A Behavioural Economic Analysis of Reproductive Health in Burkina Faso and Tanzania

The proposed research will contribute to answering the first overarching question of this call "What factors shape pathways into and out of poverty and people's experience of these, and how can policy create sustained routes out of extreme poverty in ways that can be replicated and scaled up?" The project will do so by focusing on the low or inadequate uptake of reproductive health services in sub-Saharan Africa which directly influences the health and survival prospects of women and their children, as well as their economic participation and poverty. Despite the growing availability of reproductive health services, the uptake of these services remains inadequate among the poorest in society. The research is timely because achieving 'universal access to reproductive health' was one of the Millennium Development Goals on which least progress was made in sub-Saharan Africa. The new Social Development Goals which will form the basis of the post-2015 development agenda have recognized this slow progress and have included updated reproductive health targets.

One of the main causes of the inadequate uptake of reproductive health services is women's weak control over pregnancy-related decisions. When and how many children to have, and whether and where to seek pre-natal, delivery and post-natal care, are crucial decisions that may shape an important pathway into or out of extreme poverty. To identify policy initiatives that can break the vicious circle between women's low empowerment, poor reproductive health and poverty, we need more knowledge about the decision-making processes around the use of reproductive health services.

We plan to do this by conducting new, innovative research in Burkina Faso and Tanzania, while focusing on four stages of the reproductive health cycle 1) use of family planning services (including contraceptives) before pregnancy; 2) use of antenatal care during pregnancy, 3) use of delivery services at childbirth and 4) use of post-natal services after delivery. For each of these stages we propose to analyse how the uptake of reproductive health services is influenced by a bargaining process between women and their spouses or partners, who might have diverging beliefs, preferences and access to resources. We will also study how these beliefs, preferences and access to resources are shaped by the community networks in which women and their spouses or partners are embedded.

Finally, guided by the generated evidence and in collaboration with the ministries of health in Burkina Faso and Tanzania we will identify and test innovations to existing reproductive health interventions that we expect to increase the uptake of the services offered. This will make sure that the proposed research is translated into more effective policies.

This research will bring together researchers from the United Kingdom, Norway, Burkina Faso and Tanzania who have expertise in reproductive health, behavioural economics, gender, the design and implementation of field experiments and surveys in developing countries, and an excellent contextual understanding of West and East Africa in general and the proposed study areas in particular.

Identified stakeholders will be engaged throughout the entire research programme. Local and national stakeholders will be invited to participate in an inception workshop and to sit on an advisory board, which will discuss promising new lines of inquiry and preliminary findings. The advisory board will be strengthened with identified international stakeholders and will operate via an online platform, which facilitates exchange between both African countries. Project findings will also be disseminated through policy briefings with leading international organisations as well as discussion papers before being published in high-impact peer-reviewed academic journals. The proposed research will also contribute to the further development of research capacity of the African research partners.

Our research aims to generate new insights that explain the low or inadequate uptake of reproductive health services in sub-Saharan Africa. By applying a behavioural economics lens to reproductive health and engaging African researchers as full research partners in this research we will not only make an important academic contribution; we will also build up research capacity in an area in which expertise is still limited. The generated knowledge would then be used to identify and test innovations to existing reproductive health initiatives that would increase the uptake of the services offered. Engaging policy-makers and practitioners in this research would increase the effectiveness of policies and ultimately benefit the lives of poor people.

More specifically, we envisage the following groups of beneficiaries from the findings of our research:

1. Development economists, experimental economists and social scientists in development studies, gender and reproductive health. They will benefit from our research for the reasons given in the section Academic Beneficiaries. We intend to publish about six papers in top academic journals in the fields mentioned and present our findings widely at appropriate academic seminars and conferences.

2. Researchers in Burkina Faso and Tanzania in an area that is fast-growing, but in which expertise is still very limited: behavioural development economics. To this end, we will engage researchers from both African research partners in co-production of knowledge to reach the full potential of the proposed research, and we plan to employ and thoroughly train large teams of local assistants in the use of experimental methods. We also expect the new expertise to spread beyond the African research institutes, via existing local collaborations (for example Centre MURAZ collaborates with Africsanté; and MITU with Ifakara Institute).

3. Public and private providers of reproductive health services in Burkina Faso and Tanzania. Through providing new insights in the low or inadequate uptake of reproductive health services and testing innovations to existing initiatives, our proposed research can lead to the improved design of existing policies and initiatives.

4. International development organisations involved in research and advocacy for combating poverty and stimulating gender equality and reproductive health (such as the United Nations' UN Women, United Nations Population Fund, United Nations Development Programme, World Health Organisation and the World Bank, EngenderHealth, Marie Stopes International) as well as international organisations or networks of organisations that translate research into useful information for policymakers (e.g. Population Reference Bureau, the Population and Poverty Research Network). Our research should help predict responses to policy interventions that these organisations recommend or implement, and could therefore help modify/sharpen their recommendations or increase the effectiveness of their interventions.

5. The final beneficiaries of our research will be women and their future children in the developing world who - if the tested innovations to reproductive health initiatives are successful - will have better reproductive health. This will reduce maternal mortality and morbidity, increase women's control about their fertility, increase their economic participation, and lower the poverty of their households and children.

Representatives of local and national stakeholders will be invited at an inception workshop in Burkina Faso and Tanzania separately, and a second workshop in the middle of the project. Details of these workshops and information about additional communication and engagement activities we have planned with each group of non-academic beneficiaries are described in the Pathways to Impact document.