Dying to Give Birth: How a sister's death in childbirth affects fertility in Indonesia

Background: Public health programs are one way that women can learn about the risks of childbearing but another channel is through their personal experiences and social networks.  This paper uses data from women in Indonesia who report that their sister has died in childbirth to test whether women who have experienced a sister-death in childbirth become more cautious when it comes to their own reproductive behavior by taking up behaviors that limit their risk of maternal death such as using contraceptives or limiting fertility.

Methods: This study utilizes data from the three most recent waves of the Demographic and Health Survey (DHS) in Indonesia (2002, 2007, and 2012).  Respondents to DHS surveys are women of reproductive age who report on their socio-economic characteristics, birth histories, deaths of siblings, and an array of family health behaviors. The analytical sample is limited to women whose sisters have died in childbirth (n=965).  Each woman contributes one person-year from the time she is 14 to the time of the survey.  The dependent variables are two dichotomous measures of giving birth or using contraceptives in any person-year.   The analysis utilizes OLS regression and individual fixed effects with controls for age, age-squared and parity at the beginning of each person-year.  Robust standard errors are clustered at the individual level.

Results: The results indicate that women are more likely to adopt contraceptives for the first time after their sister has died in childbirth than before but there is no change in the probability of giving birth.  This result holds across specifications.

Conclusions: Women in Indonesia whose sisters die in childbirth are more likely to take up contraceptives after their sisters have died but they are no less likely to give birth.  This is suggestive evidence that women who have personal experience of the dangers of childbearing are more likely to adopt behaviors that protect against maternal death such as removing themselves from the risk of dying by using contraceptives but that they do not adopt strategies that limit long-term fertility.  Public health programs could recruit women with personal experiences of maternal mortality to help design information campaigns.