Family Planning, Now and Later: Infertility Fears and Contraceptive Take-Up

Early fertility is thought to be one of the key barriers to female human capital attainment in sub-Saharan Africa, yet contraceptive take-up remains puzzlingly low, even among highly-educated populations with healthcare access. We study a barrier to hormonal contraceptive uptake that, while recognized in the qualitative literature, has not been causally tested: the persistent (incorrect) belief that these contraceptives cause later infertility. This belief creates a perceived tradeoff between current and future reproductive control. We use a randomized controlled trial with female undergraduates at the flagship university in Zambia to test two interventions to increase contraceptive use. Despite high rates of sexual activity, low rates of condom-use, and near zero desire for current pregnancy, only 5% of this population uses hormonal contraceptives at baseline. Providing a non-coercive conditional cash transfer to visit a local clinic – greatly reducing access costs – only temporarily increases contraceptive use. However, pairing this transfer with information addressing fears that contraceptives cause infertility has a larger initial effect and persistently increases contraceptive take-up over 6 months. This treatment reduces beliefs that contraceptives cause infertility and leads to the take-up of longer-lasting contraceptives like injections. Compliers are more likely to cite fear of infertility as the reason for not using contraceptives at baseline. IV estimates indicate that eliminating the belief that contraceptives cause infertility would more than triple contraceptive use.