INTRODUCTION
IDM, intrauterine device(IUD
This paper analyzes a randomized controlled trial of a personalized digital counseling intervention addressing informational constraints and choice architecture, cross-randomized with discounts for long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs). The counseling intervention encourages shared decision-making (SDM) using a tablet-based app, which provides a tailored ranking of modern methods to each client according to their elicited needs and preferences. Take-up of LARCs in the status quo regime at full price was 11%, which increased to 28% with discounts. SDM roughly tripled the share of clients adopting a LARC at full price to 35%, and discounts had no incremental impact in this group. Neither intervention affected the take-up of short-acting methods, such as the pill. Consistent with theoretical models of consumer search, SDM clients discussed more methods in depth, which led to higher adoption rates for second- or lower-ranked LARCs. Our findings suggest that low-cost individualized recommendations can potentially be as effective in increasing unfamiliar technology adoption as providing large subsidies.Individually tailored recommendations can be effective in increasing unfamiliar technology adoption, such as modern contraception.Nearly half of all pregnancies worldwide are considered unwanted or mistimed (Modern contraceptive technology is highly effective in preventing unintended pregnancies. However, adoption in many low- and middle-income countries (LMICs) remains low: Among adult women in LMICs who report wanting to avoid a pregnancy, about a quarter of women and half of adolescent females report not using a contraceptive method (We conducted a randomized experiment to tackle two of these barriers: (i) challenges in acquiring the relevant information about benefits and side effects and (ii) cost. The experiment was conducted at a women and children’s hospital in Yaoundé, Cameroon. A multidisciplinary team of health care providers, public health experts, and economists developed a tablet-based app, which assists nurses conducting contraceptive counseling sessions. During a structured discussion, the app records the clients’ fertility plans, needs, and preferences regarding contraceptive methods. The main innovation that the digital app brings to family planning (FP) counseling is an internal algorithm to rank methods according to their suitability for the client’s personal context. In the shared decision-making (SDM) treatment, the app reveals the most suitable method, and the provider suggests to the client, who makes the ultimate decision, that they discuss this method first. This contrasts with the individual decision-making (IDM) treatment, in which the app displays the methods available to the client in random order and the provider asks the client which method they would like to discuss first. SDM is thus aimed at providing the clients with information tailored to their individual needs, while IDM is meant to resemble the status quo in contraceptive counseling, in which individuals are given extensive information and then left to make their own independent choices (The design of the two counseling interventions is firmly rooted in the debates about how to operationalize “full, free, and informed choice” that emerged from the 1994 International Conference on Population and Development (From the supply side, digital technology like the tablet-based app in our context can overcome provider bias (by recommending methods that counselors might be reluctant to discuss with certain subgroups of clients) and improve safety (by automatically eliminating methods that are contraindicated for the client). Hence, our study is also related to the literature on digital technology enhancing the capabilities of service providers, including the quality of service and compliance (Our study is also related to a growing literature in the US on counseling interventions—such as peer counseling, a waiting room app for contraceptive counseling, and motivational interviewing techniques allowing the client to articulate goals and discuss plans—that showed promise in increasing levels of knowledge of contraceptive effectiveness, interest in adopting the implant, and adoptions of long-acting reversible contraceptives (LARCs—i.e., the intrauterine device(IUD) and the subdermal implant) (We cross-randomized a discount treatment, in which the app revealed randomly assigned discounts for modern contraceptive methods. The discount treatment relaxes the liquidity or credit constraints that prevent clients from adopting LARCs due to their high upfront costs, although they typically have lower per-month costs of protection from unintended pregnancies compared with short-acting methods, such as the pill or the injectable (Depo-Provera). Providing vouchers that fully or partially subsidize FP services increases the use of modern contraceptives among women—especially among young, unmarried, or low-income women (