Social signals for Prenatal Care and Safe Delivery: Evidence from a Field Experiment in Sierra Leone

Last registered on February 02, 2017
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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

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
February 02, 2017, 4:08 PM EST

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

Locations

Country
Sierra Leone
Region
Western and Northern Region

Primary Investigator

Name
Anne Karing
Affiliation
Princeton University
Contact Primary Investigator

Other Primary Investigator(s)

Additional Trial Information

Status
On going
Start date
2017-01-17
End date
2018-12-31
Keywords
Health
Additional Keywords
Psychology and Economics, Behavioral Economics, Social Incentives, Social Norms
JEL code(s)
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://doi.org/10.1257/rct.1921-1.0
Former 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
Sponsors & Partners

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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)
Supporting Documents and Materials
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
Analysis Plan

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials