Releasing constraints to quality maternal care, institutional delivery and post-natal care in remote villages of Nicaragua

Last registered on June 28, 2023
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Pre-Trial

Trial Information

General Information

Title
Releasing constraints to quality maternal care, institutional delivery and post-natal care in remote villages of Nicaragua
RCT ID
AEARCTR-0011537
Initial registration date
June 22, 2023

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
June 28, 2023, 2:52 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Country
Nicaragua
Region
Central America

Primary Investigator

Name
Antonella Bancalari
Affiliation
Institute for Fiscal Studies
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Other Primary Investigator(s)

PI Name
Pedro Bernal Lara
PI Affiliation
Inter-American Development Bank
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PI Name
Paola Zuñiga Brenes
PI Affiliation
Inter-American Development Bank
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PI Name
Pablo Ibarrarán
PI Affiliation
Inter-American Development Bank
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PI Name
Emmanuelle Monin
PI Affiliation
Inter-American Development Bank
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Additional Trial Information

Status
Completed
Start date
2013-06-01
End date
2019-02-09
Keywords
Behavior, Gender, Health
Additional Keywords
JEL code(s)
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Rural women worldwide face multiple barriers to quality maternal healthcare, leading to high maternal and infant mortality rates. Demand-side constraints are numerous, but it is believed that fixed costs associated to remoteness -i.e. transportation and accommodation costs- are key. Yet, it is not well understood in the Economics literature the effectiveness of lifting these interlinked constraints. We conducted a randomized controlled experiment to test whether vouchers for transportation to access quality antenatal care and vouchers for transportation and accommodation for institutional delivery and post-natal checks were effective in boosting quality antenatal, post-natal care and institutional delivery among poor, pregnant women, living in remote communities of Nicaragua (at least 4 hours away from skilled health centres and birth centres). All health services were free at the points of use. We randomly allocated 76 community clusters to the treatment and 76 to the control. The intervention was implemented between June 2013 and December 2018. We conducted a census and survey of pregnant women in the 152 community clusters by the end of 2018, and we additionally rely on administrative data. The main research questions are: RQ1 "To what extent releasing transportation and accommodation constraints increase take-up of ante-natal care?" RQ2 "To what extent releasing these constraints increase institutional delivery?" RQ3 "To what extent releasing these constraints improves take-up of post-natal checks for mothers and newborns?".
External Link(s)

Registration Citation

Citation
Bancalari, Antonella et al. 2023. "Releasing constraints to quality maternal care, institutional delivery and post-natal care in remote villages of Nicaragua." AEA RCT Registry. June 28. https://doi.org/10.1257/rct.11537-1.0
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Experimental Details

Interventions

Intervention(s)
The intervention provided to pregnant women in treated community clusters consists on releasing barriers to access free care through:
(1) Voucher for transportation to closest health centre to access quality ante-natal care for the pregnant woman and a companion
(2) Voucher for transportation to closest birth centre for delivery for the pregnant woman and a companion + transportation voucher for midwife
(3) Voucher for accommodation (covering all costs, including meals) in maternal home closest to the birth center for 10 days prior to expected delivery date and 3 days after delivery date for the mother and a companion.
Intervention Start Date
2013-06-01
Intervention End Date
2018-12-30

Primary Outcomes

Primary Outcomes (end points)
Institutional delivery; at least 1 ante-natal care (ANC) by skilled provider; at least 1 post-natal check-up for newborn and mother.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Quality ANC; quality of post-natal check-up for woman.; received a ANC transportation voucher; use a Maternal Waiting Home; received a Maternal Waiting Home voucher; received a Delivery transportation voucher; c-section; first ANC visit in 1st trimester by skilled provider; birthweight.
Secondary Outcomes (explanation)
Quality ANC will be constructed as a dummy variable capturing whether the ANC included urine and blood tests.
Quality of post-natal check-up for woman will be constructed as a dummy variable capturing whether the ANC included urine and blood tests.

Experimental Design

Experimental Design
Context: 18 remote municipalities (4+ hours to health centres)
Catchment areas: 152 community clusters selected for study.
Intervention target: pregnant women
Treatment: 76 community clusters (135 communities)
Control: 76 community clusters (128 communities)
Data collection: baseline pregnancy registry; follow-up census of randomly selected community in each of the 152 community clusters; follow-up survey for 7,055 women with pregnancies in previous 7 years.
Experimental Design Details
Randomization Method
Randomization done in office by a computer.
Randomization Unit
152 community clusters.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
152 community clusters.
Sample size: planned number of observations
7,055 women with a pregnancy 7 years prior to the data collection (2018).
Sample size (or number of clusters) by treatment arms
Treatment: 76 community clusters (135 communities)
Control: 76 community clusters (128 communities)
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Minimum detectable effect on institutional delivery: 10 percentage points (2 standard deviations). Assumptions: 80% power and 95% confidence intervals, respectively, 0.18 intra-cluster correlation, and a baseline institutional delivery of 50%.
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
IRB Approval Date
IRB Approval Number
Analysis Plan

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Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
December 30, 2018, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
February 09, 2019, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
150
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
7,345 interviewed women living in 7,151 households.
Final Sample Size (or Number of Clusters) by Treatment Arms
74 Control and 76 Treatment.
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials