4,000), Mid (CFA 2,000 or 1,000), and Low (CFA 150 or Free). SARC prices were cross-randomized at two price levels with equal probability: Full price (CFA 1,250 for the injectable and 1,500 for the pill) or for free.<sup>5</sup> Both short-acting methods need to be renewed every three months and the clients can do so at the same price offered at the initial consultation, which is valid for a period of one year, representing three renewals.

Two details about implementation matter. First, the prices for all modern methods were revealed at once and _after_ the client had chosen a method they wanted to adopt, unless they inquired about prices earlier on in the counseling session.<sup>6</sup> This decision was made after careful deliberation with the healthcare providers at the hospital and based on established best-practices and ethical norms.<sup>7</sup> Second, the reader might worry about the clients (alone or in collaboration with the providers) trying to ‘game’ the system to receive higher discounts - for example, by asking the counselor to start a new _app_ session or by returning later. Carefully developed study protocols for return clients, monitoring the data from the tablets (including meta- and para-data), and monthly audits of HGOPY’s own administrative data allows us to rule out the possibility of clients redrawing a new set of prices.

# **2.2.2 Counseling approach**

The structure of the counseling session guided by the _app_ is not fundamentally different than the accepted best practices used around the world. The main innovation that it brings to FP counseling is a small but important paradigm shift with respect to shared decision-making: the app uses an algorithm to internally rank methods from most to least suitable for the client’s preferences. In the established, or _status quo_ , approach to counseling, the client is given information about all contraceptive methods and asked to choose the method she would like to discuss. The counselor is expected to provide no guidance or advice during this _individual decision-making_ process. In contrast, in our alternative approach, the _app_ encourages _shared decision-making_ by revealing the most suitable method for the client according to the _app_ ’s internal algorithm. In order to test the effectiveness of this approach against the status quo, clients were randomly assigned to one of two interventions – each mimicking one approach:<sup>8</sup>

1. **Individual Decision-Making (IDM):** The tablet displays all available modern contraceptive methods that have not been ruled out by the client or contraindicated due to medical eligibility. The provider gives basic information on each available method (in order of the methods displayed on the tablet screen, which is randomized) covering its use, duration, and typical use effectiveness. These quick descriptions are designed to take 1-2 minutes for each method, or 5-6 minutes overall. The counselor then asks the client which method she would like to discuss, and provides detailed information with the help of the relevant cue card (see

> 5Due to low take-up of SARCs among the study population and the lack of impact of offering discounts for SARCs, the study team discontinued the cross-randomization of SARC prices on January 20, 2021. This implies that SARCs were offered at full price to everyone for approximately the last two months of the pilot study period.

> 6Only 4% of clients asked to see the random discounts before choosing a method.

> 7The clients were free to choose a different method, or no method at all, once the discounts were revealed.

> 8This randomization occurs towards the end of the consultation when the clients are ready to choose a method, after the discussion necessary for the client to make an informed choice but before the random discounts are revealed.

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