Violent instability and modern contraception: Evidence from Mali

This study examines the consequences of armed violence on family planning in Mali, a country where modern contraceptive use is low and a violent insurrection has been ongoing since 2012. I combine data from the 2006 and 2018 Demographic and Health Surveys with information on conflict events location and exploit spatial and temporal variation in violence intensity in a difference-in-difference framework to investigate changes in modern contraceptive use among men and women associated with the insurrection. Results indicate that exposure to the conflict is associated with reduced current use of modern contraception, particularly of shorter-acting methods. Further, the insurrection is linked to increases in current (unwanted) pregnancies and women’s intention to use contraception. Analyses of potential mechanisms suggest that, for women, the observed chances can be partially attributed to diminished knowledge about sources of contraception. For men, the insurrection is simultaneously related to a downward shift in fertility preferences and an upward shift in sexual activity, perhaps signalling some “supply-side” unmet need for male-controlled methods. Where violence was more intense, the conflict appears to have undermined women’s reproductive autonomy. The provision of modern contraception remains a priority in humanitarian settings. To be meaningful, interventions should consider both women’s and men’s needs and integrate a gender perspective into their design.