Download Study

General

Study Overview

Title:

Exploring Behavioral Biases in Contraceptive Decision-Making: Evidence from a Field Experiment in Urban Malawi

Study is 3ie funded:

No

Study ID:

RIDIE-STUDY-ID-5ce4f42bbc2bf

Initial Registration Date:

05/22/2019

Last Update Date:

09/06/2021

Study Status:

Ongoing

Change History for Status

Changed On	Previous Value
09/06/2021	Completed
02/16/2020	In Development

Location(s):

Malawi

Abstract:

This study seeks to investigate some of the behavioral mechanisms that play a role in contraceptive decision-making through a field experiment, in which we manipulate the specific architectural conditions under which women are counseled on family planning. The study population is married women of reproductive age who have a need for family planning in Lilongwe, Malawi. Our approach is motivated by evidence suggesting that women’s stated and realized preferences for contraception are likely to be both malleable and highly sensitive to a range of biases. To this end, we explore how key biases are characterized through a woman’s revealed preferences and decisions about a method.

Change History for Abstract

Changed On

Previous Value

02/16/2020

This study seeks to investigate some of the behavioral mechanisms that play a role in contraceptive decision-making through a field experiment, in which we manipulate the specific architectural conditions under which women are counseled on family planning. The study population is married women of reproductive age who have a need for family planning in Lilongwe, Malawi. Our approach is motivated by evidence suggesting that women’s stated and realized preferences for contraception are likely to be both malleable and highly sensitive to a range of biases. To this end, we explore how key biases are characterized through a woman’s revealed preferences and decisions about a method.

Registration Citation:

Karra, M., 2019. Exploring Behavioral Biases in Contraceptive Decision-Making: Evidence from a Field Experiment in Urban Malawi. Registry for International Development for Impact Evaluations (RIDIE). Available at: 10.23846/ridie177

Categories:

Health, Nutrition, and Population
Social Protection

Additional Keywords:

family planning; behavioral economics; cognitive overload; salience

Change History for Additional Keywords

Changed On	Previous Value
02/16/2020	Family planning

Secondary ID Number(s):

Sponsor Award ID: 2018-8083 SAP Grant Number: 55206777

Principal Investigator(s)

Name of First PI:

Mahesh Karra

Affiliation:

Boston University

Name of Second PI:

Affiliation:

Study Sponsor

Name:

The William and Flora Hewlett Foundation

Study Sponsor Location:

Malawi

Research Partner

Name of Partner Institution:

Innovations for Poverty Action (IPA) Malawi

Type of Organization:

NGO (local) or other civil society organization

Location:

Malawi

Intervention

Intervention Overview

Intervention:

All participants will receive a counseling session on contraceptive methods and family planning. Following receipt of counseling, women in all treatment arms (including the control arm) will be asked to reveal their preferred choice of method. Following this elicitation, women in all arms of the study will be offered the following package of services: 1. A free taxi ride to our partner family planning clinic in Lilongwe, the Good Health Kauma Clinic, which has been previously identified as a high quality family planning clinic that provides the full range of contraceptive methods. 2. A free consultation with a family planning service provider at the Good Health Kauma Clinic. 3. Free family planning services at the Good Health Kauma Clinic.

Change History for Intervention

Changed On

Previous Value

02/16/2020

All participants will receive a counseling session on contraceptive methods and family planning. Following receipt of counseling, women in all treatment arms (including the control arm) will be asked to reveal their preferred choice of method. Following this elicitation, women in all arms of the study will be offered the following package of services: 1. A free taxi ride to our partner family planning clinic in Lilongwe, the Good Health Kauma Clinic, which has been previously identified as a high quality family planning clinic that provides the full range of contraceptive methods. 2. A free consultation with a family planning service provider at the Good Health Kauma Clinic. 3. Free family planning services at the Good Health Kauma Clinic.

Theory of Change:

Our main outcomes of interest (stated preferred method of contraception immediately following counseling, intention to use or not use contraception immediately following counseling) aim to capture women's immediate stated preferences for contraceptive methods. In addition, by observing how women may seek family planning following their counseling visit, we will examine the short-run stability of their stated preferences and the extent to which these stated preferences are subsequently realized in the face of other barriers to use. Data examining the realization of women’s eventual contraceptive preferences (e.g. contraceptive uptake, eventual method choice) will be collected during clinic visits and at follow-up across the three arms. Short-term outcomes: stated preferred method of contraception, intention to use or not use contraception are directly asked at the post-counseling survey. Long-term outcomes: contraceptive uptake, and eventual method choice are either observed at the clinic if women visit the clinic; otherwise these outcomes will be collected during the follow-up phone surveys or home visits.

Change History for Theory of Change

Changed On

Previous Value

02/16/2020

Our main outcomes of interest (stated preferred method of contraception immediately following counseling, intention to use or not use contraception immediately following counseling) aim to capture women's immediate stated preferences for contraceptive methods. In addition, by observing how women may seek family planning following their counseling visit, we will examine the short-run stability of their stated preferences and the extent to which these stated preferences are subsequently realized in the face of other barriers to use. Data examining the realization of women’s eventual contraceptive preferences (e.g. contraceptive uptake, eventual method choice) will be collected during clinic visits and at follow-up across the three arms. Short-term outcomes: stated preferred method of contraception, intention to use or not use contraception are directly asked at the post-counseling survey. Long-term outcomes: contraceptive uptake, and eventual method choice are either observed at the clinic if women visit the clinic; otherwise these outcomes will be collected during the follow-up phone surveys or home visits.

Multiple Treatment Arms Evaluated?

Yes

Implementing Agency

Name of Organization:

Innovations for Poverty Action (IPA) Malawi

Type of Organization:

NGO (local)/Community Based Organization/Other civil society organization

Program Funder

Name of Organization:

The William and Flora Hewlett Foundation

Type of Organization:

NGO (local)/Community Based Organization/Other civil society organization

Intervention Timing

Intervention or Program Started at time of Registration?

No

Start Date:

07/15/2019

End Date:

09/16/2019

Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:

Randomized control trial

Other (not Listed) Method:

Additional Evaluation Method (If Any):

Regression with controls

Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

Analysis of quantitative study data will be conducted using STATA and R where appropriate. Descriptive analysis will be performed for all variables and unadjusted comparisons between experimental arms will be conducted. Descriptive statistics will be performed, including frequencies, means, and standard deviations. In addition, chi-square tests and t-tests will be used to examine associations in the data. A probability value of less than 0.05 will be considered statistically significant for all statistical tests that are conducted. Continuous variables will be tested for normality, and non-normal values will be categorized or transformed appropriately.

Change History for Details of Evaluation Approach

Changed On

Previous Value

02/16/2020

Analysis of quantitative study data will be conducted using STATA and R where appropriate. Descriptive analysis will be performed for all variables and unadjusted comparisons between experimental arms will be conducted. Descriptive statistics will be performed, including frequencies, means, and standard deviations. In addition, chi-square tests and t-tests will be used to examine associations in the data. A probability value of less than 0.05 will be considered statistically significant for all statistical tests that are conducted. Continuous variables will be tested for normality, and non-normal values will be categorized or transformed appropriately.

Outcomes (Endpoints):

Our main outcomes of interest (stated preferred method of contraception immediately following counseling, intention to use or not use contraception immediately following counseling) aim to capture women's immediate stated preferences for contraceptive methods. In addition, by observing how women may seek family planning following their counseling visit, we will examine the short-run stability of their stated preferences and the extent to which these stated preferences are subsequently realized in the face of other barriers to use. Data examining the realization of women’s eventual contraceptive preferences (e.g. contraceptive uptake, eventual method choice) will be collected during clinic visits and at follow-up across the three arms. Short-term outcomes: stated preferred method of contraception, intention to use or not use contraception are directly asked at the post-counseling survey. Long-term outcomes: contraceptive uptake, and eventual method choice are either observed at the clinic if women visit the clinic; otherwise these outcomes will be collected during the follow-up phone surveys or home visits.

Change History for Outcomes (Endpoints)

Changed On

Previous Value

02/16/2020

Our main outcomes of interest (stated preferred method of contraception immediately following counseling, intention to use or not use contraception immediately following counseling) aim to capture women's immediate stated preferences for contraceptive methods. In addition, by observing how women may seek family planning following their counseling visit, we will examine the short-run stability of their stated preferences and the extent to which these stated preferences are subsequently realized in the face of other barriers to use. Data examining the realization of women’s eventual contraceptive preferences (e.g. contraceptive uptake, eventual method choice) will be collected during clinic visits and at follow-up across the three arms. Short-term outcomes: stated preferred method of contraception, intention to use or not use contraception are directly asked at the post-counseling survey. Long-term outcomes: contraceptive uptake, and eventual method choice are either observed at the clinic if women visit the clinic; otherwise these outcomes will be collected during the follow-up phone surveys or home visits.

Unit of Analysis:

Individuals

Hypotheses:

To this end, we explore how key biases are characterized through a woman’s revealed preferences and decisions about a method. We test the following two hypotheses: 1. Women’s stated preferences for and choices of contraception are sensitive to the number of method choices that are presented to them, consistent with prior evidence on choice overload. Specifically, decision-making under the presence of too many choices may either be determined heuristically, in which choices over methods are driven by key method attributes (e.g. effectiveness in preventing pregnancy, incidence of side effects, etc.) or may be avoided altogether (decision deferral). 2. Giving women the choice whether or not to involve their husbands or partners as part of the counseling process is likely to affect 1) women’s decision-making around and choice of a contraceptive method; 2) the extent to which women are able to realize their preferences for family planning.

Change History for Hypotheses

Changed On

Previous Value

02/16/2020

To this end, we explore how key biases are characterized through a woman’s revealed preferences and decisions about a method. We test the following two hypotheses: 1. Women’s stated preferences for and choices of contraception are sensitive to the number of method choices that are presented to them, consistent with prior evidence on choice overload. Specifically, decision-making under the presence of too many choices may either be determined heuristically, in which choices over methods are driven by key method attributes (e.g. effectiveness in preventing pregnancy, incidence of side effects, etc.) or may be avoided altogether (decision deferral). 2. Giving women the choice whether or not to involve their husbands or partners as part of the counseling process is likely to affect 1) women’s decision-making around and choice of a contraceptive method; 2) the extent to which women are able to realize their preferences for family planning.

Unit of Intervention or Assignment:

Individuals

Number of Clusters in Sample:

N/A - this is an individual randomized controlled trial with 4 treatment arms (2x2 factorial)

Number of Individuals in Sample:

700

Size of Treatment, Control, or Comparison Subsamples:

There will be 700 women in four groups: 100 women in T0 (Control group), 200 in T1, 200 in T2, and 200 in T3.

Supplementary Files

Analysis Plan:

Other Documents:

BU IRB: 2 Appendix 1 - MBBS BU Full IRB Application (Jan 2019) - KZ MVK 5-6-19.pdf

Change History for Other Documents

Changed On	Previous Value
02/16/2020	Description: IRB application Filename: 2 Appendix 1 - MBBS BU Full IRB Application (Jan 2019) - KZ 5-6-19.pdf

Data

Outcomes Data

Description:

Surveys on women's choices on fertility and family planning.

Data Already Collected?

No

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Treatment Assignment Data

Participation or Assignment Information:

Yes

Description:

Data Obtained by the Study Researchers?

Data Previously Used?

Data Access:

Data Obtained by the Study Researchers?

Data Approval Process:

Approval Status:

Data Analysis

Data Analysis Status:

Study Materials

Upload Study Materials:

Baseline Survey: 3.1 MBBS COMPLETE BASELINE SURVEY - KZ MVK - 5-6-19.pdf

Registration Category

Registration Category:

Prospective, Category 1: Data for measuring impacts have not been collected

Completion

Completion Overview

Intervention Completion Date:

Change History for Intervention Completion Date

Changed On	Previous Value
09/06/2021	02/15/2020

Data Collection Completion Date:

Change History for Data Collection Completion Date

Changed On	Previous Value
09/06/2021	02/15/2020

Unit of Analysis:

Change History for Unit of Analysis

Changed On	Previous Value
09/06/2021	The unit of analysis for primary endpoints is the individual woman.

Clusters in Final Sample:

Change History for Clusters in Final Sample

Changed On	Previous Value
09/06/2021	N = 744 women (T0 = 102, T1 = 213, T2 = 212, T3 = 217)

Total Observations in Final Sample:

Change History for Total Observations in Final Sample

Changed On	Previous Value
09/06/2021	N = 744 women (T0 = 102, T1 = 213, T2 = 212, T3 = 217)

Size of Treatment, Control, or Comparison Subsamples:

Change History for Size of Treatment, Control, or Comparison Subsamples

Changed On	Previous Value
09/06/2021	N = 744 women (T0 = 102, T1 = 213, T2 = 212, T3 = 217)

Findings

Preliminary Report:

Change History for Preliminary Report

Changed On	Previous Value
09/06/2021	No

Preliminary Report URL:

Summary of Findings:

Change History for Summary of Findings

Changed On	Previous Value
09/06/2021	Analysis of primary endpoints is ongoing.

Paper:

Change History for Paper

Changed On	Previous Value
09/06/2021	No

Paper Summary:

Paper Citation:

Data Availability

Data Availability (Primary Data):

Change History for Data Availability (Primary Data)

Changed On	Previous Value
09/06/2021	No--Data not expected to be available

Date of Data Availability:

Data URL or Contact:

Access procedure:

Other Materials

Survey:

Change History for Survey

Changed On	Previous Value
09/06/2021	Yes

Survey Instrument Links or Contact:

Program Files:

Change History for Program Files

Changed On	Previous Value
09/06/2021	No

Program Files Links or Contact:

Change History for Program Files Links or Contact

Changed On	Previous Value
09/06/2021	N/A - program files will not be available until analysis of primary endpoints is complete.

External Link:

External Link Description:

Description of Changes:

Study Stopped

Date:

Reason: