Social signals for Prenatal Care and Safe Delivery: Evidence from a Field Experiment in Sierra Leone
Last registered on February 02, 2017

Pre-Trial

Trial Information
General Information
Title
Social signals for Prenatal Care and Safe Delivery: Evidence from a Field Experiment in Sierra Leone
RCT ID
AEARCTR-0001921
Initial registration date
February 02, 2017
Last updated
February 02, 2017 4:08 PM EST
Location(s)
Primary Investigator
Affiliation
UC Berkeley
Other Primary Investigator(s)
Additional Trial Information
Status
On going
Start date
2017-01-17
End date
2018-12-31
Secondary IDs
Abstract
Can social signaling incentivize pregnant women to attend antenatal care services and give birth with a trained provider? Working with the Ministry of Health and Sanitation Sierra Leone, I introduce a social incentive in the form of differently colored bracelets. Pregnant women receive bracelets when they come for antenatal care and when they deliver with a trained health provider. The differently colored bracelets make highly salient if the antenatal care schedule is unfinished and if other women have attended visits that you missed. Unlike most incentives, which are material or private in nature (e.g. food, cash transfers), the bracelets make the decision to attend antenatal care and deliver safely observable, allowing pregnant women to signal to others that they look after their own and their baby’s health. I implement a field experiment in government clinics to test the effects of the social incentive on timely and complete antenatal care and delivery with a trained health provider. I further measure the effect of the bracelets on individuals' knowledge and beliefs about others' pregnancy care choices. I vary the visibility of pregnancy care decisions across treatment arms by implementing different variations of the bracelet scheme. This experimental design allows me to separately identify the extent to which behavior change is driven by a demand for bracelets or reminder effects, or for a desire to signal to others.
External Link(s)
Registration Citation
Citation
Karing, Anne. 2017. "Social signals for Prenatal Care and Safe Delivery: Evidence from a Field Experiment in Sierra Leone." AEA RCT Registry. February 02. https://www.socialscienceregistry.org/trials/1921/history/13701
Experimental Details
Interventions
Intervention(s)
Intervention Start Date
2017-01-17
Intervention End Date
2018-03-31
Primary Outcomes
Primary Outcomes (end points)
Primary outcome: number of (timely) antenatal care visits a pregnant woman made; delivery with a trained provider.
Secondary outcomes: take-up and retention of bracelets over time; individual knowledge and beliefs about others' pregnancy care choices.
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
Government clinics in the selected districts are randomly assigned into one of three intervention arms:
1) Pure Control Group: no bracelets are given out at antenatal care (ANC) visits or delivery.
2) Bracelet Control Group: four color, uninformative bracelet. Every woman receives a pink, purple, yellow, or multicolor bracelet when coming for the 1st ANC visit. Women can choose their preferred color. No color changes take place for later ANC visits or at delivery. The bracelet is exchanged for an identical bracelet of the same color at the 5th ANC visits and when giving birth with a trained provider.
3) Bracelet Treatment Group: four color, informative bracelet. Every woman receives a bracelet when coming for the 1st ANC visit. Women who come on time for their first visit (i.e. within the first four months of pregnancy) receive a purple bracelet. Women who are late for their first visit receive a pink bracelet. The pink or purple bracelet is exchanged for a yellow bracelet when coming for a 5th ANC visit during the eighth or ninth month of pregnancy. The bracelet is exchanged again for a multicolor bracelet when a woman gives birth with a trained provider.

Clinic staff and pregnant women in all three intervention arms will be sensitized on the importance of regular ANC visits and delivery with a trained provider. Enumerators will visit clinics at the same frequency across arms to collect data from administrative records and survey individuals.
Experimental Design Details
Randomization Method
The randomization was conducted using a computer random number generator.
Randomization Unit
Clinics
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
90 clinics
Sample size: planned number of observations
8000 pregnant women observed from administrative records, 4500 individual survey respondents
Sample size (or number of clusters) by treatment arms
30 clinics pure control group, 30 clinics bracelet control group, 30 clinics bracelet treatment group.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Committee for Protection of Human Subjects (CPHS) UC Berkeley
IRB Approval Date
2016-06-14
IRB Approval Number
2016-03-8471
IRB Name
Sierra Leone Ethics and Scientific Review Committee
IRB Approval Date
2016-05-16
IRB Approval Number
N/A
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
No
Is data collection complete?
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
Reports and Papers
Preliminary Reports
Relevant Papers