Barriers to and Incentives for Health Behaviors among African Women.

Abstract

This dissertation looks at health behaviors of African women and the way those behaviors are affected by information, incentives, peers, and own past experiences.

This first chapter causally evaluates the relative importance of psychic costs as channels for low vaccination take-up compared to monetary costs and priming about disease severity. I measure each channel by evaluating a field experiment among women which randomizes several factors that affect tetanus vaccine take-up in rural Nigeria. Although conventional wisdom drawn from observational studies highlights the relevance of psychic costs, I found no evidence that psychic costs limit vaccination take-up. 95.7 percent of women who were incentivized just to show up at a clinic, unconditional on vaccine take-up, chose to receive the vaccine anyway. Priming about disease severity increased perceived costs of disease but did not affect vaccination take-up. Rather than these psychic costs being important barriers, direct cash incentives had large effects on vaccination take-up. Small cash incentives increased vaccination take-up by almost 20 percentage points. The results in this paper confirm economic barriers to take-up, rather than psychic barriers.

The second chapter examined the effect of the death of an infant on their mothers' health behaviors for their subsequent children, using Demographic and Health Surveys (DHS) from 26 African countries. I found that mothers who experienced the death of their first child were 1.5 percentage points more likely to deliver their second child with some assistance and 2.5 percentage points more likely to deliver their second child at health facilities than mothers who did not experience the first child's death.

The third chapter analyzes the effect of social networks on vaccination behaviors among women in rural Nigeria, using the same experimental data that I used in Chapter 1. Social networks within village, neighborhoods, and among friends all influence one's vaccination decision to a great extent. Focusing on best friends, I additionally find that the effect of a best friend receiving a vaccine on one's vaccination decision varies by the distance to a health clinic, by the distance between a woman and her best friend, and by the belief about vaccine safety.