Judging the Nudge: Applying Behavioral Economics to Promote Post-Abortion Family Planning in Nepal

Source
Marie Stopes International

Studies show that half of all pregnancies in Nepal are unintended, and almost half of these are with women using some sort of contraception. Women attending MSI clinics in the country say they want to delay their next pregnancy but contraception use after abortion has remained low.

The study team involved in this project wanted to see if they could boost the uptake of more reliable, longer-acting reversible contraception (LARC) methods among this client group. They collaborated with ideas42 to help develop an intervention based on behavioral economics, which focuses on understanding why people choose and act as they do – and then designing small ‘nudges’ to effect change.

Initial interviews and observations revealed that providers did not consistently counsel women on LARCs after abortion, missing opportunities to increase uptake. Evidence from other areas suggests campaigns around awareness and client-centered counseling can help boost LARC uptake rates. Focusing on provider-side behavior, they designed and evaluated the effectiveness of a clinic peer-performance comparison through a step-wedged cluster randomized controlled trial. This involved sending monthly posters to each clinic highlighting LARC uptake rates and how well they were doing compared to similar clinics.

By the end of the trial period, overall LARC uptake increased from 23% to 30%, mostly reflecting a shift away from short-term methods.