Impact of Deadlines on the Effectiveness of Vouchers for Free Family Planning after Childbirth in Kenya
Globally as many as 40 percent of all pregnancies worldwide were unplanned or unwanted in 2012. Pregnancy and childbirth pose major risks to those who lack access to basic health care. Providing information about or access to family planning resources is one method to safeguard women and children’s health. In partnership with Jacaranda Health, researchers are evaluating a family planning program that includes varying combinations of vouchers for free family planning methods and reminders of the importance of family planning.
As much as 40 percent of all pregnancies worldwide in 2012 were unplanned or unwanted, accounting for nearly 85 million pregnancies. Moreover, pregnancy and childbirth pose major risks of disability or death for millions of women in the developing world who lack access to basic health care. Access to contraceptives allows women to optimally time births, providing greater opportunity to invest in education or participate in the labor market during childbearing years. In contrast, households experiencing unwanted or unanticipated pregnancies may find it harder to pay for their children’s education, healthcare, and other needs. Can vouchers for free family planning methods—coupled with reminders and deadlines for redemption—increase take up of contraception among new mothers?
Context of the evaluation
According to the Kenya Demographic and Health Survey, a woman could expect to bear four children during her lifetime, or one additional child than the ideal family size reported by Kenyan women. That same year, among all currently married individuals, 47 percent of women and 42 percent of men stated that they do not wish to have another child. Moreover, 32 percent of women and 37 percent of men asserted that they would like to wait at least two years before their next birth. However, 42 percent of women reported using no contraceptives at the time of the survey and 18 percent of births occurred within two years of a previous delivery.
Jacaranda Health aims to improve the safety of pregnancy and childbirth by providing affordable care at private maternity hospitals in peri-urban areas of Nairobi. In 2015, Jacaranda conducted 18,860 outpatient visits and delivered 923 babies.
Details of the intervention
In partnership with Jacaranda Health, researchers conducted a randomized evaluation with 689 prenatal patients at Jacaranda’s maternity hospitals. In the first phase of the study, each patient received basic information about family planning, and was assigned to one of three groups:
- Voucher Only: Women received a voucher redeemable for their choice of a method of contraceptives at no cost and could redeem their voucher at any time in the year following their expected due date.
- Voucher + Deadline: To reduce potential procrastination, women received a voucher redeemable for their choice of a free contraceptive product that expired eight weeks after their expected due date.
- Comparison: Women did not receive a voucher.
In the second phase of the study, researchers introduced a reminder on top of the two voucher treatments and comparison group. In this phase, all patients were randomized to one of the following two groups (resulting in six treatment arms):
- Reminder: Women received a reminder five weeks after the expected due date to initiate family planning methods.
- Comparison: Women did not receive a reminder.
To measure the effectiveness of the vouchers, deadlines, and reminders on the use of family planning, researchers collected administrative data from Jacaranda's clinical records on the redemption of vouchers and surveyed households nine weeks, three months, six months, nine months, and one year after the expected due date of their child. Researchers asked households whether and how long after delivery they sought means of family planning, as well as if they actively practice family planning.
Results and policy lessons
Analysis ongoing; results forthcoming.
Margaret, McConnell, Claire Watt Rothschild, Allison Ettenger, Faith Muigai, and Jessica Cohen. 2018 "Free Contraception and Behavioural Nudges in the Postpartum Period: Evidence from a Randomised Control Trial in Nairobi, Kenya." BMJ Global Health 3(5).