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Household Dynamics and Family Planning in Jordan
Last registered on May 21, 2014

Pre-Trial

Trial Information
General Information
Title
Household Dynamics and Family Planning in Jordan
RCT ID
AEARCTR-0000334
Initial registration date
May 21, 2014
Last updated
May 21, 2014 2:24 PM EDT
Location(s)
Region
Primary Investigator
Affiliation
Abt Associates Inc.
Other Primary Investigator(s)
PI Affiliation
University of Michigan
Additional Trial Information
Status
On going
Start date
2013-09-23
End date
2015-01-30
Secondary IDs
Abstract
The USAID-funded Strengthening Health Outcomes through the Private Sector (SHOPS) project, together with the University of Michigan, is conducting a randomized controlled trial (RCT) to evaluate the impact of family planning counseling methods designed to change attitudes and behaviors related to use of modern contraceptives among married women in Jordan.

The SHOPS project in Jordan (locally known as the Strengthening Family Planning project) has been implementing a comprehensive community health outreach program designed to specifically address one of the most difficult programmatic challenges in family planning: changing attitudes and behaviors among women with the highest unmet need. Under the project, community health workers make home visits to married women of reproductive age across Jordan to discuss the benefits and options of modern family planning methods as well as provide referrals for family planning. Given the important role of husbands in family planning decision-making (DHS data and available qualitative evidence), the project is implementing a pilot outreach program where couples are counseled as well.

The main objectives of this research are to (1) measure the impact of counseling women on family planning uptake, (2) measure the impact of counseling couples on family planning decisions and uptake as compared to counseling women alone, and (3) identify the mechanisms (spousal communication, bargaining power, fertility preferences, etc.) through which counseling - either alone or as a couple - affects family planning use. After a screening exercise to identify study eligible households and a baseline survey, women are randomly assigned to three groups: counseling alone, counseling with their husbands, or no counseling. Outreach visits by the community health workers and a detailed endline survey are then conducted to measure differences in family planning uptake between the three groups.

The study is among the first to measure the effect of husband's involvement on family planning use in an Arab country, where important contextual factors related to fertility decision making within a household or a couple may lead to different results than in other settings.
External Link(s)
Registration Citation
Citation
El-Khoury, Marianne and Rebecca Thornton. 2014. "Household Dynamics and Family Planning in Jordan." AEA RCT Registry. May 21. https://doi.org/10.1257/rct.334-1.0.
Former Citation
El-Khoury, Marianne and Rebecca Thornton. 2014. "Household Dynamics and Family Planning in Jordan." AEA RCT Registry. May 21. https://www.socialscienceregistry.org/trials/334/history/1800.
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Experimental Details
Interventions
Intervention(s)
The family planning counseling outreach intervention consists of a series of door-to-door counseling visits to eligible women (married women of reproductive age not using a modern family planning method) and couples. During those visits, community health workers (CHWs) counsel women/couples on modern family planning methods, provide referrals to public and private service providers for family planning, provide free or discounted vouchers for network service providers, and record data.

Intervention Start Date
2013-10-02
Intervention End Date
2014-10-24
Primary Outcomes
Primary Outcomes (end points)
-Knowledge of modern FP methods (wife and husband)
-Fertility preferences (wife and husband)
-Knowledge of each other's fertility preferences
-Attitudes towards modern and traditional FP methods (wife and husband)
-Spousal communication on FP
-Communication with other family and friends on FP
-Desire or interest in modern FP (measured through voucher acceptance), including husband's influence
-Voucher redemption
-Use of FP method
-Uptake of family planning methods
-Continuation of family planning methods
-Number of pregnancies
-Spacing between pregnancies


Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
1. Site selection (urban only)
The study was limited to urban areas only that are not currently an area targeted for family planning outreach activities by other agencies or previous home outreach locations by General Union of Voluntary Services and Circassian Charity Association (the project's current home implementing partners). This study area has not received outreach work by the predecessor project in the past three years.

2. Research firm recruitment and training
Interviewers were recruited through a research firm. Interviewers were fluent in Arabic and English and have experience conducting surveys. The interviewers participated in a week-long training which covered survey interviewing techniques, project goals, research ethics and confidentiality, and practice interviews.

3. Household screening, selection of eligible women
Within the selected study site(s), a screener visit was conducted by a research firm to determine which households contain eligible women. Women are eligible if they met the following criteria:
- Currently married
- Ages 15-49
- Not currently pregnant
- Not currently using modern family planning
- Resides with her husband
- Family does not intend on changing residence in the next year

During the screener visit basic information was collected that enabled us to determine eligibility, and locate the household again (i.e. names, phone numbers of key family members, house address). Screeners first asked any adult member of the household whether any married women between the ages of 15 and 49 currently lived in the household with their husbands. If there was more than one woman in the household who met those basic criteria, only one woman was be randomly chosen to be further screened for participation in the study. Note that all potentially eligible women in the household had an equal chance of being selected for further screening, even if they were not at home during the first visit.

For the second part of the screening, screeners met in a private location with the randomly selected woman who met the basic eligibility criteria to ask more sensitive screening questions about pregnancy intentions and use of family planning. Screeners also asked about whether the woman had ever used a modern family planning method (used for stratification). If the woman was eligible to participate according to all of the eligibility criteria, the screener sought her consent and proceeded with the baseline survey if the respondent was available. Otherwise, screeners would set up appointments for the baseline survey with the respondent who agreed to participate.

Each eligible woman was assigned an identification (ID) number, regardless of whether she consented to participate in the study. The research firm developed and assigned a unique ID number for each survey respondent.

4. Baseline survey
The baseline survey includes questions on demographic and socio-economic characteristics, communication with family members, fertility history and preferences, as well as family planning experiences. The husband, other family members, friends, or other people were not present during the survey. The only exception was children ages 5 and under. Only those who agreed to be surveyed and counseled completed a baseline survey.

5. Randomization to treatment arms (T1, T2, C)
Based on the data entered from the screening form, the research team randomized participant households into one of three counseling treatment arms:
- Treatment #1 (T1): Women counseled alone
- Treatment #2 (T2): Women counseled with their husbands
- Control (C): No counseling for women or their husbands
Randomization was stratified on previous use of modern methods and other explanatory variables to insure balanced groups. This variable was captured in the screening process.

Randomization was conducted in phases to avoid a long time window between the survey and counseling intervention and, thereby, reduce the likelihood of attrition. The research team had a 2 week window between the survey and counseling. This required close monitoring of the data collection and a data entry process that enabled quick entry of the screening and cover sheet data.

6. Counseling outreach visits
Only those who fully completed the baseline survey participated in the counseling.

Lists of names and contact information collected during the screener visits were given to the implementing partner to use for their health workers to conduct their visits. The CHWs were also handed data cards to record information on women or couples during the counseling visits. For households selected to participate in couple counseling, the CHW counseled the couple for at least the first household visit. Thereafter, the CHW may have counseled the woman alone if the husband was not available.
Vouchers were given to all women who were interviewed.

During follow-up outreach visits for each group (women alone or women and husbands), information about voucher redemption and use of FP services at private or public clinics/doctors were collected.

7. Follow-up survey
After completion of the outreach counseling cycle, endline surveys will be collected among all participant women and their husbands, separately.
Experimental Design Details
Randomization Method
Randomization done in office by a computer using Stata
Randomization Unit
Household
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
14 clusters (stratification by 7 sub areas and by ever use of family planning method)
Sample size: planned number of observations
Planned 1,600 households, but actual study has fewer observations
Sample size (or number of clusters) by treatment arms
Planned 532 households control, 532 households treatment 1 (wife only counseling), 532 households treatment 2 (husband and wife counseling)
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Abt Associates Inc., Institutional Review Board
IRB Approval Date
2013-06-07
IRB Approval Number
0628
IRB Name
University of Michigan Eresearch
IRB Approval Date
2012-08-02
IRB Approval Number
HUM00065682
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