A Randomized-Controlled Trial to Increase the Uptake of LARCs in Cameroon

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.

Conditions

• Contraception
• Contraception Behavior
• Contraceptive Usage
• Contraceptive Method Switching

Interventions

BEHAVIORAL

Price discounts for SARCs

SARCs are offered free to the client

BEHAVIORAL

Price discounts for LARCs

LARCs are offered at lower prices to the client

BEHAVIORAL

Sequential vs. simultaneous recommendations

Top ranked methods are presented to the client sequentially or simultaneously

Sponsors & Collaborators

• Stanford University

  collaborator OTHER

• George Washington University

  collaborator OTHER

• University of Exeter

  collaborator OTHER

• University of California, San Diego

  collaborator OTHER

• Yaounde Gynecology, Obstetrics and Pediatrics Hospital

  collaborator UNKNOWN

• World Bank

  lead OTHER

Principal Investigators

• Berk Ozler, PhD · World Bank

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

SEQUENTIAL

Eligibility

Min Age

10 Years

Max Age

49 Years

Sex

FEMALE

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2021-03-23

Primary Completion

2022-12-31

Completion

2024-12-31

Countries

• Cameroon

Study Locations