Choosing a Contraceptive Provider: Access, Awareness and Fertility Decisions in Urban Senegal

摘要

Contraceptive use is low in most parts of Sub-Saharan Africa, contributing to high fertility rates and sustained population growth in this region. As a result, there is growing emphasis on promoting family planning and improving access to contraceptives through various measures. I incorporate the most common types of interventions---implementing an awareness campaign, reducing contraceptive prices, and increasing the quantity and quality of providers---into a dynamic fertility model to compare the effectiveness of these interventions. The model includes the decisions of married women to be sexually active, to use birth control and to select a contraceptive provider among all the providers located within a given distance of their dwelling place. I estimate the model on a rich data set that includes all the contraceptive providers in three cities of Senegal, linked to a longitudinal sample of women. Simulations indicate that price reductions and quality improvements could increase contraceptive use in urban Senegal. However, travel costs and cultural barriers, including the fear of contraceptives and personal opposition, are greater obstacles towards using contraceptives. I find that contraceptive use increased significantly between 2011 and 2015 in the three cities, driven by a large-scale awareness campaign that addressed the benefits of family planning, its acceptance by religious leaders, and widespread misconceptions about the harmfulness of contraceptives.