%, respectively; decreases use of traditional fertility control methods such as unsafe abortions, coital infrequency, and postpartum behaviors; and increases short-run fertility by 10%. Consistent with the predictions of our model, completed fertility does not increase and short-run fertility increases are confined to rural women 20–45. Our results confirm that improved control over unwanted pregnancies can produce the divergent fertility responses found in the literature and suggest that access to modern contraceptives is welfare-improving for women, despite having counterintuitive implications for fertility.