HIGHLIGHTS

• Despite the provision of free and subsidized family planning services and an intention from clients to delay pregnancies, family planning uptake among women who receive abortion and postabortion services in Nepal remains low.
• We partnered with Sunaulo Parivar Nepal (SPN), one of Nepal’s largest non-governmental sexual and reproductive health providers, to facilitate access to long-acting reversible contraceptives (LARC) for women who had elected an abortion.
• Results suggest that giving health providers timely and salient feedback on their performance relative to their peers is an effective way to improve provision of post-abortion family planning uptake while ensuring a woman’s informed choice.

The Challenge

Despite the provision of free and subsidized family planning services and an intention from clients to delay pregnancies, family planning uptake among women who receive abortion and postabortion services at Sunaulo Parivar Nepal (SPN), one of Nepal’s largest non-governmental sexual and reproductive health (SRH) providers, remains low. Given that a woman’s fertility can return one week after abortion, post-abortion family planning uptake is important to ensure that women are able to achieve their fertility preferences [1].

Our Approach

In partnership with SPN we worked to facilitate access to long-acting reversible contraceptives (LARC) for women who had elected an abortion. Through meetings, interviews, and observations with SPN’s stakeholders, service providers, and clients at its 36 SRH centres, we found that the lack of benchmarks against which providers could compare their own performance and the lack of feedback on the performance were impeding providers from consistently counseling on post-abortion family planning (PAFP).

Based on these insights, we designed a peer-comparison poster that allows providers at one center to compare their performance with that of other similar centers. This tool made a clinic’s LARC uptake rate salient to its staff, contextualized each clinic’s uptake relative to other clinics’, and prompted staff at low-performing clinics to think about ways to improve their LARC uptake rate while commending high-performing clinics as role models.

More on our approach can be found here. 

Results

A randomized controlled trial found that our peer-comparison solution led to a 6.96 percentage point increase in LARC uptake, which represents an increase of 32% from the control group baseline. Qualitative data with clients confirmed that they did not feel pressured to take up contraceptives and had made an informed, active choice. Given the cost-effectiveness of the solution, SPN scaled our solution across all of its clinics in Nepal.

Takeaway

Interventions employing peer comparison have proven effective in other health settings. The current study suggests that giving sexual and reproductive health service providers timely and salient feedback on their performance relative to their peers is an effective way to improve provision of post-abortion family planning uptake while ensuring that women’s informed choice is respected.

Interested in our work applying behavioral science to global health? Email gh@ideas42.org or tweet at @ideas42 to join the conversation.

[1] The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study. Wilcox AJ, Dunson D, Baird DD BMJ. 2000 Nov 18; 321(7271):1259-62.