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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:
05/21/2019
Study Status:
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.
Categories:
Health, Nutrition, and Population
Social Protection
Additional Keywords:
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.
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.
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.
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.
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.
Unit of Intervention or Assignment:
Individuals
Number of Clusters in Sample:
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:
IRB application: 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:
Data Collection Completion Date:
Unit of Analysis:
Clusters in Final Sample:
Total Observations in Final Sample:
Size of Treatment, Control, or Comparison Subsamples:

Findings

Preliminary Report:
Preliminary Report URL:
Summary of Findings:
Paper:
Paper Summary:
Paper Citation:

Data Availability

Data Availability (Primary Data):
Date of Data Availability:
Data URL or Contact:
Access procedure:

Other Materials

Survey:
Survey Instrument Links or Contact:
Program Files:
Program Files Links or Contact:
External Link:
External Link Description:
Description of Changes:

Study Stopped

Date:
Reason: