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BRIEF May 6, 2021

Cameroon: A sequential and adaptive experiment to increase the uptake of long-acting reversible contraceptives among adolescent females in Cameroon

In sub-Saharan Africa, about one in four teenaged girls has been pregnant or had a baby. In Cameroon, 30 percent of teenaged girls who give birth say the pregnancy was unwanted at the time, but only a minority of sexually active unmarried women use any form of modern contraception. Less than one percent use a long-acting reversible contraceptive like an inter-uterine device or implant. A number of obstacles could be keeping adoption rates of long-acting reversible contraceptives low, such as lack of knowledge and bias against these among health care providers, sub-optimal subsidies to providers, and low ability or willingness to pay among adolescents. Using data from tablets used by nurses during family planning counseling sessions with patients, this evaluation will test the impacts of different approaches to increase adoption of long-acting reversible contraceptives, including training for nurses on modern contraceptive methods, a tablet-based decision-support app that takes patients’ preferences and circumstances into account, and the provision of free family planning services to adolescents. In a companion study, the research team will use machine learning techniques to tailor app recommendations to patients’ circumstances. 


Study title: A sequential and adaptive experiment to increase the uptake of long-acting reversible contraceptives among adolescent females in Cameroon.
Research question:Will improving the quality of family planning services through an app that allows tailored counselling to increase the take up of more reliable contraceptive methods, especially among adolescent females? How do the relative fees of different contraceptive methods affect take-up?
Policy problem:Low uptake of long acting reversible contraceptives to prevent unintended pregnancies, particularly among unmarried adolescents.
Evaluation design:

Treatment 1 Nurses that receive an app-based job-support tool that displays all available modern contraceptive methods that have not been ruled out by the client or contraindicated due to medical eligibility. The available modern methods are presented as unranked and nurses provide basic information on all available methods.  The nurse then asks the client to indicate which method they would like to discuss in more detail. 

Treatment 2 Nurses that receive an app-based job support tool that displays the method that is deemed most suitable for the client given her preferences. The nurse asks the client if she would like to discuss that method in more detail. The order of methods discussed (if more than one) is determined by the app’s ranking. 

Other experimental arms The experiment also comprises five price categories for long-acting reversible contraceptives {High, Mid, Low, Very Low, and Free} and two price categories for short-acting reversible contraceptives {High and Free}, implying a total of ten possible price combinations, or ten experiment arms for each main treatment group above. 

Data sources:Data from app used by nurse counselors.
Researchers:Susan Athey, Sarah Baird, Julian Jamison, Craig McIntosh, Berk Ozler, Dohbit Sama