Consumer-focused Research to Accelerate Voluntary Uptake of Modern Contraceptives: Using Novel Data and Artificial Intelligence to Assess Consumer Intent, Identify Barriers and Enablers, and Uncover High-Impact Practices in Sindh, Pakistan

2 INTRODUCTION It has been estimated that for every $1 invested in family planning, society reaps $120 in lifetime benefits spanning health, economic and social advantages. Modern contraception can prevent unintended pregnancies and reduce the number of unsafe abortions, maternal mortality, and health problems arising from complications in pregnancy and childbirth. Modern contraceptives help couples effectively space childbirth and assume greater control over their preparedness for parenthood. Increased contraceptive uptake has been associated with social benefits such as higher education attainment among girls, women's prolonged participation in economic activities and increased agency in household decision-making. The ripple-on impacts include poverty reduction and improvement in the GDP growth rate. At a national and global level, modern contraception is vital for achieving the Sustainable Development Goals.

Despite the advantages of effective modern contraceptives and investments in the past decade, uptake remains slow in Sub-Saharan Africa (29%) and South Asia (52%). These regions face both higher maternal and infant mortality rates and lower female literacy rates along with some of the highest poverty rates in the world. Modern contraceptive uptake varies across countries and within each region, with some seeing concentrated vulnerability. Modern contraceptive prevalence rate (MCPR) in Senegal and Ethiopia is 26% and 25% respectively) and even lower in Côte d' Ivoire and Nigeria (18% and 12% respectively). The adoption of modern contraceptive for spacing is lowest among younger women who have a greater need for modern contraceptives. Similarly in South Asia, Pakistan (25%) has a lower MCPR than other countries in the region such as Bangladesh (59%) and India (56%). Within these areas exist significant populations of women who want to use modern contraceptives but are constrained by a range of barriers that require greater understanding and precise targeting.

To maximize the impact of dollars invested in family planning, focusing interventions on women who have family planning (FP) uptake intent, and targeting them with "high impact practices" - evidence-backed FP uptake drivers - will likely have some of the biggest and swiftest returns, and may yield shifts in broader norms. Recent studies have shown that intention to use within a specified period (e.g., 12 months), is a far better predictor of modern contraceptive use than either unmet need, often a core outcome metric, or even intention to use without a specified timeframe. However, there is a lack of foundational data to deeply measure intent, understand what drives intent, and how that varies for different groups (aka segments) of the population. This foundational data is needed to identify populations and geographies that may yield swift and significant improvements in modern contraceptive uptake, the exact barriers to address, and appropriate channels to address different groups of women.

2.2 STUDY RATIONALE This study will take a consumer-centered approach to understanding women's intention to use modern contraception methods and the barriers they face in using them. This study will generate new data that will allow government and their local partners to improve planning for programs that support women in voluntarily taking up modern contraceptive methods, leading to an increase in FP uptake in the near term. To generate this data, the investigators will undertake a multi-step process.

1. Collect comprehensive formative data on drivers of FP intention and uptake. To determine priority areas for intervention, the investigators will collect novel data that holistically capture behavioural and contextual barriers to the uptake of modern contraceptives. The study will gather a 360-degree view of potential drivers of women's FP decisions in each geography from key target populations, focusing on adult women of reproductive age. Using Surgo's peer-reviewed CUBES frameworks and years of family planning survey experience, the investigators will use innovative methods to capture key barriers and preferences across contexts through in-depth quantitative survey. These surveys will also include an innovative modular index aiming to add precision to the measurement of FP intent. These questions will be iterated through cognitive testing through qualitative interviews utilizing the quantitative questionnaire, and will be validated using data collected in the first phase of the project.
2. Apply advanced AI-powered analytics to drive strategy. (1) uncover the who, why, where, and how of underlying consumer forces that drive modern contraceptive intent and use will be uncovered, and (2) identify distinct segments with varied needs and barriers within the target population.. Based on the sample size and analytical approach applied, insights will be disaggregated at different geographical levels (described in the Sampling section of this document) to aid meaningful programmatic targeting on the ground.
3. Co-develop analytics-driven solutions with implementation partners. The precision of the survey findings will allow AKU with sponsor, in collaboration with government partners and local partner, to generate segment-specific intervention recommendations that draw from, refine or add to high-impact practices identified by the FP High Impact Practice (HIP) consortium. This will include generating data-driven inputs for on-ground teams to design and strategize service approaches and target the right HIP to the right individuals. Findings will be shared with key government and partner stakeholders to support implementation at scale via a variety of mechanisms. AKU and Surgo will also support innovation uptake through concurrent learning and iteration with program partners and government stakeholders to guide insight use.