A Randomized-Controlled Trial to Increase the Uptake of LARCs in Cameroon

Not Applicable

Completed

• Conditions: Contraception; Contraception Behavior; Contraceptive Usage; Contraceptive Method Switching
• Interventions: Behavioral: Price discounts for SARCs; Behavioral: Price discounts for LARCs; Behavioral: Sequential vs. simultaneous recommendations

• Registration Number: NCT03733678
• Lead Sponsor: World Bank

Brief Summary

Cameroon exhibits a high and non-decreasing level of maternal mortality (roughly 600 per 100,000 live births), partially related to its relatively high total fertility rate (roughly 4.6). Survey evidence furthermore suggests that a significant fraction of these pregnancies is unwanted or considered mistimed by the mother, especially among females aged 15-19. Despite this, the rate of utilization of family planning (FP) is low: e.g. only 48% of sexually active unmarried women use any form of (modern) contraception, or MC, and even then, it is primarily condoms. The use of LARCs (long-acting reversible contraceptives, i.e. the IUD and implant) is less than 1% according to the most recent Demographic Health Survey.

The study investigators propose to use an integrated behavioral science approach to increase the take-up of both SARCs (short-acting reversible contraceptives, i.e. the pill and injectable) and especially LARCs among reproductive-age females in Cameroon, including adolescents who may be unmarried and/or nulliparous. In addition to decreasing maternal mortality and undesired pregnancies, indirect effects for the community will include: increased welfare from reduced side effects that arise due to current one-size-fits-all FP counseling; healthier children due to improved birth spacing; and increased human capital formation both for children and for young (often school-aged) potential mothers.

The study investigators propose to conduct the study at HGOPY for a duration of 12 months. The study investigators will provide tablets to each of five nurses that conduct FP counseling to participants at the hospital. The tablets contain a counseling "app" (or decision-support tool or a job-aid) that was jointly developed by professionals from HGOPY, the World Bank, and the Ministry of Health. The study investigators propose an individually-randomized experiment, where the participants will be offered randomly varying discounts for the modern contraceptive methods they wish to adopt. The study investigators also propose to experiment with certain aspects of the "app" to improve its effectiveness - both for the participant and for the nurse. More details on the experimental design are provided below.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2018-10-31
• Study First Submitted QC: 2018-11-05
• Study First Posted: 2018-11-07
• Study Start: 2021-03-23
• Primary Completion: 2022-12-31
• Study Completion: 2024-12-31
• Status Verified: 2025-05
• Last Update Submitted: 2025-05-08
• Last Update Posted: 2025-05-14

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 2500

Inclusion Criteria

• Female
• Ages 10-49
• Presenting at HGOPY seeking FP counseling/services
• HGOPY clients referred to the family planning unit for consultation

Exclusion Criteria

* No exclusion criteria

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SEQUENTIAL

Arm && Interventions

Group	Intervention	Description
Free SARC, LARC=5000, Recommendation	Price discounts for SARCs	Free SARC, LARC=5000 CFA, Sequential recommendation
Regular SARC, LARC=500, Recommendation	Price discounts for LARCs	Regular price SARC, LARC=500 CFA, Sequential recommendation
Regular SARC, Free LARC, No Recommendation	Price discounts for LARCs	Regular Price SARC, Free LARC, Simultaneous recommendation
Free SARC, Free LARC, Recommendation	Price discounts for LARCs	Free SARC, Free LARC, Sequential recommendation
Regular SARC, LARC=2140, No Recommendation	Sequential vs. simultaneous recommendations	Regular Price SARC, LARC=2140 CFA, Simultaneous recommendation
Free SARC, Free LARC, Recommendation	Price discounts for SARCs	Free SARC, Free LARC, Sequential recommendation
Free SARC, LARC=1000, Recommendation	Price discounts for SARCs	Free SARC, LARC=1000 CFA, Sequential recommendation
Free SARC, LARC=500, Recommendation	Price discounts for SARCs	Free SARC, LARC=500 CFA, Sequential recommendation
Free SARC, LARC=500, Recommendation	Price discounts for LARCs	Free SARC, LARC=500 CFA, Sequential recommendation
Free SARC, LARC=1000, No Recommendation	Price discounts for SARCs	Free SARC, LARC=1000 CFA, Simultaneous recommendation
Free SARC, LARC=1000, No Recommendation	Sequential vs. simultaneous recommendations	Free SARC, LARC=1000 CFA, Simultaneous recommendation
Regular SARC, LARC=5000, No Recommendation	Sequential vs. simultaneous recommendations	Regular Price SARC, LARC=5000 CFA, Simultaneous recommendation
Free SARC, LARC=2140, Recommendation	Price discounts for SARCs	Free SARC, LARC=2140 CFA, Sequential recommendation
Free SARC, LARC=2140, Recommendation	Price discounts for LARCs	Free SARC, LARC=2140 CFA, Sequential recommendation
Regular SARC, Free LARC, Recommendation	Price discounts for LARCs	Regular price SARC, Free LARC, Sequential recommendation
Free SARC, Free LARC, No Recommendation	Price discounts for LARCs	Free SARC, Free LARC, Simultaneous recommendation
Free SARC, LARC=500, No Recommendation	Price discounts for SARCs	Free SARC, LARC=500 CFA, Simultaneous recommendation
Free SARC, LARC=500, No Recommendation	Price discounts for LARCs	Free SARC, LARC=500 CFA, Simultaneous recommendation
Free SARC, LARC=500, No Recommendation	Sequential vs. simultaneous recommendations	Free SARC, LARC=500 CFA, Simultaneous recommendation
Regular SARC, LARC=500, No Recommendation	Price discounts for LARCs	Regular Price SARC, LARC=500 CFA, Simultaneous recommendation
Free SARC, LARC=5000, No Recommendation	Price discounts for SARCs	Free SARC, LARC=5000 CFA, Simultaneous recommendation
Regular SARC, Free LARC, No Recommendation	Sequential vs. simultaneous recommendations	Regular Price SARC, Free LARC, Simultaneous recommendation
Free SARC, LARC=1000, Recommendation	Price discounts for LARCs	Free SARC, LARC=1000 CFA, Sequential recommendation
Regular SARC, LARC=1000, Recommendation	Price discounts for LARCs	Regular price SARC, LARC=1000 CFA, Sequential recommendation
Free SARC, Free LARC, No Recommendation	Sequential vs. simultaneous recommendations	Free SARC, Free LARC, Simultaneous recommendation
Regular SARC, LARC=2140, No Recommendation	Price discounts for LARCs	Regular Price SARC, LARC=2140 CFA, Simultaneous recommendation
Regular SARC, LARC=2140, Recommendation	Price discounts for LARCs	Regular price SARC, LARC=2140 CFA, Sequential recommendation
Free SARC, Free LARC, No Recommendation	Price discounts for SARCs	Free SARC, Free LARC, Simultaneous recommendation
Free SARC, LARC=1000, No Recommendation	Price discounts for LARCs	Free SARC, LARC=1000 CFA, Simultaneous recommendation
Free SARC, LARC=2140, No Recommendation	Price discounts for SARCs	Free SARC, LARC=2140 CFA, Simultaneous recommendation
Free SARC, LARC=2140, No Recommendation	Price discounts for LARCs	Free SARC, LARC=2140 CFA, Simultaneous recommendation
Free SARC, LARC=2140, No Recommendation	Sequential vs. simultaneous recommendations	Free SARC, LARC=2140 CFA, Simultaneous recommendation
Free SARC, LARC=5000, No Recommendation	Sequential vs. simultaneous recommendations	Free SARC, LARC=5000 CFA, Simultaneous recommendation
Regular SARC, LARC=1000, No Recommendation	Price discounts for LARCs	Regular Price SARC, LARC=1000 CFA, Simultaneous recommendation
Regular SARC, LARC=1000, No Recommendation	Sequential vs. simultaneous recommendations	Regular Price SARC, LARC=1000 CFA, Simultaneous recommendation
Regular SARC, LARC=500, No Recommendation	Sequential vs. simultaneous recommendations	Regular Price SARC, LARC=500 CFA, Simultaneous recommendation

Primary Outcome Measures

Name	Time	Method
The client adopted a modern contraceptive method (LARC or SARC)	1-day	using data from the counseling sessions
The client adopted a LARC	1-day	using data from the counseling sessions

Secondary Outcome Measures

Name	Time	Method
Did the health provider give information about contraceptive methods that was easy to understand during the counseling session?	2-weeks	Self-reported indicator variable using follow-up surveys two weeks after counseling session
Discontinuation of adopted contraceptive method	2-week, 16-week, and 52-week measurements	using 2-week, 16-week, and 52-week follow-up surveys
Was the client treated with respect by the provider during the counseling session?	2-weeks	Self-reported indicator variable using follow-up surveys two weeks after counseling session
Percentage of participants with unintended pregnancy within the time frame	16-week and 52-week measurements	using 16-week and 52-week follow-up surveys
Did the client trust the provider during the counseling session?	2-weeks	Self-reported indicator variable using follow-up surveys two weeks after counseling session
Client satisfaction with adopted contraceptive method	2-week and 16-week measurements	using 2-week and 16-week follow-up surveys

Trial Locations

Locations (1)

Hôpital gynéco-obstétrique et pédiatrique de Yaoundé (HGOPY); 🇨🇲 Yaoundé, Cameroon