Increasing the Uptake of Long-acting Reversible Contraceptives Among Adolescent and Young Women 2017-2018
Cameroon exhibits a high level of maternal mortality (roughly 600 per 100,000 live births), partially related to its high total fertility rate (roughly 4.6). Survey evidence furthermore suggests that a significant fraction of pregnancies is unwanted or considered mistimed by the mother, especially among females under the age of 20. 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 the implant) is less than 1% according to the most recent Demographic Health Survey in 2011.
In this context, the Ministry of Health has convened a team of experts to develop a new curriculum to train health providers on family planning. Furthermore, the study team, in collaboration with local partners, has separately developed a tablet-based application or decision-support-tool to technologically augment this training during the one-on-one family planning counseling sessions. The “app” guides the nurse through the counseling protocol by asking the client a series of questions about her current circumstances, goals, and preferences. It then assists the health provider in recommending the most suitable method(s) for her based on her answers (and the latest clinical knowledge).
Meanwhile, multiple regions in the country have instituted a performance-based financing (PBF) system for the provision of health services. In the case of family planning, clinics are paid a fixed amount for each unit of modern contraception they administer on a quarterly basis. The higher these payments (or subsidies), the greater the incentives for facilities to build demand for FP, either via reduced prices or sensitization and community outreach. Prices may be a barrier especially for adolescents (defined here as ages 15-24), who may not be able to afford contraceptives themselves and may be reluctant to ask parents, partners, or husbands for money to purchase them.
The goal of this study is to evaluate the effectiveness of these interventions – i.e. training health providers on family planning; the introduction off the “app”; and varying payments for contraceptives to facilities – on take-up of modern contraceptive methods and, therefore, incidence of unwanted and mistimed pregnancy rates among adolescent females and young women. We will use a cluster-randomized controlled trial (RCT), clustered at the facility level, with a factorial design to assess the effectiveness of each intervention on its own as well as in combination with the others.
Kind of data
Administrative records data [adm]
The entirety of the East Région in Cameroon
Unit of analysis
Family planning consultation
All clinics in the East region that provide family planning services and that have performance based financing contracts during the study period.
Producers and sponsors
University of Exeter
George Washington University
University of California, San Diego
Hôpital Gynéco Obstétrique de Yaoundé
Global Financing Facility
Knowledge for Change Program
Strategic Impact Evaluation Fund
The sample includes all health facilities in the East region of Cameroon that provide family planning services and that are operating under performance based financing contracts in the last quarter of the year 2018.
Dates of collection
Mode of data collection
Ozler, Berk (World Bank)., Julian Jamison (University of Exeter)., Sarah Baird (George Washington University)., Craig McIntosh (University of California, San Diego)., Susan Athey (Stanford University)., Dohbit Sama (Hôpital Gynéco Obstétrique de Yaoundé). Increasing the Uptake of Long-acting Reversible Contraceptives Among Adolescent and Young Women (LARCS) 2017-2018. Ref: CMR_2017_LARCSIE-BL_v01_M. Downloaded from [url] on [date].
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
L'utilisateur des données reconnait que le producteur des données, le distributeur agréé, ainsi que les bailleurs de fonds ayant contribué au financement de la production de ces données, ne sont nullement responsables de l'utilisation qui sera faite de ces données, ni des interprétations et conclusions dérivées de leur analyse et utilisation.