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

Akito Kamei, Ryoko Sato, Rebecca Thornton, Akito Kamei, Ryoko Sato, Rebecca Thornton

Abstract

Background: Unmet 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.

Methods: A 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.

Results: When 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.

Conclusion: Demand 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://ichgcp.net/clinical-trials-registry/NCT03975933.

Keywords: Family planning; Pregnancy tests; Randomized controlled trial; Uganda; Unmet needs of contraception.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
CONSORT figure: flowchart of sample selection and random treatment assignment
Fig. 2
Fig. 2
Research design: On-the-spot and pregnancy testing for future use. “On-the-spot" means women in this group were offered to take pregnancy testing service. Following the baseline survey, women in this treatment arm were offered the opportunity to take an on-the-spot pregnancy test. The pregnancy test consisted of a simple dip-strip urine-based pregnancy test together with an explanation of how to interpret the results with enumerators. “Future-use" means that they were offered pregnancy testing kit to be used in the future. Women in this treatment arm were offered a home pregnancy test kit to keep for their own use any time in the future. Enumerators explained how to use the pregnancy test kit and respondents were provided with both a single pregnancy test strip and informational a pamphlet explaining how to use the test and interpret the results
Fig. 3
Fig. 3
Average take-up of pregnancy testing kit. The figure shows the take-up of the intervention among women who were offered. Women in on-the-spot pregnancy test treatment were offered the opportunity to take a pregnancy test just after the conclusion of the survey. The pregnancy test consisted of a simple dip-strip urine-based pregnancy test together with an explanation of how to interpret the results with enumerators. Some women in future-use pregnancy test treatment were offered pregnancy test to keep for their own use any time in the future with the random price. The price offered was 100 (2.7 cents), 500 (14 cents), 1000 (27 cents), 1500 (41 cents), 2000 (51 cents) in Uganda Shillings (Number in parenthesis shows the price in US cents). Together with the single pregnancy test strip, we provide an informational pamphlet explaining how and when to use the test and interpret the results

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