Examining the Impact of Family Planning on Fertility, Maternal and Child Health, and Economic Well-Being: Evidence from a Field Experiment in Urban Malawi
Last registered on May 19, 2016

Pre-Trial

Trial Information
General Information
Title
Examining the Impact of Family Planning on Fertility, Maternal and Child Health, and Economic Well-Being: Evidence from a Field Experiment in Urban Malawi
RCT ID
AEARCTR-0000697
Initial registration date
May 07, 2015
Last updated
May 19, 2016 5:51 AM EDT
Location(s)
Region
Primary Investigator
Affiliation
Harvard University
Other Primary Investigator(s)
PI Affiliation
Harvard University
Additional Trial Information
Status
Completed
Start date
2016-08-15
End date
2018-12-31
Secondary IDs
Abstract
This study seeks to identify the causal impact of a family planning intervention on fertility, maternal and child health outcomes, and downstream economic outcomes by means of a randomized control trial. The proposed trial will be conducted in Lilongwe, Malawi, where total fertility is high, contraceptive prevalence is low, and access to services is poor. As part of the intervention, women in the study sample who are randomly assigned to the intervention arm will receive a multicomponent family planning package that includes:
1. a family planning information package and private counseling visits;
2. free transportation to a family planning clinic with low waiting times; and
3. financial reimbursement for family planning services, including out of pocket expenditures related to family planning care and treatments that are received at the family planning clinic (e.g. medications, contraceptive methods, consultation fees, exam fees, treatment of contraceptive-related side effects), and free over-the-phone consultations and referral services from a doctor in the event that she experiences contraindications or side effects related to her use of family planning

Short-term outcomes of interest include modern contraceptive use, intention to use, and knowledge of family planning. Intermediate outcomes include fertility outcomes (parity, birth spacing), changes in desired fertility, unmet need, and outcomes associated with maternal and child health, including safe pregnancy, child birth height and weight, and nutritional status. Longer-term outcomes include educational attainment, labor market and employment outcomes, income, and household expenditure.
External Link(s)
Registration Citation
Citation
Canning, David and Mahesh Karra. 2016. "Examining the Impact of Family Planning on Fertility, Maternal and Child Health, and Economic Well-Being: Evidence from a Field Experiment in Urban Malawi." AEA RCT Registry. May 19. https://www.socialscienceregistry.org/trials/697/history/8341
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
As part of the intervention, women in the study sample who are randomly assigned to the treatment arm will receive a multicomponent family planning package that includes:
1. a family planning information package and private counseling visits;
2. free transportation to a family planning clinic with low waiting times; and
3. financial reimbursement for family planning services, including out of pocket expenditures related to family planning care and treatments that are received at the family planning clinic (e.g. medications, contraceptive methods, consultation fees, exam fees, treatment of contraceptive-related side effects), and free over-the-phone consultations and referral services from a doctor in the event that she experiences contraindications or side effects related to her use of family planning.
Intervention Start Date
2016-12-01
Intervention End Date
2017-11-30
Primary Outcomes
Primary Outcomes (end points)
Primary outcomes include: knowledge of family planning, including knowledge of birth spacing and timing and perceptions toward contraception (intentions to use); contraceptive use, including changes in contraceptive prevalence; changes in method mix; and adherence to methods; pregnancy status at 24 months; parity within 24 months; delivery in a facility; months since last birth; wantedness of last birth; and intentions to become pregnant in future.

Secondary intermediate outcomes include: child anthropometric outcomes (child height, weight, and anemia status) for all children born after the start of the intervention; women’s anthropometric outcomes, including height, weight, and anemia status; women's completed fertility; women’s and children’s educational attainment.

Secondary longer- term outcomes include: women's labor force participation, income, and employment, including women’s time use (time spent on childcare versus household and income-generating activities); changes in household wealth; household consumption; and expenditures.

Please refer to attached experiment proposal for additional details.
Primary Outcomes (explanation)
Please refer to attached experiment proposal for additional details.
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
Households in Lilongwe will first be screened for women who meet our eligibility criteria, and identified eligible women who consent to participate will be recruited into the study. Recruitment will continue until 2,000 eligible women have been selected. Following recruitment, a baseline survey will be administered to eligible women. Women will be randomized to either the control or the treatment arm once baseline surveys have been completed. Women who are randomized into the treatment arm will begin receiving the family planning intervention no more than one month after randomization. The intervention will be administered to women for a total of 12 months following randomization. Detailed follow-up surveys will be conducted 12 months and 24 months following roll-out of the intervention.
Experimental Design Details
Please refer to attached experiment proposal for additional details.
Randomization Method
Following administration of the baseline survey, women will be randomized to treatment and control groups using the Bruhn and MacKenzie (2009) minimum maximum t-statistics method, in which treatment assignment will be balanced according to the following baseline characteristics: neighborhood/household cluster, distance to the nearest family planning clinic, number of living children, months since last live birth, current use of family planning, age of marriage, educational attainment, and household wealth. Randomization will be conducted on a computer using a program written in Stata.
Randomization Unit
This is an individual-level field experiment that randomizes women (and their associated households) into one of two intervention arms, a treatment arm or a control arm. The unit of randomization is the woman/household (since only one eligible woman can be selected from a household). Women who are assigned to the treatment arm will receive the multicomponent family planning intervention described previously, while women who are assigned to the control arm will receive a package of publicly available literature and information on the benefits of family planning as well as information about their nearest family planning clinic. This basic information package will be delivered to all women at the time of the baseline interview, with women in the treatment arm receiving the intervention in addition.
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
2,000 women
Sample size: planned number of observations
2,000 women
Sample size (or number of clusters) by treatment arms
1,000 women assigned to treatment arm
1,000 women assigned to control arm
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Please refer to attached experiment proposal for additional details. We are sufficiently powered to detect differences in all of our primary endpoints (modern contraceptive use, method mix, family planning knowledge and attitudes, pregnancy within the next 2 years, fertility intentions) over the two year study period. However, we are not likely to be sufficiently powered to detect longer term outcomes related to completed fertility, women's employment, and income, which require longer follow up. With this said, we measure shorter term outcomes, such as women's time use and short-term shifts from informal into formal sector labor, that suggest changes in longer term outcomes, and we begin collecting data for longer term outcomes with the expectation of conducting a longer term follow-up.
Supporting Documents and Materials

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IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
National Ethics Committee of Burundi
IRB Approval Date
2016-05-01
IRB Approval Number
IRB16-0421
IRB Name
Harvard School of Public Health, Office of Human Research Administration
IRB Approval Date
2016-05-01
IRB Approval Number
IRB16-0421
Analysis Plan

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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