Reproductive health in Zambia:

My ideal intervention
Jen Shen

What I did this past summer:

Interned for Erica Field, a development
economist, with a study on male and female
preferences for fertility in Lusaka, Zambia
Randomly assigned information on the
benefits of reducing number of children to
males and females
Goal is to measure the impact of this
information on willingness to use
contraceptives

During this time:

I traveled around Zambia and visited the
breathtaking Victoria Falls.
Spent time speaking with community health
workers, nurses, and patients at the Chipata
Clinic
Collected stories to dig deep on why people in
Zambia want children, and why people chose
to use contraceptives

Questions I asked
e questions I asked people were motivated
purely by curiosity.
Why did you come to the clinic today?
How many children do you have? Why did you
have your last child? Why did you have your
second to last child?
Why do men want more children?
Do you think about whether you can provide
for a child before having him or her?

Takeaways
People have diculty planning for the future, and some
may not believe that they can control their futures. One of
the most striking conversations I had was with a volunteer
at the clinic. I asked her if she and her husband ever sat
down to discuss whether they can provide for a child. She
laughed and me and thought I asked her a ridiculous
question. She then said that it does not make sense for
anyone to plan for children because she might die. e
translator told me that Zambians who live in peri-urban
areas are constantly surrounded by death. Because death is
so common, she does not believe that she can control her
future. You could plan as well as you can, but then you
might die.

Takeaways
One thing I heard from many people was that men want
more children to show o that they are men. Having many
children in their family is a status symbol. Some women
complained that men do not think about if they can
provide for their children it will all solve itself in the
future according to these men. is is not all men,
however. ere was one volunteer who is proud of his
children who are educated, and believes that a part of what
he did is where they are today. Regarding men who drink
and fail to bring up healthy and educated children, he
believes that things are falling part, there is a selfcenteredness, and thinks that strengthening the family as
a unit is extremely important for childrens wellbeing.

Takeaways
I noticed three areas that may lack dialogue. e first is on
household finances. Men take care of rentals, water, and
electricity. Women take care of school fees and relish for
food. ere is little discussion over household finances,
and decision-making is understandably ad-hoc. One
person believed that it is not possible to know how much
you need to provide for another child, and does not take
financing into consideration. Another area that lacked
dialogue was sex, especially the activities of men with
women besides their wives. e final was the lack of
dialogue on quarreling and domestic violence. Even when
domestic violence occurred, women seem unwilling to
discuss this out in the open. e threat of quarrelling
causes women to hide contraceptives or avoid using
contraceptives altogether.

MY IDEAL INTERVENTION

Bigger picture idea

inking about reproductive health needs to be
tied to the question: why do people decide to
prevent pregnancy?
When they believe the number of children they
have is within their control
When the costs of another child outweighs the
benefits

Costs and Benefits

When do costs outweigh benefits of having
another child?
When people are aware of the costs of having
another child:
Impact on income and ability to provide for family
Impact on lives of current children

When costs to the lives of their current family

are large enough

Questions
1. Can hope and optimism lead to a mothers
realization that the future is within her
control?
2. How do we make investing in the quality of
children a status symbol?
3. Does financial education lead to better
planning for the future?

First stage
Social support counselors will visit members
of communities through door-to-door
outreach. Male counselors speak to men, and
female counselors speak to women. Both will
engage in counseling women and men into
having more optimism about their futures.
e purpose of this stage is to reduce fatalism
and increase the desire to shape ones future.

Second stage
Social support counselors will again visit
members of the community door-to-door.
e focus this time will be on the values of
having fewer children. Male counselors will
dig deep on the following question: do you
believe that educated and well-nourished
children is more respectful than the number
of children you have? Why or why not?

Third stage
In the third stage, social support counselors
will hold group activities at community
centers. Activities will include conversations
on the value of well-educated children, the
methods available for birth control, and
games that teach financial education and
planning.