The Demand for Medical Male Circumcision

The study consists of uncircumcised men in the catchment area of BLM clinic in Lilongwe. Two different interventions, orthogonal to one another, were made:
a) Each participant was given a voucher for a subsidized circumcision at the BLM clinic, valid for three months. The value of the vouchers randomly ranged from a full subsidy, in which the procedure was free, to a small subsidy that reduced the price to US$6.19 (MWK900).
b) A random half of the respondents also received comprehensive information after the survey about male circumcision and the reasons why the procedure is partially protective against HIV transmission. Those who did not receive this comprehensive information were told about the BLM clinic’s services and that male circumcision was available there.

2010-01-01

2011-05-31

Take- up of voluntary medical male circumcision

Researchers used health records from the clinic to track participants’ take-up of circumcision. They also asked men for self-reported circumcision status during follow-up interviews approximately one year after the baseline surveys.

The catchment area of the clinic was first divided into 29 enumeration areas as defined by the Malawian National Statistics Office. Each enumeration area was subdivided into a total of 114 neighborhood blocks that were demarcated using roads and rivers as natural dividing lines. Blocks were randomly selected into the study, stratified by enumeration area.

Within each selected block, a household census was conducted in which men aged 18-35 years old, regardless of circumcision status, were identified. In households with more than one eligible man, one man was randomly selected as the target respondent. A baseline survey was conducted with this respondent.

After the survey, the respondent was offered a voucher which randomly varied the amount of the circumcision subsidy from fully free to almost full-price. In addition, half of the respondents received comprehensive information about circumcision and HIV. Those who did not receive the information were simply told about the partner clinic’s services and that male circumcision was available there.

1) Block randomization (sampling) by computer
2) Individuals randomized in the office with mixed up envelopes
3) Census Day - by computer

Three levels of randomization:
1) Neighborhood block: to assign which blocks to be included in the study.
2) Individual: the vouchers subsidizing the cost of the circumcision were randomly assigned to survey respondents.
3) Census day: Half of the respondents were randomly assigned, by day of the initial household census, to receive comprehensive information about male circumcision and HIV while the other half were only told that the service could be availed at the clinic.

No

Study not clustered

1,634 uncircumcised men

Voucher treatment (cost of circumcision randomly varied):
Free (control): 393
50 MKW: 416
100 MKW: 222
200 MKW: 214
500 MKW: 211
900 MKW: 178

Information treatment (half the participants received comprehensive information about the survey):
No information: 803
Information: 831

THE DEMAND FOR MEDICAL MALE CIRCUMCISION

This paper measures the demand for adult medical male circumcision using an experiment that randomly offered varying-priced subsidies and comprehensive information to 1,600 uncircumcised men in urban Malawi. We find low demand for male circumcision: only 3 percent are circumcised over a three month period. Despite the low overall level of take-up, both price and information are significant determinants of circumcision. Still, the main barriers to male circumcision—cultural norms and fear of pain—are not affected by prices or information. Significant demand generation efforts are needed for this HIV prevention strategy to be effective.

Chinkhumba, Jobiba, Susan Godlonton, and Rebecca Thornton. 2014. "The Demand for Medical Male Circumcision." American Economic Journal: Applied Economics 6(2): 152-177.

https://www.povertyactionlab.org/sites/default/files/publications/380_261%20Demand%20for%20Male%20Circumcision%202014.pdf