Household Bargaining and Female Condom Use
Last registered on March 19, 2019

Pre-Trial

Trial Information
General Information
Title
Household Bargaining and Female Condom Use
RCT ID
AEARCTR-0003804
Initial registration date
January 21, 2019
Last updated
March 19, 2019 10:50 AM EDT
Location(s)
Region
Primary Investigator
Affiliation
Vrije Universiteit Amsterdam
Other Primary Investigator(s)
PI Affiliation
Institute for Fiscal Studies & University of Oxford
PI Affiliation
Utrecht University & University of Oxford
PI Affiliation
Amsterdam Institute for Global Health and Development
Additional Trial Information
Status
Completed
Start date
2014-04-01
End date
2018-12-31
Secondary IDs
Abstract
Women may face systematically greater benefits than men from adopting certain household technologies, or greater costs from non-adoption. Yet women may also hold systematically lower bargaining power, which may act as a constraint to take-up if the adoption decision is joint. Introducing a version of the technology that is second-best in terms of cost or effectiveness, but more acceptable to men, may increase
adoption and potentially welfare.

We conducted a field experiment in Maputo, Mozambique, introducing female condoms in a setting with high HIV prevalence. The intervention consisted of six group training sessions lasting ninety minutes each, held fortnightly over a three month period. Sessions were held in community buildings with groups of five to twelve women, facilitated by female health workers from the local area. The intervention allows us to study which women, if any, adopt female condoms when informational, supply and price constraints are alleviated.

External Link(s)
Registration Citation
Citation
Janssens, Wendy et al. 2019. "Household Bargaining and Female Condom Use." AEA RCT Registry. March 19. https://www.socialscienceregistry.org/trials/3804/history/43666
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Experimental Details
Interventions
Intervention(s)
Our study took place in Matola, which is the capital of Maputo Province and lies approximately 10km west of Maputo City. HIV prevalence in Maputo Province is high and disproportionately affects women, at an estimated 29.6% for women and 15.8% for men (Ministerio da Saude, 2015). The intervention is run by Pathfinder International, and is aimed at women in populations with high HIV transmission risk.

The programme consists of six interactive group sessions lasting ninety minutes each, held fortnightly over a three month period. Pathfinder trains female health workers from the local area to facilitate the programme, and thus facilitators are socially proximal to the participants. Group sizes range from a minimum of five to a maximum of twelve women aged 18-49 years, with on average 10 women per group, creating an environment conducive to discussion.

The sessions are guided by a curriculum covering: information on female condoms and demonstration of their use on pelvic models; information about other contraceptive methods; information on HIV/AIDS and other STIs; and discussions around consent, negotiation of contraceptive use, intimate partner violence, and women's rights. Female condoms are also added to the set of products carried by local health workers, which already include male condoms, that participants can access freely and discreetly at the end of each session.
Intervention Start Date
2014-09-01
Intervention End Date
2014-12-31
Primary Outcomes
Primary Outcomes (end points)
Key outcome variables are 1) female condom use (measured as: Ever use of female condoms, Use of female condoms in the last 30 days, Current use of female condoms -- with "Current use" being the preferred outcome variable), and 2) frequency of sex acts (measured using the diaries as: Likelihood of a sex act per individual per week)
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary outcome variable: male condom use (measured as: Ever use of male condoms, Use of male condoms in the last 30 days, Current use of male condoms)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
We conducted a phased-in randomised control trial in Maputo Province, Mozambique, to study the adoption of condoms, and to examine how intra-household bargaining affects the adoption of female condoms when they are introduced in a setting where only male condoms are widely available. Specifically, we assess the short-run impacts of the intervention on women who were assigned to participate in the programme in the second half of 2014, compared to women who were assigned to participate six months later. In addition to baseline and
endline data, we collected weekly sexual diary data for a subsample of the women. This allows us to investigate impacts at the sex-act level, including effects on the frequency of sex acts. To measure bargaining power, we collect information about assets brought by the woman to the relationship, and also use two different survey modules covering decision-making and power dynamics in the relationship.

Pathfinder International began its female condom programme in Matola in 2011. We expanded the programme to four additional neighbourhoods in 2014, using a phased-in experimental design. The healthcare workers who facilitated the programme first conducted
door-to-door recruitment to identify women willing to participate. The eligibility criteria were threefold: women needed to be between 18 and 49 years of age, sexually active, and not pregnant. All recruited women participated in a baseline survey.

Once the entire sample had responded to the baseline survey, participants were assigned to either the first or second wave of group sessions. Participants in the first wave constitute our treatment group. Participants in the second wave constitute our control group. Randomization was done at the level of the facilitator: half of the respondents recruited by each facilitator were allocated to the first round of sessions and half were allocated to the second round of sessions. The reason for stratifying on facilitator was to improve power, and to ensure that there would be enough space for treatment and control participants to attend sessions close to their home.

The treatment group then received the intervention from September-December 2014. The endline survey was conducted in February-March 2015, two to three months after treated individuals had received their last group session. Baseline participants (both treatment and control) were traced and administered the endline survey. Following the endline survey, the control group then received the intervention from
March-May 2015.

During the period between baseline and end of the intervention, a subsample of participants from both the treatment group and the control group participated in weekly coital/sexual diaries.



Experimental Design Details
Randomization Method
Randomization was done in office using a computer program: A member of the research team took the list of respondents for each facilitator,
sorted them by a randomly-generated number, and assigned the first half to treatment and the second half to control.
Randomization Unit
The unit of randomization was the individual, stratified by facilitator. That is, the women recruited per facilitator were randomly assigned to the treatment or the control group -- within facilitators.
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
Planned number of units: 340 women (20 women per facilitator)
Sample size: planned number of observations
Planned number of observations: 340 women (20 women per facilitator)
Sample size (or number of clusters) by treatment arms
Planned sample size: 170 women in treatment group, 170 women in control group.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Based on the final realized sample, we have 80% power to detect the following minimum detectable effect sizes at the 5% level in a two-tailed test: ever use -- female condoms 7.6 pp; use last 30 days -- female condoms 3.5 pp; current use -- female condoms 4.9 pp. pp, male condoms 13.9 pp.
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Comite Institucional de Bioetica em Saude da Faculdade de Medicina/Hospital Central de Maputo, Mozambique
IRB Approval Date
2014-03-04
IRB Approval Number
N/A
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
Yes
Intervention Completion Date
December 31, 2014, 12:00 AM +00:00
Is data collection complete?
Yes
Data Collection Completion Date
March 31, 2015, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Final baseline sample: 298 women (Not all facilitators recruited a total of 20 women, and one facilitator fell long-term ill during baseline so all her recruited participants were dropped from the study).
Final endline sample: 232 women.
Final sexual diaries subsample: 56 women
Was attrition correlated with treatment status?
Yes
Final Sample Size: Total Number of Observations
Final baseline sample: 298 women.
Final endline sample: 232 women.
Final sexual diaries subsample: 56 women
Final Sample Size (or Number of Clusters) by Treatment Arms
Sample size by treatment arm of baseline survey: 152 treatment, 146 control Sample size by treatment arm of endline survey: 125 treatment, 107 control Sample size by treatment arm of weekly sexual diaries subsample: 27 treatment, 29 control
Data Publication
Data Publication
Is public data available?
No

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Program Files
Program Files
No
Reports and Papers
Preliminary Reports
Relevant Papers