Effects of tuition-free primary education on women's access to family planning and on health decision-making: A cross-national study.

At least one in ten married or in-union women of reproductive ages had an unmet need for family planning in 2017. Gender inequalities in multiple social settings, including education, work and household decision-making, influence access to family planning. In this paper, we examine whether laws and policies that increase gender equality in education can lead to improved family planning outcomes. In particular, we focus on tuition-free primary education policies as a means of change. We estimate the impact of girls being exposed to tuition-free primary education policies on their health decision-making and on their family planning needs as women. Using a difference-in-difference methodology on 17 low- and middle-income countries, we find that women who were exposed as children to tuition-free education policy throughout primary school have a greater likelihood of meeting their family planning needs and of shifting from traditional to modern contraceptives, relative to women without similar exposures. These women also have a greater likelihood of having some say in health-related decisions of the couple. More gender-equal decision-making is shown to mediate a portion of the positive impact of the education policy on reproductive health. The results of this study indicate the need for increased investments in education and for health policy makers to prioritize cross-sectoral engagements.