Contraception, Contraception Behavior, Contraceptive Method Switching, Contraceptive Usage
Conditions
Keywords
adolescent sexual and reproductive health, maternal mortality, teen pregnancy, LARCs, family planning counseling
Brief summary
Cameroon exhibits a high and non-decreasing level of maternal mortality (roughly 600 per 100,000 live births), partially related to its relatively high total fertility rate (roughly 4.6). Survey evidence furthermore suggests that a significant fraction of these pregnancies is unwanted or considered mistimed by the mother, especially among females aged 15-19. Despite this, the rate of utilization of family planning (FP) is low: e.g. only 48% of sexually active unmarried women use any form of (modern) contraception, or MC, and even then, it is primarily condoms. The use of LARCs (long-acting reversible contraceptives, i.e. the IUD and implant) is less than 1% according to the most recent Demographic Health Survey. The study investigators propose to use an integrated behavioral science approach to increase the take-up of both SARCs (short-acting reversible contraceptives, i.e. the pill and injectable) and especially LARCs among reproductive-age females in Cameroon, including adolescents who may be unmarried and/or nulliparous. In addition to decreasing maternal mortality and undesired pregnancies, indirect effects for the community will include: increased welfare from reduced side effects that arise due to current one-size-fits-all FP counseling; healthier children due to improved birth spacing; and increased human capital formation both for children and for young (often school-aged) potential mothers. The study investigators propose to conduct the study at HGOPY for a duration of 12 months. The study investigators will provide tablets to each of five nurses that conduct FP counseling to participants at the hospital. The tablets contain a counseling app (or decision-support tool or a job-aid) that was jointly developed by professionals from HGOPY, the World Bank, and the Ministry of Health. The study investigators propose an individually-randomized experiment, where the participants will be offered randomly varying discounts for the modern contraceptive methods they wish to adopt. The study investigators also propose to experiment with certain aspects of the app to improve its effectiveness - both for the participant and for the nurse. More details on the experimental design are provided below.
Interventions
BEHAVIORALPrice discounts for SARCs
SARCs are offered free to the client
BEHAVIORALPrice discounts for LARCs
LARCs are offered at lower prices to the client
BEHAVIORALSequential vs. simultaneous recommendations
Top ranked methods are presented to the client sequentially or simultaneously
Sponsors
Stanford University
George Washington University
University of Exeter
University of California, San Diego
Yaounde Gynecology, Obstetrics and Pediatrics Hospital
World Bank
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Masking description
Participants are masked in some interventions related to the workings of the tablet-based decision-support tool, but not to the price discounts they receive for the contraceptive methods.
Intervention model description
The study independently experiments with two aspects of the health provider-client relationship: 1. First, a tablet-based counseling app that is used by the provider gives random discounts to clients - separately for LARCs and SARCs. 2. Second, the tablet-based app presents recommendations to the client sequentially (i.e. the top-ranked method, followed by the next one if that recommendation is declined by the client, etc.) vs. simultaneously (i.e. presenting the top recommendations to the client all at once and asking her to choose which one to discuss further).
Eligibility
Sex/Gender
FEMALE
Age
10 Years to 49 Years
Healthy volunteers
Yes
Inclusion criteria
* Female * Ages 10-49 * Presenting at HGOPY seeking FP counseling/services * HGOPY clients referred to the family planning unit for consultation
Exclusion criteria
\* No
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The client adopted a LARC | 1-day | using data from the counseling sessions |
| The client adopted a modern contraceptive method (LARC or SARC) | 1-day | using data from the counseling sessions |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Did the health provider give information about contraceptive methods that was easy to understand during the counseling session? | 2-weeks | Self-reported indicator variable using follow-up surveys two weeks after counseling session |
| Client satisfaction with adopted contraceptive method | 2-week and 16-week measurements | using 2-week and 16-week follow-up surveys |
| Was the client treated with respect by the provider during the counseling session? | 2-weeks | Self-reported indicator variable using follow-up surveys two weeks after counseling session |
| Percentage of participants with unintended pregnancy within the time frame | 16-week and 52-week measurements | using 16-week and 52-week follow-up surveys |
| Discontinuation of adopted contraceptive method | 2-week, 16-week, and 52-week measurements | using 2-week, 16-week, and 52-week follow-up surveys |
| Did the client trust the provider during the counseling session? | 2-weeks | Self-reported indicator variable using follow-up surveys two weeks after counseling session |
Countries
Cameroon
Outcome results
None listed