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Stimulating Demand for Long Acting Reversible Contraception in Zimbabwe

Development Challenge

In sub-Saharan Africa, women struggle to effectively control the timing and spacing of pregnancies.  High rates of unintended pregnancies result in adverse economic and health consequences for women and families, including decreased educational and employment opportunities, inability to support other children, and poor maternal and infant health outcomes. Long Acting Reversible Contraceptive (LARC) methods, including implants and intrauterine contraceptives (IUC), represent a currently underutilized approach to meeting women’s unmet need for contraception. There is minimal evidence of why LARC utilization remains low in this setting, though some research does indicate that lack of awareness about these methods, misconceptions about method efficacy and safety, and low levels of provider training on method insertion, can prevent the widespread adoption of LARC. This study will contribute to understanding how behavioral constraints can be overcome to stimulate demand for long acting contraception among women in Zimbabwe. 

Context

In Zimbabwe, less than three percent of women use LARC methods. At an individual level, lack of awareness and misconceptions about LARC have prevented uptake, while at the provider level, lack of training and awareness have prevented its successful integration into family planning discussions. Currently, Population Services International Zimbabwe (PSI/Z) is addressing the supply constraint through provider capacity building programs in its diverse network of clinics, yet widespread misconceptions and lack of information may continue to prevent uptake of LARC methods. 

Evaluation Strategy

This pilot research project will evaluate the impact of a community-based intervention to increase LARC uptake in PSI/Z clinics, including two variations on the intervention that directly address proposed behavioral constraints to LARC uptake. The intervention will be modeled after a similar program in Zambia that utilized hairdressers to educate women about female condoms. Hairdressers will be randomly assigned into three groups and trained to discuss LARC methods with their clients. In the first treatment group, hairdressers will provide basic education about LARC to clients. In the second group, hairdressers will frame the content of their message to emphasize the adverse consequences of not taking up LARC. In the third treatment group, an incentive system will be in place for hairdressers to both have LARC discussions with clients and successful referrals to PSI/Z clinics. The comparison group will consist of areas in which no hairdressers are involved in the intervention. Administrative data from PSI/Z clinics will be used to determine LARC uptake and new client visits. Researchers will then compare results from the different groups to determine the most effective method to increase LARC uptake, and design a full scale evaluation of that method. 

Results and Policy Implications

Project ongoing, results forthcoming

Timeline

2013-Ongoing

Photo from PSI Zimbabwe