Improving Contraceptive Uptake: Improved Access, Cost of Children and Social Anxiety

The key research objective is to answer the following questions:

(1) Does increasing anonymity when procuring condoms increase uptake (by reducing social anxiety/embarrassment related to interacting with shopkeepers to buy condoms)?

(2) Does maintaining privacy while ordering condoms increase uptake?

We will attempt to answer these questions by leveraging a field experiment that we have designed and that a local implementer will execute. The experiment has four-arms – a pure control and three treatment arms – that attempt to test the hypotheses. Our project implementation partner, Rahnuma Family Planning Association of Pakistan (FPAP), will implement the intervention.

The pure control will receive no intervention. This pure control will be "activated" if we are able to raise funds for an endline survey (our primary outcome measure is coupon uptake - since control households do not receive coupons, there is no way we can measure their contraceptive uptake without an endline survey).

The shop-treatment arm will receive one counseling session related to family planning and nearby locations where contraceptives can be obtained. Households in this arm will be given coupons to obtain condoms free of cost from registered stores/pharmacies or the Family Health Hospital operated by our project implementer, Rahnuma Family Planning Association of Pakistan (FPAP). Counselling will constitute standard counselling content as currently provided by FPAP.

The discrete-treatment arm couples will receive counseling and coupons, as above, along with an option to use mobile phones to redeem coupons to order contraceptives by calling on a designated phone number. The couples will be advised to not mention condoms while placing an order. This means that neither of the two parties in the phone conversation will specify ordering of condoms. Couples will only need to register the coupon number and house address to order condoms free of cost at their door-step.

The explicit-treatment arm couples will receive counseling and phone-redeemable coupons, as in the discrete-treatment arm. However, the couples will be advised to explicitly mention condoms while placing an order. This means that both parties in the phone conversation will mention that condoms are being ordered.

2019-10-01

2019-11-30

Coupon redemption.

Couples in our sample will be given coupons to obtain contraceptives free of cost. The variable 'coupon redemption' will be our primary outcome variable and the data will be captured by our field supervisor who will deliver contraceptives to household door-step and collect redeemed coupons from registered shops/pharmacies.

We will administer a randomized controlled trial to answer our research questions.

First, we will administer a community survey (which will also serve as a baseline) to identify 1,400-eligible households prior to intervention deployment. Administrative data on coupon use will constitute our primary outcome data, however, if we are able to raise funds, we will also conduct an endline survey to gather detailed information on contraceptive use after project implementation. The experiment is located in one of the catchment areas of FPAP i.e. in Johar Town, Lahore.

The proposed research plan will randomize households into one of four experimental arms: a pure control group, C (n = 350) and three treatment arms, i.e. shop-treatment, discrete-treatment and explicit-treatment with 350-households in each, for a total sample size of 1,400-households. This allows us to detect a difference of 2.9 percentage points between the pure control (350) and all treatment arms (1,050). The pure control will be "activated" if we are able to raise funds for an endline survey. The primary outcome measure - usage of coupons to claim condoms - is an administrative measure (recorded by the coupon claim system that the research team will maintain) that will be used to measure impact across the three treatment arms. The sample size of the three treatment arms will allow us to detect a 3.5 percentage point increase in contraceptive use over a base-case usage rate of 20.3% (own data) i.e. assuming shop-treatment has a 20.3% uptake, we will be able to detect a 3.5 percentage point difference in uptake in discrete-treatment and explicit-treatment arm.

The outcome of interest is coupon redemption by couples across the 3-arms of the experiment. We will use Ordinary Least Squares to statistically estimate the difference between contraceptive take-up across arms. We do not expect selection bias due to randomized treatment assignment (we will also stratify on number of children and age, and balance on strata).

A comparison between shop-treatment & discrete-treatment will inform us about the marginal impact of improved and reliable access to contraceptives on uptake.

A comparison between shop-treatment and explicit-treatment will inform us about the marginal impact of improved and reliable access to contraceptives while removing the privacy factor from the conversation.

Furthermore, a comparison between discrete-treatment and explicit-treatment will inform us about the impact of maintaining privacy while ordering condoms at the door-step.

Randomization done on computer software.

Household.

No

0.

1,400 households. Of these, 1,050-households will be part of the core experiment and 350-households will be "activated" as a pure control if we are able to raise funds for an endline survey.

Pure Control: 350-households
Shop-treatment: 350-households
Discrete-treatment: 350-households
Explicit-treatment: 350-households

The proposed research plan will randomize households into one of four experimental arms: a pure control group, C (n = 350) and three treatment arms, i.e. shop-treatment, discrete-treatment and explicit-treatment with 350-households in each, for a total sample size of 1,400-households. This allows us to detect a difference of 2.9 percentage points between the pure control (350) and all treatments (1,050). The pure control will be "activated" if we are able to raise funds for an endline survey. The primary outcome measure - usage of coupons to claim condoms - is an administrative measure (recorded by the coupon claim system our logistics partner will maintain) that will be used to measure impact across the three treatment arms. The sample size of the three treatment arms will allow us to detect a 3.5 percentage point increase in contraceptive use over a base-case usage rate of 20.3% (own data) i.e. assuming shop-treatment has a 20.3% uptake, we will be able to detect an 3.5 percentage point difference in uptake in the discrete-treatment and explicit-treatment arms.