FP counseling flowchart.
*Or wanted to renew their current method without discussing other methods (approximately 10% of this group of clients). **In rare cases where a client’s preferred method is contra-indicated they were counselled on the next most suitable method according to a default ranking.For clients seeking to adopt a specific method, the app follows a slightly different protocol depending on whether that method is a LARC or not. Clients who want to adopt or renew a LARC are directed to the method choice section to discuss their desired method in detail, after a check on their medical history to assess any contraindications: Approximately 80% of clients seeking to adopt a specific method fall into this category. In contrast, for the remaining 20% who want to adopt or renew a SARC (or other methods with lower typical use effectiveness), the app prompts the provider to inquire whether the client would be willing to discuss other methods that are more effective in preventing pregnancies and might be more suitable for her. Such clients (68%) were willing to consider other methods and thus eligible to be randomly assigned to a counseling intervention, while the remaining clients were directed to the method choice section to discuss their preferred (non-LARC) method in detail. This resulted in roughly half of the clients being randomly assigned to a counseling intervention, while the other half were counseled on their preferred method (There are two motivations for the asymmetry in how the app treats MiM clients seeking a LARC versus a SARC. First, LARCs have much higher typical use effectiveness in preventing unintended pregnancies, which is an important attribute of contraceptive methods. Second, knowledge of LARCs is typically lower than that of SARCs: The 2011 DHS shows if a woman had heard of a LARC, she almost certainly had also heard of a SARC. However, the reverse is not true: Among clients who had heard of a SARC, only two thirds had heard of a LARC. This makes the odds of knowing about the other group of contraceptives 25 times higher among people who heard of a LARC versus a SARC. (While these odds have decreased considerably to approximately 7 in the 2018 Cameroon DHS, which was not yet publicly available during the study preparations, the information asymmetry still exists between SARCs and LARCs among women of reproductive age in Cameroon). As Senderowicz (