User-Centered Counseling in Contraceptive Decision-Making: Evidence from a Field Experiment in Urban Malawi

Mahesh Karra, Boston University
Kexin Zhang, Boston University

We conduct a randomized controlled trial to test how woman-centered approaches to counseling shape contraceptive preferences and behavior. We explore how women’s decision-making is driven by: 1) the number of contraceptive methods that are presented to women based on their stated contraceptive preferences (targeted counseling); and 2) the presence of women’s husbands at counseling. A total of 782 women were randomized to one of four treatment arms in which they received either targeted or standard counseling, cross-randomized with an invitation to bring their husbands. Women who received targeted counseling were 15.6 percent less likely to be using their stated ideal method and were 17.9 percent more likely to exhibit discordance between their ideal method and actual method use. Women who were encouraged to invite their husbands were 14.1 percent less likely to change their stated ideal method over time but were 16.4 percent more likely to be concordant at follow-up.