JMIR Publications

ABSTRACT

Background:

As a means to achieve full, free, and informed choice within the frameworks of reproductive autonomy and women’s rights, family planning programs have increasingly begun to adopt user-centered approaches to counseling and service provision. These approaches have stressed the role of the individual client as the focal point of interaction and the key decision-maker. However, little is known about how user-centered approaches to family planning, particularly through the family planning counseling process, shape women’s and couple’s preferences and characterize their choices.

Objective:

We conduct a multi-armed randomized controlled trial that identifies the causal impact of user-centered counseling on women’s decision-making for family planning in urban Malawi. The causal effect of the interventions will be determined by comparing outcomes for respondents randomly assigned to three intervention arms (T1, T2, or T3) against outcomes from the control arm (T0).

Methods:

Married women aged 18-35 who were neither pregnant nor had given birth within the past 6 months were recruited and randomly assigned to one of the three intervention arms or a control arm characterized by two interventions: 1) an intervention that encouraged women to invite their husbands to family planning counseling; and 2) a tailored counseling session where women were counseled on a targeted range of 5 contraceptive methods based on women’s stated baseline preferences, in contrast to the standard range of 13 method that women were typically counseled on at public facilities. All women received a package of family planning services over a one-month period starting from the counseling day, which included: 1) free transportation to a clinic; and 2) financial reimbursement for family-planning-related services. Follow-up surveys were conducted with women either at the clinic or by phone/through home visits with those who did not visit the clinic over the service period.

Results:

A total of 785 women completed the baseline survey and 782 eligible respondents were randomized to one of the three intervention groups or a control group (T1: 223, T2: 225, T3: 228, and T0: 108). From November 2019 to February 2020, a total of 767 women were reached for follow-up surveys. Among these 767 reached women, 731 completed the follow-up survey, among which 435 were reached by phone, 254 received home surveys, and 67 women were followed up at the clinic.

Conclusions:

Results from this trial seek to fill the current knowledge gaps on the effectiveness of: 1) tailored family planning counseling, and 2) male involvement in family planning, on women’s stated and realized contraceptive preferences. More generally, the study findings provide evidence that user-centered counseling could improve women’s willingness to use and continue contraceptive methods, facilitate realization of contraceptive preferences, and improve women’s well-being. Clinical Trial: This trial was registered at the American Economics Association Registry for randomized controlled trials (https://www.socialscienceregistry.org) on May 20, 2019 (AEARCTR-0004194) and at the Registry for International Development Impact Evaluations (RIDIE, ridie.3ieimpact.org/) on May 22, 2019 (RIDIE-STUDY-ID-5ce4f42bbc2bf).