Fraction of clients who adopted a long-acting reversible contraceptives (LARC).
The figure shows the fraction of clients who adopted a LARC during the study period under Discounted and Full LARC prices across counseling styles. The lines above the bars show the estimate (d) and Among clients with a MiM, 42% adopted a LARC at full price. Offering discounts for LARCs increased this share by 20 percentage points (pp). MiM clients differ from other study participants: They are older, more likely to be married, have higher levels of education, and want no more children, all of which may help explain their higher demand for LARCs.Among those who were unsure about the method they would like to adopt, when clients were randomly assigned to IDM, only 11.4% of them adopted a LARC at full price. Receiving a discount, on average, increased this share to 28.5%. Under SDM, the uptake of LARCs at full price jumped to 35.3%—an increase of more than 300% over IDM. SDM seems to have also caused clients to become less sensitive to LARC prices: Offering them discounts made no difference to LARC adoptions. The difference in the effect of providing discounts for LARCs between IDM and SDM is 18.7 pp (As LARC uptake is significantly higher under SDM than IDM, it follows that the probability of unintended pregnancy is lower among SDM clients. While prevention of unintended pregnancies is clearly an important outcome for FP interventions, it is not the only one. It is also critical that the outcomes (including the decision to adopt no method) are aligned with client preferences, that the quality of care is high, and that the clients are satisfied with the services they receive. Hence, before examining the mechanisms through which SDM increased the uptake of LARCs, we present some evidence on these outcomes.Table S8, using survey data collected from the follow-up cohort mentioned in the “Data” section, shows that the quality of care received by the clients was high (panel A). The quality of care index is based on a measure developed and validated by Jain Another indication of the concordance of clients’ choices with their preferences is whether they continue to use the methods they adopted: If the increased LARC adoptions among SDM clients are, on average, not aligned with their preferences, then we should observe more discontinuations or switching to other methods. To examine this issue, we can track the decisions clients in our study made over time—from the day of their initial counseling until several months later. Figure S4 replicates our main impact findings presented in The evidence presented so far suggests that the SDM approach in counseling led to an increase in the take-up of LARCs. Furthermore, the quality of FP services and client satisfaction with those services are high overall and no lower in SDM than IDM. Similarly, discontinuation rates for LARCs are low—the number of LARC users increases over time net of discontinuations and switching. Taken as a whole, these findings suggest that SDM not only lowered the probability of unintended pregnancies but it also resulted in outcomes that are highly likely to be aligned with client preferences. We now turn to an investigation of mechanisms through which these effects were obtained.