Family Planning, Now and Later: Infertility Fears and Contraceptive Take-Up

Last registered on June 24, 2024


Trial Information

General Information

Family Planning, Now and Later: Infertility Fears and Contraceptive Take-Up
Initial registration date
June 14, 2024

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 24, 2024, 1:49 PM EDT

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



Primary Investigator


Other Primary Investigator(s)

PI Affiliation
PI Affiliation
Brown & NBER
PI Affiliation
Whaton (UPenn) & NBER

Additional Trial Information

Start date
End date
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Early fertility is thought to be one of the key barriers to female human capital attainment in sub-Saharan Africa, yet contraceptive take-up remains puzzlingly low, even among highly-educated populations with healthcare access. We study a barrier to hormonal contraceptive uptake that, while recognized in the qualitative literature, has not been causally tested: the persistent (incorrect) belief that these contraceptives cause later infertility. This belief creates a perceived tradeoff between current and future reproductive control. We use a randomized controlled trial with female undergraduates at the flagship university in Zambia to test two interventions to increase contraceptive use. Despite high rates of sexual activity, low rates of condom-use, and near zero desire for current pregnancy, only 5% of this population uses hormonal contraceptives at baseline. Providing a non-coercive conditional cash transfer to visit a local clinic -- greatly reducing access costs -- only temporarily increases contraceptive use. However, pairing this transfer with information addressing fears that contraceptives cause infertility has a larger initial effect and persistently increases contraceptive take-up over 6 months. This treatment reduces beliefs that contraceptives cause infertility and leads to the take-up of longer-lasting contraceptives like injections. Compliers are more likely to cite fear of infertility as the reason for not using contraceptives at baseline. IV estimates indicate that eliminating the belief that contraceptives cause infertility would more than triple contraceptive use.
External Link(s)

Registration Citation

Bau, Natalie et al. 2024. "Family Planning, Now and Later: Infertility Fears and Contraceptive Take-Up." AEA RCT Registry. June 24.
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Experimental Details


We implement a randomized controlled trial with Zambian female college students designed to directly address the fear that hormonal contraceptives cause later-life infertility. Our key treatment ("Fertility") combines an informational treatment to dispel myths that contraceptives cause infertility with a non-coercive conditional cash transfer ("CCT") that pays women a small sum to visit a local, partner clinic that provides family planning services (reducing barriers related to access and stigma). The fertility treatment was designed to convey information in a salient and persuasive way and includes both a presentation on how hormonal contraceptives work and personal stories by facilitators about fertility returning after using hormonal contraceptives. We compare this treatment to an active control and an arm that received the non-coercive CCT without the information. The inclusion of the CCT-only arm allows us to compare the effects of reducing barriers to access alone to the marginal effect of dispelling fears of infertility. All three arms, including the control, attended a workshop led by the same two young, Zambian women and received information about the local, off-campus partner clinic, the fact that it offered contraceptives, and a card that guaranteed free service and no wait-time at the partner clinic. We evaluate the effect of the two treatments on the take-up of hormonal contraceptives and other family planning services, as well as beliefs, using both administrative data from our partner clinic and data on self-reported usage over six months from a high-frequency mobile survey.
Intervention Start Date
Intervention End Date

Primary Outcomes

Primary Outcomes (end points)
Hormonal contraceptive take-up. For details, please refer to the working paper "Family Planning, Now and Later: Infertility Fears and Contraceptive Take-Up"
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
We conduct a randomized control trial with two treatment arms and an active control group. Every treatment group attended an on-campus workshop during which participants consented and baseline data were collected. All workshops were run by the same team of facilitators, who were employees of our program.

The content of the workshop differed depending on which group a student was randomized into. For the control group, facilitators informed students about the location of a youth-friendly health clinic that was roughly 25 minutes walk from campus. In the first treatment arm, a non-coercive conditional cash transfer (CCT), students were given the same information as students in the control group and a small payment for visiting said clinic (but not to take-up contraceptives or any other medical care). In the second treatment arm, in addition to receiving the CCT, students received targeted information intended to counter the incorrect belief that hormonal contraceptives cause permanent infertility.

We contacted 2703 potential participants at UNZA between August 2022 and April 2023 and invited them to participate in the study. Invitees were recruited using a variety of different strategies, ranging from e-mails to in-person recruitment. During recruitment, students were asked whether they were interested in attending a workshop (all study arms attended on-campus workshops) to learn about women's health. Students were informed that the workshop was part of an academic study on women's health and that they would receive airtime for their participation in the workshop and subsequent data collection. If students expressed interest and passed our inclusion criteria (they were enrolled at UNZA and between 18-25 years old), they were provided with a link to sign up for an on-campus workshop. At the time of sign-up, they were randomized into a treatment arm and only shown workshops belonging to their treatment arm.

To be included in the study, invitees had to attend their assigned workshop during which students provided informed consent and baseline data were collected. Out of the 2,703 invitees, 1,508 ultimately attended a workshop and consented to participate in the study: 508 Control, 486 CCT, and 514 Fertility. Attrition was balanced by treatment arm.

We use two datasets to evaluate the intervention. The first data set was collected in partnership with our partner clinic by an enumerator based at the clinic. It contains information on the services received at the clinic. We collected information not only on whether students requested any contraceptive services but also which type they requested. We also collected information on whether they took up any other healthcare related services, such as sexually transmitted infection (STI) tests and pregnancy tests.

The second data set comes from smartphone surveys completed by participants every two weeks after the intervention for up to 6 months. The first of these mobile surveys, which served as a baseline, was conducted at the workshop for all participants. Participants were sent the survey link to their mobile phones and asked to complete the survey upon receipt. This allowed the facilitators to ensure that all participants were receiving the links, solve any technical issues, and answer any questions about the survey. Following the workshop, participants were sent a new survey link on their mobile phone every two weeks on Friday evenings. Each survey had a maximum length of fifteen minutes. Every survey asked about contraceptive use, sexual encounters in the last two weeks, partner information, pregnancy, and clinic visits, forming a panel of data on these key outcomes. Importantly, unlike the clinic data, which measures contraception take-up, the survey data measures actual usage. For some contraceptives, such as the pill, these measures may differ since a young woman can take-up the pill at the clinic but then fail to use it or delay using it until she starts having sex. In addition, different survey rounds included rotating questions on beliefs, attitudes and fears around contraceptives, child-bearing and marriage, enabling us to explore additional outcomes and the mechanisms underlying the responses we observe.
Experimental Design Details
Randomization Method
Randomization conducted by Qualtrics
Randomization Unit
Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters
1500 individuals
Sample size: planned number of observations
1500 individuals
Sample size (or number of clusters) by treatment arms
500 for each of the treatment arms.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

Institutional Review Boards (IRBs)

IRB Name
UNZA Biomedical research ethics committee
IRB Approval Date
IRB Approval Number
IRB Name
UPenn Institutional Review Board
IRB Approval Date
IRB Approval Number


Post Trial Information

Study Withdrawal

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Is the intervention completed?
Intervention Completion Date
August 31, 2023, 12:00 +00:00
Data Collection Complete
Data Collection Completion Date
June 04, 2023, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Was attrition correlated with treatment status?
Final Sample Size: Total Number of Observations
Final Sample Size (or Number of Clusters) by Treatment Arms
508 control, 486 CCT, 514 Fertility
Data Publication

Data Publication

Is public data available?

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials