Networks and Global Health: Experimental Evidence of Women’s Social Networks, Reproductive Health, and Well-Being

Last registered on June 28, 2024

Pre-Trial

Trial Information

General Information

Title
Networks and Global Health: Experimental Evidence of Women’s Social Networks, Reproductive Health, and Well-Being
RCT ID
AEARCTR-0003283
Initial registration date
September 12, 2018

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
September 16, 2018, 12:24 PM EDT

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

Last updated
June 28, 2024, 1:32 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Primary Investigator

Affiliation
The World Bank

Other Primary Investigator(s)

PI Affiliation
BOSTON UNIVERSITY
PI Affiliation
DELHI SCHOOL OF ECONOMICS
PI Affiliation
NORTHEASTERN UNIVERSITY
PI Affiliation
NORTHEASTERN UNIVERSITY

Additional Trial Information

Status
Completed
Start date
2018-06-26
End date
2019-12-15
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
We will implement a randomized control trial to explore the causal impact of a social network-based family planning intervention on young women’s contraceptive use, reproductive health, fertility and well-being in rural India. Our proposed intervention consists of a “bring-a-friend” family planning voucher package that exploits young women's social networks to reduce barriers and to improve access to high-quality family planning services. Through this study, we aim to evaluate whether enabling a woman to recruit a friend to accompany her to the clinic leads to a greater shift in family planning practices and attitudes than targeting both of those women individually. Our project aims to identify innovative and cost-effective strategies for delivering reproductive health services through social networks in low-income settings.
External Link(s)

Registration Citation

Citation
ALMANZA, CATALINA et al. 2024. "Networks and Global Health: Experimental Evidence of Women’s Social Networks, Reproductive Health, and Well-Being." AEA RCT Registry. June 28. https://doi.org/10.1257/rct.3283-2.0
Former Citation
ALMANZA, CATALINA et al. 2024. "Networks and Global Health: Experimental Evidence of Women’s Social Networks, Reproductive Health, and Well-Being." AEA RCT Registry. June 28. https://www.socialscienceregistry.org/trials/3283/history/226646
Sponsors & Partners

Sponsors

Partner

Type
none
Experimental Details

Interventions

Intervention(s)
Women who are administered the baseline surveys will be randomly assigned to one of three treatment arms: 1) a no-voucher group (50%), 2) a solo-voucher group (25%), and 3) a “bring-a-friend” (BAF) group (25%). All participants will receive an information brochure that describes the benefits of family planning, healthy birth spacing, and timing of pregnancy. Women who are randomly assigned to the solo-voucher and BAF groups will also receive a voucher for discounted access to family planning services at a high-quality private clinic. In addition, women who are randomly assigned to the BAF group will be encouraged to bring a friend who may also be, in consultation with a doctor at the FP clinic, eligible to receive the same voucher for family planning as the treated woman.
Intervention (Hidden)
During the baseline interview, women will receive a detailed informative brochure on family planning and on the benefits of healthy timing and spacing of births as well as general information on modern family planning methods. The brochure will be provided to women by the field managers, who will be trained by the Delhi School of Economics.

The three intervention arms are as follows:

1. Solo- Voucher Arm:
Women assigned to the solo-voucher arm will be given a voucher package for receiving family planning and reproductive health services at our partner family planning clinic, the ADC Clinic in Chandwak, Jaunpur. This voucher package will grant access to a wide range of contraceptive methods and services at the ADC Clinic which is known to be a high-quality family planning clinic with well-trained staff, relatively low waiting times, and a full range of contraceptive methods. As part of this package, each woman assigned to the solo-voucher arm will receive one free initial family planning consultation at the ADC Clinic. In addition, she will be provided a voucher of INR 2,000 (about $30 USD) that can be used to cover the costs of family planning services at the ADC Clinic over a 10-month period. Specifically, the voucher can be used to cover costs associated with procuring contraceptive methods as well as other family planning-related costs, such as the treatment and management of contraceptive-related side effects. This voucher will be valid only for 10 months starting on the day it is given to the woman. A woman can use the voucher over multiple clinic visits; however, the voucher will only cover up to INR 2,000 of her family planning-related expenses over all of her visits during these 10 months. A woman will be responsible for covering any expenses that are not related to family planning as well as for any family planning services that exceed her Rs.2,000 limit over the intervention period.

2. Bring-a-Friend (BAF) Arm:
Similar to women assigned to the solo-voucher arm, women assigned to the BAF arm will also receive a free first consultation at the ADC Clinic and will be provided with a voucher of INR 2,000 that can be used to obtain family planning services at the ADC Clinic over a 10-month period. In addition, if a woman assigned to the BAF arm chooses to bring friends with her to the ADC Clinic, her friends will also be eligible to receive the same voucher of INR 2,000 for any family planning services that they take up over the 10-month intervention period. A woman assigned to the BAF arm may bring up to two friends during each visit and may either bring different friends or the same friend(s) for each subsequent visit. Each friend that the BAF woman brings will receive coverage in the amount of INR 2,000 for her family planning expenses over all of her visits to the ADC Clinic over the intervention period. Any expenditures that are not related to family planning or any family planning expenditures that exceed INR 2,000 over the course of the 10-month intervention period that are incurred by either the BAF woman or her friend will have to be covered out of pocket.

No intervention woman can receive more than INR 2,000 in total in coverage for family planning-related services over the course of the intervention period, and no woman can redeem more than one voucher for family planning at any time (i.e., a woman cannot take advantage of a solo-voucher as well as a BAF voucher and double her coverage limit over the course of the intervention period).

At least one of our field managers will be stationed at the clinic throughout the 10-month intervention period to record all women who come to the clinic and will collect information on the friends whom they bring, whom else they asked (or who else asked them) to come along, and the services that they used at the clinic. All activities over the intervention period, both by voucher recipients and their peers, will be monitored, recorded, and linked back to the social network data that were collected at baseline. New peers who are found to have not been identified by the voucher recipient during the baseline social network mapping will be registered on a rolling basis into the network database at the clinic by the field manager, and their detailed socio-demographic information will be collected so as to be able to track their expenditure and voucher coverage over the intervention period.

In order to be able to redeem the voucher amount for reimbursement for services, a woman (or the friend of a BAF woman) must have received a family planning related service at the ADC clinic on that day. However, a BAF woman’s voucher is not contingent on her friends receiving family planning services at the ADC Clinic. Similarly, the voucher for the friend of a BAF woman is not conditional on the BAF woman receiving family planning services at the ADC clinic. Any unused voucher amount will not be disbursed at the end of the intervention period.

Transportation Costs: The field manager will reimburse solo-voucher and BAF women (and for the BAF women, their friends whom they bring) for transportation to the clinic at a flat rate of INR 40 per person per visit, and the total reimbursement over the course of the program period will not exceed INR 120 per person (i.e., transportation coverage for a maximum of 3 visits per person). The transportation reimbursement will be provided to the women at the end of their visit to the ADC Clinic by the field manager, who will be stationed at the ground floor of the clinic. Any transportation costs that exceed INR 40 per visit for a total of 3 visits per person will not be covered. However, a woman’s transportation reimbursement is not contingent on her friends receiving family planning services at the ADC Clinic. Similarly, the transportation reimbursement for the friend of a BAF woman is not conditional on the BAF woman receiving family planning services at the ADC clinic. Reimbursement for transportation to the ADC Clinic will only be provided during the clinic’s daily working hours, which are between 8 AM and 6 PM daily. Any unused voucher or transportation reimbursement amounts will not be disbursed at the end of the intervention period.

3.Control (No-Voucher) Arm: Women in the control arm will receive only the information brochure (at the baseline survey) and they will only be re-contacted by the research team at the time of the follow-up survey.

Intervention Start Date
2018-09-04
Intervention End Date
2018-09-30

Primary Outcomes

Primary Outcomes (end points)
1. Attitude/Knowledge of Family Planning, including: knowledge of family planning; knowledge of birth spacing and timing; and perceptions toward contraception (including intentions to use).
2. Contraceptive Use, including: changes in contraceptive prevalence; changes in method mix; and adherence to methods (compliance, discontinuation).
3. Pregnancy and Fertility Outcomes, including: pregnancy status; parity; delivery in a facility; months since last birth; wantedness of last birth; and intentions to become pregnant in future.
4. Social Network Outcomes: including: network formation, peer effects, centrality, etc.
5. Intervention Uptake: use of the voucher, number of peers that were brought to the clinic, etc.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Conducted 2-month long baseline survey among eligible women, where eligible women are those who:
1. are 18-30 year old;
2. are currently married;
3. have at least one child;
4. are not sterilized nor has had a hysterectomy;
5. are neither pregnant nor are more than six months postpartum at the time of the screening; and
6. live in one of the survey sites.

We visited 2,781 household in adjacent villages for the study and found an estimate of 671 households that had at least one woman with these characteristics. We interviewed the youngest woman in case there was more than one eligible woman present in the household at the time of the survey. Data on women’s social networks, background characteristics, reproductive and contraceptive histories, and other information was collected as part of the baseline survey. The field enumerators also distributed, right after the interview, to all participants an information brochure that describes the benefits of family planning, healthy birth spacing, and timing of pregnancy. The information brochure was not accompanied by a counseling session. As part of the baseline survey, we collected identifying information (addresses, phone numbers, household GPS locations, etc.) needed for the follow-up. We also collected photographs of interviewed women to construct a photo album that will be used to validate mentioned network ties.

Next, we randomized the sample of eligible women into the three treatment arms. Doing the randomization after the baseline survey allowed us to balance on baseline covariates.

Following randomization, women who are assigned to the voucher and BAF arms will receive a visit from a field worker, who will inform them about the services that are available to them as part of their respective intervention and who will provide them with the voucher for access to family planning at our partner family planning clinic, the ADC Clinic in Chandwak, Jaunpur. Intervention field workers will also be able to use the photo album in order to verify the baseline social network information, particularly, the network ties and alters that were provided by women assigned to the voucher and BAF arms. Women will be able to use the vouchers once we complete the randomization and the photo verification process which we expect to implement within 1 to 2 weeks.

This will be followed by a 10-month-long intervention period during which women who are provided with vouchers may redeem them at the ADC Clinic. During this period, a field manager will monitor and record data on all clinic visits by women in the sample.

Following re-hiring and training of field staff, we will implement a 2-month-long endline survey to capture changes in family planning practices and attitudes.
Experimental Design Details
Randomization Method
We randomized women into intervention and control arms using stratification methods, in which intervention assignment was balanced according to the following baseline characteristics: village, current use of family planning, educational attainment, desire for another child, and number of peers mentioned in our social networks module.
Randomization Unit
Household
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
671 households (one woman per household)
Sample size: planned number of observations
671 households (one woman per household)
Sample size (or number of clusters) by treatment arms
Control = 350 women
Solo-voucher Treatment = 156 women
Bring-a-friend Treatment = 165 women
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Please see the attached document for detailed power calculations we conducted before the baseline survey. However, since then, we managed to survey more women than we had planned in our baseline survey.
Supporting Documents and Materials

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IRB

Institutional Review Boards (IRBs)

IRB Name
The Northeastern University Institutional Review Board
IRB Approval Date
2018-06-06
IRB Approval Number
18-04-24
Analysis Plan

Analysis Plan Documents

Analysis Plan

MD5: f30fb05c95ff824cc02ec86841e381f3

SHA1: de34f8b8ea6412586662fb71405019dbe8857b88

Uploaded At: September 12, 2018

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
June 30, 2019, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
October 31, 2019, 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
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials