An economic analysis of the determinants of contraceptive use in Matlab, Bangladesh.

Abstract

This research analyzes the determinants of contraceptive use in Matlab, Bangladesh using a microeconomic decision-making framework. The Matlab region of Bangladesh has experienced a large and sustained increase in contraceptive use since the late 1970s. This change in contraceptive use rates is of particular interest because of its occurrence in a country that is very poor, is religiously conservative, and has experienced little economic development in recent years. It is often argued that a transition from high fertility to high contraceptive prevalence and low fertility is not possible under such conditions. This research focuses on the role of an intensive family planning and health care services project in Matlab in contributing to the increase in contraceptive use. The study develops a theoretical model of contraceptive use behavior which is based on the assumption of rational decision-making and uses a household consumption/production expected utility maximizing framework. The model is sequential in nature allowing for adaptive behavior and child spacing, and also incorporates the psychic and resource costs of contraception, heterogeneity of fecundity, child mortality, the uncertainty of fertility regulation, and the contributions of children to household production. The empirical work employs an econometric methodology which is correctly specified given the nature of the dependent variables and the possibility of correlated error structures. The empirical framework exploits the existence of comparable data from project treatment and control areas in order to evaluate contraceptive use decisions in the presence and in the absence of the services of the project and to account for the difference in contraceptive use across areas. The results indicate that it is appropriate to model contraceptive use behavior in this society within a rational choice framework, and that the intensive family planning and health care project has had an effect on use rates. The project has acted to change both the values of factors which determine contraceptive use and to change the degree of influence of these factors. Specific factors which contribute to the difference in contraceptive use include the prevalence and effect of opposition by others towards family planning, the variety of contraceptive methods available and knowledge of these methods and their sources, and the incidence of and reaction to contraceptive side effects. Demand for additional children is also a strong determinant of contraceptive use behavior, particularly in the treatment area where those who desire to space births are more likely to attempt to achieve this objective through fertility regulation.