# **5 Concluding discussion**

We conducted a randomized experiment to tackle two main barriers to the uptake of contraceptives: credit constraints and information. Offering discounts was very effective in increasing LARC adoptions, particularly among younger, unmarried clients. Clients presenting in the maternity or the gynecology ward, most of whom had recently given birth, also responded strongly to low prices for LARCs (Table A11). While increasing demand for LARCs by reaching more women outside health care settings is surely important, current clients of clinics represent an important opportunity. Checklists for antenatal visits, childhood vaccinations, postpartum and post-abortion clients should all include an item to ask whether the client is using an effective contraceptive method and, if not, whether she would like a brief counseling session (accompanied with improved and discounted services). Our findings are consistent with recent evidence on the effect of price reductions in increasing the uptake of LARCs. They are also consistent with the use of incentives to increase the take-up of other preventive health measures, such as immunizations in India (Banerjee et al., 2021) or male circumcisions in South Africa (Friedman and Wilson, 2021).

Counseling clients with the shared decision-making approach ( _SDM_ ) substantially increased the adoption of LARCs at full price. In fact, _SDM_ was so effective in raising willingness-to-pay for LARCs that offering discounts to these clients did not further increase adoption. This is particularly striking given the relatively minor differences between _SDM_ and _IDM_ : in both cases the client can choose (or decline) to discuss one method in more detail first, followed by other methods until she decides. The only variation is in whether or not the _app_ suggests an initial order of discussion. This tweak caused increases in LARC uptake that were as large as the effect of providing these methods for _free_ under _IDM_ . As such, we not only show that LARC uptake can be substantially increased within a comprehensive framework for high-quality counseling (Holt et al., 2017), but also that such a shift might be cost-effective in preventing unintended pregnancies without causing any trade-offs in client satisfaction or autonomy.

Finally, the heterogeneity analysis suggests that unmarried adolescents may be highly motivated to avoid unintended pregnancies and are responsive to low prices. For example, clients who respond strongly to discounts for LARCs are more likely to be students than those who respond weakly. Campaigns to reach adolescent girls and young women might be successful if they can combine high-quality counseling with affordable prices and convenient (and discreet) opportunities to adopt. This is consistent with recent evidence, also from Cameroon, which showed that providing sexual and reproductive health information to adolescents at school can decrease the incidence of teenage pregnancies (Dupas et al., 2018).

# **References**

Anukriti, S., C. Herrera-Almanza, and M. Karra (2021). Women’s access to family planning: Experimental evidence on the role of peers and vouchers. Technical report.

- Ashraf, N., E. Field, and J. Lee (2014). Household bargaining and excess fertility: an experimental study in zambia. _American Economic Review 104_ (7), 2210–37.

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