Experimental Researcher Helps Improve Health Care in Zambia

In seven years of field work in Zambia, Africa, professor Nava Ashraf's work is helping get low-cost health care products and services to the people who need them most. From the HBS Alumni Bulletin.
by Roger Thompson

Sometimes big ideas start with small experiments. That's been the experience of Harvard Business School professor Nava Ashraf, whose experimental approach to research in developing countries has produced insights that have influenced government policies.

Ashraf, an economist by training, has conducted behavioral-change experiments in health, agriculture, and microfinance in Africa, Latin America, and Southeast Asia. She brings that globetrotting experience to bear when teaching a second-year course called Managing Global Health.

At a recent HBS faculty research symposium, she traced her interest in global health to the realization that an estimated 13 million people die each year for lack of low-cost products that could save their lives. Over the past seven years, she has conducted research projects in Zambia aimed at better understanding "how to get products to people, and how to get people to use them."

In one study exploring the country's high birth rates, 1,031 women were randomly chosen to receive a voucher guaranteeing free and immediate access to a range of modern contraceptives through a private appointment with a family planning nurse. A control group of 768 received nothing. To uncover the effect of disagreements between spouses about the number of children to have—women generally want fewer than men—half of the women chosen to receive vouchers got them without their husbands present, and the remainder with their husbands present. This gave a select group the opportunity to withhold information from their husbands about access to contraception.

The results? Providing cheap and convenient forms of birth control led to a reduction in unwanted births only when women were given full autonomy over accessing the products. Women who received the birth control option information without their partners present had a 57 percent reduction in unwanted births.

When Ashraf presented her findings to the Zambian Ministry of Health last summer, officials pointed out that it was government policy to emphasize men's involvement in contraceptive use. Rather than change policy, officials asked Ashraf to conduct research on how to change men's preferences for having more children. "So I'm piloting projects on that right now," she said.

Ashraf is one of a small number of HBS faculty who pursue experimental field research. For her, it's essential. "We can't solve the challenges of global health without deeply understanding what motivates customer and provider behavior," she said. And field experiments make that possible.

About the Author

Roger Thompson is the editor of the HBS Alumni Bulleti.
    • Harish K
    • Advani, Nokia Siemens Networks
    Dear Ms. Nava Ashraf

    Congrats on bringing the benefits of education from classrooms to field for betterment of society.

    • Anonymous
    Interesting research and finding.
    As someone who is passionate about gender equality, this also highlights the challenges that this area still needs to overcome.
    • Dharmik Shah
    • Student, Indian Institute of Health Management Research,Jaipur,India
    But if you look at this in a country like India:

    1)Women do not want to use contraceptives,because they want more and more children as the maternal mortality rates are high and health indicators are poor.They want more hands who could feed them in their old age and survive to do so.If they have 4-5 children,may be at least one survives.This is with specificity to rural India.

    2)Also,did you look at the cultural turbulence and after effects this could lead to.Again,I don't know about Zambia,but in India,if the in- laws (in most of the rural areas )come to know about woman using contraceptives without her informing her husband,then that could lead to a big trouble for the woman.

    Though good work.Appreciate it.
    • Gilbert Mwansa
    Am Zambian who seems so intrigued by what Nava did.Coming from that part of the world, you really did a good job, and if fully implemented, it can be a game changer.
    Good job Nava.
    • Anonymous
    I am a Zambia woman and it is interesting to read that the Ministry of Health chose not to change the policy but instead opted to research on how to change men's preferences for having more children.

    I certainly think that women should have full autonomy in the accessing of birth control products. As much as it would be great to have husbands involved, it is really up to a woman to be proactive in that area.