A Behavioural Economic Analysis of Reproductive Health in Burkina Faso and Tanzania

这项拟议的研究将有助于回答这一呼吁的第一个首要问题：什么因素决定了进入和摆脱贫困的途径以及人们对这些途径的体验，以及政策如何以可复制和扩大的方式创造可持续的摆脱极端贫困的途径？该项目将侧重于撒哈拉以南非洲对生殖健康服务的接受程度低或不足，这直接影响到妇女及其子女的健康和生存前景，以及她们的经济参与度和贫穷。尽管生殖健康服务的可得性越来越高，但社会上最贫穷的人对这些服务的接受仍然不足。这项研究是及时的，因为实现‘普遍获得生殖健康’是撒哈拉以南非洲在实现千年发展目标方面进展最少的目标之一。新的社会发展目标将构成2015年后发展议程的基础，它承认了这一缓慢进展，并列入了更新的生殖健康目标。生殖健康服务普及不足的主要原因之一是妇女对与怀孕有关的决定控制不力。何时生育和生育多少孩子，以及是否和在哪里寻求产前、分娩和产后护理，这些都是可能形成进入或摆脱极端贫困的重要途径的关键决定。为了确定能够打破妇女赋权低、生殖健康差和贫穷之间恶性循环的政策举措，我们需要更多地了解有关使用生殖健康服务的决策过程。我们计划通过在布基纳法索和坦桑尼亚进行新的创新研究来做到这一点，同时将重点放在生殖健康周期的四个阶段：1)怀孕前使用计划生育服务(包括避孕药具)；2)怀孕期间使用产前护理；3)分娩时使用分娩服务；4)分娩后使用产后服务。对于每个阶段，我们建议分析妇女与其配偶或伴侣之间的讨价还价过程如何影响生殖健康服务的接受，因为她们可能有不同的信仰、偏好和获得资源的机会。我们还将研究妇女及其配偶或伴侣所在的社区网络如何塑造这些信念、偏好和获得资源的机会。最后，我们将以所产生的证据为指导，并与布基纳法索和坦桑尼亚的卫生部合作，确定和测试现有生殖健康干预措施的创新，以期增加对所提供服务的接受。这将确保拟议的研究转化为更有效的政策。这项研究将汇集来自联合王国、挪威、布基纳法索和坦桑尼亚的研究人员，他们具有生殖健康、行为经济学、性别、发展中国家实地试验和调查的设计和实施方面的专门知识，并对整个西非和东非以及特别是拟议的研究领域有很好的背景了解。地方和国家利益攸关方将被邀请参加一次启动讲习班，并担任顾问委员会成员，该委员会将讨论有希望的新调查路线和初步调查结果。咨询委员会将通过确定的国际利益攸关方得到加强，并将通过一个促进两个非洲国家之间交流的在线平台运作。项目成果还将通过与主要国际组织的政策简报会以及讨论文件进行传播，然后在具有高度影响力的同行评议的学术期刊上发表。拟议的研究还将有助于进一步发展非洲研究伙伴的研究能力。

The proposed research will contribute to answering the first overarching question of this call "What factors shape pathways into and out of poverty and people's experience of these, and how can policy create sustained routes out of extreme poverty in ways that can be replicated and scaled up?" The project will do so by focusing on the low or inadequate uptake of reproductive health services in sub-Saharan Africa which directly influences the health and survival prospects of women and their children, as well as their economic participation and poverty. Despite the growing availability of reproductive health services, the uptake of these services remains inadequate among the poorest in society. The research is timely because achieving 'universal access to reproductive health' was one of the Millennium Development Goals on which least progress was made in sub-Saharan Africa. The new Social Development Goals which will form the basis of the post-2015 development agenda have recognized this slow progress and have included updated reproductive health targets. One of the main causes of the inadequate uptake of reproductive health services is women's weak control over pregnancy-related decisions. When and how many children to have, and whether and where to seek pre-natal, delivery and post-natal care, are crucial decisions that may shape an important pathway into or out of extreme poverty. To identify policy initiatives that can break the vicious circle between women's low empowerment, poor reproductive health and poverty, we need more knowledge about the decision-making processes around the use of reproductive health services.We plan to do this by conducting new, innovative research in Burkina Faso and Tanzania, while focusing on four stages of the reproductive health cycle 1) use of family planning services (including contraceptives) before pregnancy; 2) use of antenatal care during pregnancy, 3) use of delivery services at childbirth and 4) use of post-natal services after delivery. For each of these stages we propose to analyse how the uptake of reproductive health services is influenced by a bargaining process between women and their spouses or partners, who might have diverging beliefs, preferences and access to resources. We will also study how these beliefs, preferences and access to resources are shaped by the community networks in which women and their spouses or partners are embedded. Finally, guided by the generated evidence and in collaboration with the ministries of health in Burkina Faso and Tanzania we will identify and test innovations to existing reproductive health interventions that we expect to increase the uptake of the services offered. This will make sure that the proposed research is translated into more effective policies.This research will bring together researchers from the United Kingdom, Norway, Burkina Faso and Tanzania who have expertise in reproductive health, behavioural economics, gender, the design and implementation of field experiments and surveys in developing countries, and an excellent contextual understanding of West and East Africa in general and the proposed study areas in particular.Identified stakeholders will be engaged throughout the entire research programme. Local and national stakeholders will be invited to participate in an inception workshop and to sit on an advisory board, which will discuss promising new lines of inquiry and preliminary findings. The advisory board will be strengthened with identified international stakeholders and will operate via an online platform, which facilitates exchange between both African countries. Project findings will also be disseminated through policy briefings with leading international organisations as well as discussion papers before being published in high-impact peer-reviewed academic journals. The proposed research will also contribute to the further development of research capacity of the African research partners.