The role of social contacts and women’s perception of midwife-led care

Last registered on March 05, 2026

Pre-Trial

Trial Information

General Information

Title
The role of social contacts and women’s perception of midwife-led care
RCT ID
AEARCTR-0016912
Initial registration date
February 27, 2026

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
March 05, 2026, 8:40 AM EST

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

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Primary Investigator

Affiliation
UNIVERSITY OF INSUBRIA

Other Primary Investigator(s)

PI Affiliation
UNIVERSITY OF MILAN

Additional Trial Information

Status
In development
Start date
2026-02-26
End date
2026-08-01
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
We will conduct a survey experiments to explore the role of social contacts or networks in influencing women's perceptions regarding midwife-led model. Specifically, the study seeks to assess the role of these networks or social contacts in shaping women's decision-making during pregnancy and childbirth. We vary the extent to which a participant is exposed to different types of information by their social contacts and investigate their effects on beliefs, preferences and behaviour towards the midwife-led model. This will be accomplished through the vignettes which contain treatment: (1) information about a friend's positive birth experience using the midwife-led model, (2) information about a friend's negative birth experience using the midwife-led model which resulted in an emergency c-section, (3) information from a gynaecologist/obstetrician sharing positive experiences using the midwife-led model, (4) information from a gynaecologist/obstetrician sharing negative experiences using the midwife-led model which may result in an emergency c-section, and (5) information about breast cancer awareness. We expect there will be a significant increase in the beliefs and perceptions of women regarding the non-medicalisation of pregnancy and childbirth. Understanding the role these networks play is crucial for developing strategies that promote wider adoption of this model of care in Italy.
External Link(s)

Registration Citation

Citation
MHISHI, KUDZAI SANDRA and ANNA CECILIA ROSSO. 2026. "The role of social contacts and women’s perception of midwife-led care." AEA RCT Registry. March 05. https://doi.org/10.1257/rct.16912-1.0
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Sponsors

Experimental Details

Interventions

Intervention(s)
Our study employs a vignette-based survey experiment to explore the role of social contacts in influencing women’s perceptions about midwife-led care. The intervention includes five hypothetical scenarios containing: (i) a positive (or good) birth experience of a friend using the midwife-led care, and (ii) a negative (or bad) birth experience of a friend using the midwife-led model but resulted in an emergency c-section, (iii) a gynaecologist sharing positive experiences using the midwife-led model, (iv) a gynaecologist sharing negative experiences using the midwife-led model which may result to emergency c-section and (v) information on breast cancer awareness.
Intervention Start Date
2026-02-27
Intervention End Date
2026-04-15

Primary Outcomes

Primary Outcomes (end points)
(i) Beliefs about pregnancy and childbirth and
(ii) Perceptions about the midwife-led model
(iii) Behaviour towards the midwife-led model
which are composite indices holding the values between 0 and 1.
Primary Outcomes (explanation)
Index 1: Beliefs about Pregnancy and Childbirth
This composite index is constructed from two binary indicators, each receiving equal weights.
1. Views about pregnancy
where 1 = Natural process and 0 = Medical condition requiring intervention
2. Concerns about cesarean
where 1 = Very concerned OR concerned and 0 = Not concerned
Formula:
Pregnancy & Childbirth Beliefs = (Views + Concerns) / 2
Range: 0 to 1, where higher values indicate an individual’s stronger beliefs that pregnancy is a natural process and that they are very concerned with the high caesarean section rates

Index 2: Perceptions of the Midwife-led model
This composite index is constructed from three binary indicators, each receiving equal weights.
1. Goodness of the midwife-led model
where 1 = Yes (the model is good) and 0 = No
2. Model reduces c-sections
where 1 = Yes (believes the model reduces c-sections) and 0 = No or otherwise
3. Consideration of using the model now or future
where 1 = Will often OR always consider and 0 = Will never considered
Formula:
Midwife-Led Model Perception Index = (Goodness + Reduces CS + Consider model) / 3
Range: 0 to 1, where higher values indicate more positive perceptions of the midwife-led model being good and helping to reduce c-sections, and the respondents’ desire to use the model.

Outcome 3: Behaviour measurements
We will ask the respondents for an amount they are willing to donate, from 100 euros they received (hypothetically) from a lottery to an association supporting the midwife-led model.
Donation amount is a categorical variable whereby 1 = Non-donor (donated 0 euros), 2 = Low donors (donated between1-25 euros), 3 = Medium donors (donated between 25-75 euros), and 4 = High donors (donated between 75-100 euros).

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
We will conduct a survey experiment. The participants will be randomly assigned to one of the five groups – four treatment and one control – using a computer from the platform where the survey will be distributed. Those in treatment groups will be presented with a vignette:
(i) Treatment 1: a friend sharing her positive birth experience using midwife-led care
(ii) Treatment 2: a friend sharing her negative experience using midwife-led care, which resulted in an emergency c-section.
(iii) Treatment 3: a gynaecologist doctor sharing positive experiences using midwife-led care
(iv) Treatment 4: a gynaecologist doctor sharing negative experiences using midwife-led care, which may result in an emergency c-section
(v) Treatment 5: general information on breast cancer – this is the control group.

The main hypotheses we will test is whether a woman’s access to information from social contacts can influence her perception of the midwife-led care model. Our main hypotheses is that there are differences in perceptions about the midwife-led model among women who are exposed to information from their social contacts compared to those without information (control group).
Other hypotheses we will test include: (i) the information source effect - i.e., there are differences in perceptions about the midwife-led model among individuals who receive information from friends and medical professionals compared to the control group, and (ii) the direction of the social contact’s influence - i.e., whether there are differences in perceptions about the model among individuals who are exposed to positive or negative birth experiences from social contacts.

Our proposed sample consists of 2,079 women aged 24–55 years, residing in Italy and recruited via online panels. Of these, 250 will participate in a pilot study (50 per arm), leaving 1,829 women for the main study, allocated across five treatment arms of approximately 366 respondents each. Although this falls short of the 700 respondents per arm recommended by Haaland et al. (2023) for information experiments, we argue that our sample remains sufficiently powered to detect effect sizes commonly observed in this literature.

Following Haaland et al. (2023)—who show that information experiments typically generate large effects on beliefs but smaller effects on stated preferences or behavioural outcomes, and that null results are frequent—we adopt their recommendation that such studies should maintain at least 80% power to detect a treatment effect of 0.15 standard deviations. To account for multiple hypothesis testing across four planned pairwise comparisons, we apply a Bonferroni correction, yielding an adjusted significance level of α = 0.0125. Under this correction, our sample of approximately 366 respondents per arm achieves 80% power to detect effect sizes of 0.17 standard deviations or larger. Effect sizes between 0.15 and 0.17 standard deviations are consistent with the small-to-moderate treatment effects widely documented in the information-experiment literature, supporting both the plausibility and policy relevance of effects detectable within our power parameters.

To ensure representativeness, we employ stratified random sampling with re-weighting, benchmarking the distribution of key observable characteristics—including age, education, employment status, and macro-areas indicators—against official ISTAT population data. We adopt the entropy-balancing strategy recommended by Grembi et al. (2024) to achieve covariate balance with respect to known population characteristics, applying regional weights derived from age and educational shares. We incorporate these weights into both baseline estimation models and population-level inference, thereby ensuring that our results are generalisable to the broader population of women in Italy while preserving sufficient statistical power to detect effect sizes between 0.15 and 0.17 standard deviations at the adjusted significance level of α = 0.0125.

Data collection will capture key observable characteristics, including age, education, employment status, and macro-area indicators. Pre-treatment questions will collect demographic information (age, marital status, education, employment), pregnancy status, and awareness of alternative maternity care models, as well as factors influencing model choice. To mitigate demand effects, we will incorporate a social desirability index. Post-treatment questions will measure respondents' perceptions of pregnancy, childbirth, and the midwife-led care model. Quality-control measures will include monitoring survey completion times and implementing a post-treatment attention check that requires respondents to recall information provided before treatment (e.g., prior pregnancy history), in order to identify and exclude inattentive respondents.
Experimental Design Details
Not available
Randomization Method
The participants will be randomly assigned to one of the five groups – four treatment and one control – using a computer from the platform where the survey will be distributed. Those in treatment groups will be presented with a vignette. Data collection will be on important observable characteristics, such as age, education, employment, and macroarea dimensions.
Randomization Unit
Individual level
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
N/A
Sample size: planned number of observations
1829 women
Sample size (or number of clusters) by treatment arms
366 women in each treatment arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Our proposed sample consists of 2,079 women aged 24–55 years, resident in Italy, and recruited by Demetra via online panels, of whom 250 will participate in a pilot study (50 per arm), leaving 1,829 women allocated across five treatment arms of approximately 366 respondents each. Although this falls short of the 700 respondents per arm recommended by Haaland et al. (2023) for information experiments, we argue that our sample remains sufficiently powered to detect effect sizes commonly observed in this literature, where large effects on beliefs and smaller effects on stated preferences or behavioural outcomes are typical and null results are common. Following Haaland et al. (2023), we maintain at least 80% power to detect a treatment effect of 0.15 standard deviations. To account for multiple hypothesis testing across four planned pairwise comparisons, we apply a Bonferroni correction, yielding an adjusted significance level of α = 0.0125, under which our sample of approximately 366 respondents per arm achieves 80% power to detect effect sizes of 0.17 standard deviations or larger. Effect sizes in the range of 0.15 to 0.17 standard deviations correspond to small-to-moderate treatment effects consistent with those widely documented in the information-experiment literature supporting both the plausibility and policy relevance of effects detectable within our power parameters.
IRB

Institutional Review Boards (IRBs)

IRB Name
Research Ethics Committee, University of Insubria
IRB Approval Date
2024-10-24
IRB Approval Number
0119183