Maternal Mortality Risk and Spousal Differences in the Demand for Children

Abstract

Fertility decisions are often made by partners who may disagree. We develop a model in which conflicting interests prevent effective communication between spouses about the costs of child-bearing incurred by women. This mechanism is likely to further widen the spousal disagreement over fertility in environments where maternal health risk is high and imperfectly observed. We design an intervention to experimentally vary exposure to information about maternal health costs to either the husband or the wife among approximately 500 couples in Lusaka, Zambia. At baseline, husbands exhibit lower knowledge of maternal health risk compared to their wives. One year after the intervention, husbands significantly update their beliefs about maternal risk but only if the information is delivered directly to them, whereas wives update their beliefs about risk regardless of who in the household is treated. The intra-household asymmetry in information spillovers is strongest among men with more urgent demand for children. Households treated with information on maternal risk experience a sizable reduction in the probability of pregnancy - an effect which is strongest when the woman faces a higher risk of complications - but only when the information is delivered to wives rather than husbands is this decline in fertility accompanied by a significant reduction in transfers to the wife. These patterns are consistent with differences in initial beliefs and demand for children generating a barrier to credible communication between spouses.