Delivering contraceptives at the doorstep: reducing costs of access or increasing costs of stigma?

In this paper, we study the role cultural practices play in determining the impact of development interventions. Focusing on India’s patrilocal and patrilineal context, we examine a government policy that introduced doorstep delivery of contraceptives. This intervention replaced the existing system in treated areas, where contraceptives were previously available free of charge at village health centres. Using a quasi-experimental difference-in-differences design, we find that exposure to the policy reduced women’s reported uptake of home-delivered methods such as condoms and oral pills, while increasing substitution toward more concealable modern and traditional methods. We find that this response is driven by increased visibility and reduced privacy associated with doorstep delivery, particularly in patrilocal joint family settings where parents-in-law are likely to exert significant influence on women’s contraceptive decisions. Our results, particularly for oral contraceptives, which are concealable and therefore face the greatest visibility burden, are robust to a variety of sensitivity checks.