Experimental Design Details
As part of the trial, each woman in the study will be randomly assigned to one of three experimental arms or a control arm.
1. A control arm T0, in which women are visited by a trained family planning counselor and are presented with a free counseling session where they will receive the standard of care in family planning counseling in Malawi. The session will consist of methods being presented using a standardized flipchart that has been developed by the Malawi Ministry of Health and Reproductive Health Directorate. The flipchart lists all 15 available contraceptive methods in order of effectiveness in preventing pregnancy (most effective to least effective).
2. A treatment arm T1 in which women will be presented with the choice to invite their husbands to the counseling session. Following the invitation, women and their husbands (should they choose to invite them) will receive the standard of care family planning counseling session described above.
3. A treatment arm T2 that that aims to minimize choice overload and increase the salience of a woman’s most preferred method attribute (e.g. method effectiveness in preventing pregnancy, duration of use, ease of use, likelihood of method-related side effects, etc.). In this arm, a woman will be asked first to compare and rank method-specific attributes (e.g. does she prefer that a method have a lower incidence of side effects over a method that is more effective at preventing pregnancy?). Once a ranking of method attributes has been elicited, the counselor will identify the attribute that the woman reveals to be most important to her and will present a limited set of 5 methods that rank highest along that revealed attribute. Particular emphasis will be placed on making the order of presentation salient, in which women will be reminded and primed to consider the relative ranking of a method across the stated attribute.
4. A treatment arm T3 that provides women both with the choice to invite their husbands (treatment arm 2 above) and presents a counseling session that minimizes choice overload across the woman’s most preferred method attribute (treatment arm 3).
Following receipt of counseling, women in all treatment arms (including the control arm) will be asked to reveal their preferred choice of method. Following this elicitation, women in all arms of the study will be offered the following package of services:
1. A free taxi ride to our partner family planning clinic in Lilongwe, the Good Health Kauma Clinic, which has been previously identified as a high quality family planning clinic that provides the full range of contraceptive methods.
2. A free consultation with a family planning service provider at the Good Health Kauma Clinic.
3. Free family planning services at the Good Health Kauma Clinic.
These services have already been tested and implemented in the field as part of a recently completed family planning study in Lilongwe (NHSRC Protocol No. 16/7/1628). To increase the salience of the offer, the package of services will be time-limited for one month following the counseling session. By offering the package of three services above, which together aim to reduce the barriers to accessing family planning services at our partner clinic, we will be able to elicit a measure of demand for family planning and will also be able to observe how a woman’s demand (her final choice of method) aligns with her initially stated preferences for family planning immediately following counseling.
A follow-up survey will be conducted one month following a woman’s counseling session. Outcome data that captures a woman’s preferences and decision-making around contraception will be collected at baseline survey, pre-counseling session, post-counseling session, and at every clinic visit. In situations where women do not show up at the clinic, our enumerators will make phone calls or home visits to conduct end-line surveys with the women and ask about their preferences and decision-making around contraception.