Does User-Centered Counseling Have an Impact on Family Planning? Evidence from Malawi
By Yunus Kurt
Family planning is a series of important decisions on when/if to have children, and it involves a wide range of contraceptive methods. Abundance of contraceptive methods offers a larger set of alternatives to women in their contraceptive decision-making. However, a larger set of alternatives means more information to process and might introduce new challenges, such as cognitive overload in decision-making processes.
Counseling sessions play a major role in this context as they aim to help women make family planning choices based on reliable and medically accurate information. Counselors or family planning service providers can help women realize their preferences and guide them to act on their preferences. However, due to uncareful design and/or limited number of healthcare professionals, long and standard counseling sessions might impact the quality or efficacy of counseling in providing complete information and endowing women with what they need in the family planning process, especially in low- and middle-income countries.
One potential solution is structuring counseling sessions to be centered around the individual woman and her needs. Instead of pouring information on the pros and cons of contraceptive methods ranging from female sterilization to birth control pills, a more user-centered approach in which only a small subset of methods, based on women’s elicited preferences, could be covered during the counseling session.
How will a user-centered approach help women better realize their contraceptive preferences? This summer, I traveled to Lilongwe, Malawi with a team of Boston University researchers to investigate this question as part of the ongoing Malawi Behavioral Bias Study (MBBS). Mahesh Karra and Kexin Zhang previously studied how a user-centered, tailored approach to family planning counseling impacts women’s contraceptive preferences and subsequent realized behavior in the short-run. Their findings suggest that women who received user-centered counseling are more likely to change their preferences but are not more likely to change their contraceptive method choice. Moreover, women who used user-centered counseling were more likely to have a disagreement between their preferences and choice regarding contraceptive methods. In terms of male involvement, women who were encouraged to invite their partners were less likely to change their preferences which might suggest that women invite partners if they believe that their partners are supportive; additionally, they were more likely to change their contraceptive method choice which might suggest that they feel compelled to adjust their contraceptive method choices to be concordant with their partner’s.
Nearly three years since Karra and Zhang’s study started, it is interesting to explore the medium- or longer-term outcomes of the findings. Contraceptive method switching and discontinuation are prevalent in Malawi, which suggests the effects of user-centered counseling might vary over time. To address this possibility, we are collecting a new wave of data on women’s family planning preferences and choice. We spent around two weeks in Lilongwe between late May and early June to set up and administer a follow-up survey and launch a new round of data collection. A major challenge for this follow-up study is tracking the women in the original sample as women move frequently due to highly volatile rent prices and work opportunities, especially in rural areas.
Currently, around 80 percent of the data collection is completed. We expect to finish by the end of September and then start our data analysis. Once it is complete, our analysis will provide new empirical evidence and insights on the effects of user-centered family planning counseling sessions on women’s changes and discontinuation in contraceptive methods in the medium run.
Yunus Kurt is a Research Assistant with the Human Capital Initiative and a PhD Candidate in Economics at Boston University.
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