# **1 Introduction**

Globally, the maternal mortality ratio (MMR) remains high at 211 maternal deaths per 100,000 live births in 2019, despite significant reductions since 2000 (WHO, 2019). In sub-Saharan Africa the MMR is 534, implying that one in 38 women aged 15 will eventually die from a maternal cause. As many of the causes are preventable or treatable, substantial reductions in MMR can be achieved on the intensive margin – by expanding coverage and improving the quality of routine reproductive health care for pregnant women (Kassebaum et al., 2016).

However, there is also ample room for improvement on the extensive margin: nearly half of all pregnancies worldwide are considered unwanted or mistimed (Sully et al., 2020). In Cameroon, the setting for our experiment, the share of such births is twice as high among adolescents as adults (DHS, 2018), and the risk of complications in pregnancy and childbirth is also higher (WHO, 2019). Therefore, increasing access to contraception, especially among adolescents, can contribute to large reductions in MMR. Delayed fertility is associated with improved maternal and child health outcomes (see Baird et al. 2011, and citations within), while unintended pregnancies are strongly predictive of short inter-pregnancy intervals, which are in turn positively associated with babies being born prematurely, at low birth weight, or small for their gestational age (DeFranco et al., 2015; Frost et al., 2014). Lower fertility rates may also contribute to economic growth through increased female labor supply (Bloom et al., 2009, 2020).

Modern contraceptive technology is highly effective in preventing unintended pregnancies. However, adoption in many low- and middle-income countries (LMIC) remains low: among women in LMICs who report wanting to avoid a pregnancy, about a quarter of women and half of adolescent females also report not using a contraceptive method (see Sully et al. 2020). Our formative qualitative work in Cameroon shows that there are a multitude of demand-side factors impeding adoption: concerns over side effects, misconceptions about methods, financial cost, concerns over discretion, and opposition from parents, spouses, or partners. These barriers are further exacerbated by supply-side problems, such as stock-outs of contraceptives, lack of trained health providers, and provider bias against recommending certain contraceptive methods to adolescents and women without children.

We conducted a randomized experiment to tackle two of these barriers: cost and uncertainty about returns from adopting contraceptives. The experiment was conducted at a women and children’s hospital in Yaoundé, Cameroon, and it constituted the pilot phase for an adaptive experiment that was being planned at the hospital. We developed a tablet-based _app_ , which assists healthcare providers conducting family planning (FP) counseling sessions. During a structured discussion, the _app_ records the clients’ fertility plans, needs, and preferences regarding contraceptive methods. The main innovation that the _app_ brings to FP counseling is an internal algorithm to rank methods according to their suitability for the client’s context. In the _shared decision-making_ treatment (SDM), the _app_ reveals the most suitable method and the provider suggests to the client that they discuss this method first. This contrasts with the _individual decision-making_ treatment (IDM), in which the provider asks the client to decide which method they’d like to discuss first, choosing from the full, unranked set of modern contraceptives. SDM is thus aimed at providing the clients with better information tailored to their individual needs, while IDM is meant to resemble the _status quo_ in contraceptive counseling. We also cross-randomized a _discount_ treatment, in which the _app_ revealed randomly-assigned discounts for modern contraceptive methods. The _discount_ treatment 2