15. Do the Poor Control Their Fertility Decisions?

The poor may not be able to control their fertility due to their inaccessibility to modern contraception methods. However, low usage of contraception methods is not a sign of lack of access. 

The supply and demand wallahs:

Supply wallahs - emphasize the importance of access to contraception—people who use modern contraceptive methods have much lower fertility rates

Demand wallahs - those who want to reduce fertility mostly find their way to the right kind of contraception without any outside help

The data was matched on observing that regions that had more clinics had lower fertility, but the decline in fertility over time was unrelated to the increase in the number of clinics.

A Matlab program does more than simply making contraceptives available—one component was visits by a female health worker to households where women were in purdah, which limited their mobility. This brought the discussion of contraception to places where it used to be a taboo. Therefore, the program directly altered the households’ desired number of children rather than simply giving them the tools to control their fertility. 

However, the difference between program areas and other control areas started to narrow, and thus the program actually had very little effect on overall fertility. 

We can conclude that contraceptive access does make people happy, but ultimately plays a little role in reducing fertility. 

On the good note, contraceptives can help teenagers postpone pregnancies. However, since many countries assume they would not be able to use contraception properly, the result is that teenage pregnancy rates are extremely high in many developing countries. This kind of misguided effort is most present in Kenya—the official strategy is to teach sexual abstinence.

The first strategy was a program that informed students what kind of people are most likely infected—older men. This also promoted protected sex with boys their own age, causing a reduction by two-thirds in pregnancies where an older male partner was involved.

Another program made it easier for girls to remain in school by paying for a school uniform. More girls stayed in school because of the free uniform, delaying their first pregnancy. 

These programs teach girls in Kenya that unprotected sex leads to pregnancy—but what if getting pregnant was not such a bad thing at all? In some cases, having a child and starting a family may be a more attractive option, especially for those who can’t afford a school uniform and therefore stay in school.

The one clear thing is poor people make conscious choices about their own life and find ways to achieve abstinence and control. 

Often, we must consider the issue of who makes fertility decisions. Usually, women end up paying most of the physical costs of bearing children. 

Do the poor control their family decisions? The answer is that they do, and even the lack of availability of contraception is not a constraint. Women may be pressured by their husbands or social norm to bear more children. Therefore, simply having contraception available is not sufficient. In the next blog, we will explore how the poor view children as economic investments and financial instruments.