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The Demand for Medical Male Circumcision
Last registered on May 23, 2016
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Pre-Trial

Trial Information
General Information
Title
The Demand for Medical Male Circumcision
RCT ID
AEARCTR-0001180
Initial registration date
May 23, 2016
Last updated
May 23, 2016 10:37 AM EDT
Location(s)
Country
Malawi
Region
Africa
Primary Investigator
Name
Rebecca Thornton
Affiliation
University of Illinois at Urbana-Champaign
Contact Primary Investigator
Other Primary Investigator(s)
PI Name
Susan Godlonton
PI Affiliation
International Food Policy Research Institute
Contact Investigator
PI Name
Jobiba Chinkhumba
PI Affiliation
Malaria Alert Center, College of Medicine, Blantyre, Malawi
Contact Investigator
Additional Trial Information
Status
Completed
Start date
2010-01-01
End date
2011-08-01
Keywords
Finance & Microfinance, Health
Additional Keywords
Male circumcision, HIV prevention, price elasticity, preventative health care, subsidy, Malawi
JEL code(s)
I11, I18, O15, Z13
Secondary IDs
Abstract
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.
External Link(s)
J-PAL Evaluation Summary
Registration Citation
Citation
Chinkhumba, Jobiba, Susan Godlonton and Rebecca Thornton. 2016. "The Demand for Medical Male Circumcision." AEA RCT Registry. May 23. https://doi.org/10.1257/rct.1180-1.0.
Former Citation
Chinkhumba, Jobiba et al. 2016. "The Demand for Medical Male Circumcision." AEA RCT Registry. May 23. https://www.socialscienceregistry.org/trials/1180/history/8422.
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Experimental Details
Interventions
Intervention(s)
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.
Intervention Start Date
2010-01-01
Intervention End Date
2011-05-31
Primary Outcomes
Primary Outcomes (end points)
Take- up of voluntary medical male circumcision
Primary Outcomes (explanation)
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.
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
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.
Experimental Design Details
Randomization Method
1) Block randomization (sampling) by computer
2) Individuals randomized in the office with mixed up envelopes
3) Census Day - by computer
Randomization Unit
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.
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
Study not clustered
Sample size: planned number of observations
1,634 uncircumcised men
Sample size (or number of clusters) by treatment arms
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
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
The College of Medicine, University of Malawi COMREC
IRB Approval Date
2009-12-09
IRB Approval Number
P.09/09/825
IRB Name
University of Michigan IRB
IRB Approval Date
2009-07-23
IRB Approval Number
HUM00030672
Analysis Plan
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
Yes
Intervention Completion Date
May 31, 2010, 12:00 AM +00:00
Is data collection complete?
Yes
Data Collection Completion Date
August 01, 2011, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Study not clustered
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
1,169 uncircumcised men in the analytical sample
Final Sample Size (or Number of Clusters) by Treatment Arms
In the analytical sample Voucher treatment (cost of circumcision randomly varied): Free (control): 279 50 MKW: 303 100 MKW:161 200 MKW: 147 500 MKW: 151 900 MKW: 128 Information treatment (half the participants received comprehensive information about the survey): No information: 549 Information: 620
Data Publication
Data Publication
Is public data available?
Yes
Public Data URL
https://www.aeaweb.org/articles?id=10.1257/app.6.2.152
Program Files
Program Files
Reports and Papers
Preliminary Reports
Relevant Papers
Abstract
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.
Citation
Chinkhumba, Jobiba, Susan Godlonton, and Rebecca Thornton. 2014. "The Demand for Medical Male Circumcision." American Economic Journal: Applied Economics 6(2): 152-177.
Url
https://www.povertyactionlab.org/sites/default/files/publications/380_261%20Demand%20for%20Male%20Circumcision%202014.pdf