Improving Uptake of Antenatal Care Services in Rural Côte d'Ivoire

Summary

The past two decades have brought significant increases in the availability of maternal health care services in many low- and middle-income countries, with a large increase in the number of health facilities that provide these services. However, many women still do not receive the basic services recommended by the World Health Organization. In many settings, antenatal care is associated with substantial financial cost, which means that obtaining high quality care can involve complex intrahousehold bargaining and decision-making. Women have more access to information about these services, but men generally make the financial decisions. If men are unaware of the magnitude and timing of financial needs, securing adequate financial resources may be difficult.

The investigators plan to conduct a randomized-controlled experiment of supply- and demand-side solutions to increase uptake of recommended antenatal care services in rural Côte d'Ivoire, where there are currently substantial gaps in service coverage. Despite Côte d'Ivoire's "free maternity care" policy, many recommended services - including ultrasounds and laboratory tests - continue to carry costs for patients. On the supply side, the study will evaluate the impact of providing key services (including ultrasounds, laboratory testing, and iron and folic acid supplements) for free to pregnant women (in line with Côte d'Ivoire's policy of free provision). On the demand side, the study will evaluate the impact of providing information about antenatal care recommendations to pregnant women (alone or with their partners), and of providing a financial planning session to pregnant women or their partners, or both together. The study will evaluate the impacts of these interventions on the uptake of recommended antenatal care services.

Conditions

• Uptake of Antenatal Health Care Services

Interventions

BEHAVIORAL

Information video

Participants will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire. In arms (1a-1b) and (2a-2b), this video will be shown only to the pregnant woman. In arms (3a-3b), this video will be shown to the pregnant woman together with her partner.

BEHAVIORAL

Financial planning session

In this intervention, a member of the study team will facilitate a structured discussion about planning for the expenses of health care services and related transportation costs over the course of pregnancy. The discussion will follow a series of questions and prompts set up as a survey form in ODK (attached to this protocol). The study team member will also share a list of the local prices of recommended antenatal care services. In arms (2a-2b), this intervention is delivered only to pregnant women. In arms (3a-3b), this intervention is delivered to pregnant women together with their partners.

OTHER

Vouchers

This intervention consists of vouchers for a pre-defined set of antenatal care services. Pregnant women who are randomized to receive this intervention will be given vouchers for one ultrasound, one "bilan prenatal" (a recommended set of prenatal laboratory tests in Côte d'Ivoire), and a 6-month supply of iron \& folic acid supplements (with dosage based on their health care provider's recommendation). The study team will establish agreements with local health facilities to provide services in exchange for these vouchers, with reimbursement by the study team.

Sponsors & Collaborators

• Centre Suisse de Recherches Scientifiques en Cote d'Ivoire

  collaborator OTHER

• Swiss National Science Foundation

  collaborator OTHER

• Swiss Tropical & Public Health Institute

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

15 Years

Sex

FEMALE

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-01-16

Primary Completion

2027-02-28

Completion

2027-02-28

Countries

• Côte d’Ivoire

Study Locations