Family Planning and Fertility: Estimating Program Effects using Cross-sectional Data

This paper uses a novel set of instruments to identify the effects of a family planning program when there is potentially non-random program placement and only cross-sectional data are available, a situation common in many developing countries. The instruments are based on the idea that areas compete for resources and that the relative ranking of characteristics across areas is not correlated with the outcomes of interest. Using data from Ethiopia we find that access to family planning substantially reduces the number of children ever born for women without education; the reduction is especially pronounced for women younger than 20 and older than 30. Completed fertility, measured as children ever born for women aged 40 to 45, falls by more than one birth with access to family planning. These effects are statistically significant and substantially larger than previous studies have found. For women who have gone to school there is no evidence of an impact of family planning on fertility. Based on a relative small reduction in child mortality we argue that the effect on fertility is due to family planning access and not the impact of the concurrent presence of health facilities. Finally, family planning access reduces unwanted fertility, especially for older women.