Chapter 20: Contraceptive access, fertility and well-being in lower income countries

What is the effect of contraceptive access on fertility and well-being in lower income countries? We start by presenting the long-standing debate on the importance of contraception as a driver of fertility decline, the underlying theoretical arguments and the implications for policies. Next, we review the empirical evidence, from older studies evaluating the effect of historical family planning programs to more recent randomized controlled trials in various contexts. We conclude that there is no strong evidence that simply making contraceptives more affordable and more available substantially reduces fertility and improves well-being. However, we argue that the limited effects of contraceptive supply interventions to date do not imply that all pregnancies are desired and that there is no room for public policy. Finally, we warn against extrapolating the limited effects of increasing supply to forecast the impact of decreasing supply—these are likely to be asymmetrical. This is especially important given the downward trend in international aid.