Article Text
PDF
Abstract
Background Short birth intervals are a major risk factor for poor maternal and newborn outcomes. Utilisation of modern contraceptive methods during the postpartum period can reduce risky birth intervals but contraceptive coverage during this critical period remains low.
Methods We conducted a randomised controlled experiment to test whether vouchers for free contraception, provided with and without behavioural ‘nudges’, could increase modern contraceptive use in the postpartum period. 686 pregnant women attending antenatal care in two private maternity hospitals in Nairobi, Kenya, were enrolled in the study. The primary outcomes were the use of modern contraceptive methods at nearly 3 months and 6 months after expected delivery date (EDD). We tested the impact of a standard voucher that could be redeemed for free modern contraception, a deadline voucher that expired 2 months after delivery and both types of vouchers with and without a short message service (SMS) reminder, relative to a control group that received no voucher and no SMS reminder.
Results By nearly 6 months after EDD, we find that the combination of the standard voucher with an SMS reminder increased the probability of reporting utilisation of a modern contraceptive method by 25 percentage points (pp) (95% CI 6 pp to 44 pp) compared with the control group. Estimated impacts in other treatment arms were not statistically significantly different from the control group.
Conclusions Reducing financial barriers to postpartum contraception alone may not be enough to encourage take-up. Programmes targeting the postpartum period should consider addressing behavioural barriers to take-up.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Statistics from Altmetric.com
Footnotes
Handling editor Seye Abimbola
Contributors MM designed the study, secured funding for the study, designed data collection tools, performed data analysis, drafted the manuscript and edited the manuscript. CWR designed data collection tools, fielded the study, performed data analysis and reviewed the manuscript. AE and FM designed data collection tools, fielded the study and reviewed the manuscript. JC designed the study, secured funding for the study, designed data collection tools, contributed to data analysis, contributed to drafting and editing manuscript and reviewed the manuscript.
Funding We gratefully acknowledge funding from the William and Flora Hewlett Foundation (Grant number2014-9962). This project was also made possible through the generous support of the Saving Lives at Birth partners: the United States Agency for International Development (USAID), the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, the U.K. Department for International Development (DFID), and the Korea International Cooperation Agency (KOICA). It was prepared by the authors and does not necessarily reflect the views of any funders.
Competing interests None declared.
Patient consent Not required.
Ethics approval This study was approved by Institutional Review Boards at Harvard T H Chan School of Public Health and the Ethical and Scientific Review Committee of Amref Health Africa (AMREF) in Nairobi, Kenya.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data from this manuscript are not available to share at this moment. Interested researchers should contact the corresponding author.