Effect of pregnancy tests on demand for family planning: evidence from a randomized controlled trial in Uganda

Akito Kamei,Rebecca Thornton,Ryoko Sato

doi:10.1186/s12978-021-01279-5

Abstract

BackgroundUnmet need for family planning and unintended pregnancies are high in developing countries. Home pregnancy tests help women determine their pregnancy status earlier and the confirmation of a negative pregnancy status can facilitate the adoption of family planning. This study provides the first experimental evidence of the effect of access to pregnancy tests on women’s demand for modern family planning.MethodsA randomized controlled trial was conducted among 810 women of reproductive age in northern Uganda. During a baseline survey, women were randomly allocated to either: (1) an offer to take a hCG urine pregnancy test during the survey (on-the-spot pregnancy test) (N = 170), (2) an offer of a home pregnancy test kit to be used at any time in the future (future-use pregnancy test) (N = 163), (3) offers of both on-the-spot and future-use pregnancy tests (N = 153), or (4) a control group (N = 324). Future-use pregnancy tests were offered either for free, or randomly assigned prices. Approximately 4 weeks after the baseline survey, a follow-up survey was conducted; modern contraception methods were made available at no charge at local community outreach centers.ResultsWhen offered a free, on-the-spot pregnancy test, 62 percent of women accepted (N = 200). Almost all, 97 percent (N = 69), of women offered a free future-use pregnancy test strip, accepted it. Purchases of future-use pregnancy tests declined with price. The offer of either on-the-spot, future-use tests, or both, have no overall large or statistically significant effects on the take-up of modern family planning.ConclusionDemand for pregnancy tests is high and access to pregnancy tests has the potential to facilitate the demand for family planning. At the same time, more research is needed to understand underlying beliefs about pregnancy status and risk that guide behaviors ultimately important for maternal and neonatal health.Trial registration The study was pre-registered in July 2018 for AEA RCT registry (AEARCTR-0003187) and clinicaltrials.gov (NCT03975933). Registered 05 June 2019, https://clinicaltrials.gov/ct2/show/record/NCT03975933

Highlights

Women in developing countries, especially in Africa, have high-unmet needs for family planning as well as high-unintended rates of pregnancy
This paper experimentally evaluates the effect of the provision of home pregnancy tests on family planning take-up among Ugandan women
Demand for pregnancy tests is high and access to pregnancy tests has the potential to facilitate the demand for family planning

Summary

Introduction

Especially in Africa, have high-unmet needs for family planning as well as high-unintended rates of pregnancy. 225 million women in developing countries have an unmet need for modern family planning [1]. While earlier knowledge of pregnancy status can lead to the facilitation of family planning uptake [4, 5], women in developing countries may not learn that they are pregnant until later in their pregnancy due to irregular menstrual periods, malnutrition [6,7,8,9,10], or limited access to home pregnancy tests [11]. Unmet need for family planning and unintended pregnancies are high in developing countries. This study provides the first experimental evidence of the effect of access to pregnancy tests on women’s demand for modern family planning

Methods

Results

Conclusion