Skip to main content
Top
Published in: Reproductive Health 1/2021

Open Access 01-12-2021 | Contraception | Research

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

Authors: Akito Kamei, Ryoko Sato, Rebecca Thornton

Published in: Reproductive Health | Issue 1/2021

Login to get access

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://​clinicaltrials.​gov/​ct2/​show/​record/​NCT03975933
Footnotes
1
This study follows CONSORT guideline. CONSORT 2010 checklist of information to include when reporting a randomized trial is available upon request.
 
2
We drop one additional woman from the study because her household location was not recorded.
 
3
The locations of the outreach centers were chosen so that the distance from respondents’ residential location to each outreach center did not correlate with treatment status. The average distance to the closest center from respondents’ home was 2.2 km and 90 percent of respondents lived within 3.7 km.
 
Literature
1.
go back to reference Singh S, Darroch JE, Ashford LS. Adding it up: the costs and benefits of investing in sexual and reproductive health 2014. New York: Guttmacher Institute; 2014. Singh S, Darroch JE, Ashford LS. Adding it up: the costs and benefits of investing in sexual and reproductive health 2014. New York: Guttmacher Institute; 2014.
3.
go back to reference Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. Lancet Glob Health. 2018;6(4):e380–9.CrossRef Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: estimates from a Bayesian hierarchical model. Lancet Glob Health. 2018;6(4):e380–9.CrossRef
4.
go back to reference Shelton JD, Angle MA, Jacobstein RA. Medical barriers to access to family planning. Lancet (London, England). 1992;340(8831):1334–5.CrossRef Shelton JD, Angle MA, Jacobstein RA. Medical barriers to access to family planning. Lancet (London, England). 1992;340(8831):1334–5.CrossRef
5.
go back to reference Stanback J, Vance G, Asare G, Kasonde P, Kafulubiti B, Chen M, Janowitz B. Does free pregnancy testing reduce service denial in family planning clinics? A cluster-randomized experiment in Zambia and Ghana. Global Health Sci Pract. 2013;1(3):382–8.CrossRef Stanback J, Vance G, Asare G, Kasonde P, Kafulubiti B, Chen M, Janowitz B. Does free pregnancy testing reduce service denial in family planning clinics? A cluster-randomized experiment in Zambia and Ghana. Global Health Sci Pract. 2013;1(3):382–8.CrossRef
6.
go back to reference Gebre B, Biadgilign S, Taddese Z, Legesse T, Letebo M. Determinants of malnutrition among pregnant and lactating women under humanitarian setting in Ethiopia. BMC Nutr. 2018;4(1):1–8.CrossRef Gebre B, Biadgilign S, Taddese Z, Legesse T, Letebo M. Determinants of malnutrition among pregnant and lactating women under humanitarian setting in Ethiopia. BMC Nutr. 2018;4(1):1–8.CrossRef
7.
go back to reference Harlow BL, Signorell LBO. Factors associated with early menopause. Maturitas. 2000;35(1):3–9.CrossRef Harlow BL, Signorell LBO. Factors associated with early menopause. Maturitas. 2000;35(1):3–9.CrossRef
8.
go back to reference Harlow SD, Matanoski GM. The association between weight, physical activity, and stress and variation in the length of the menstrual cycle. Am J Epidemiol. 1991;133(1):38–49.CrossRef Harlow SD, Matanoski GM. The association between weight, physical activity, and stress and variation in the length of the menstrual cycle. Am J Epidemiol. 1991;133(1):38–49.CrossRef
9.
go back to reference Lindsay KL, Gibney ER, McAuliffe FM. Maternal nutrition among women from Sub-Saharan Africa, with a focus on Nigeria, and potential implications for pregnancy outcomes among immigrant populations in developed countries. J Hum Nutr Diet. 2012;25(6):534–46.CrossRef Lindsay KL, Gibney ER, McAuliffe FM. Maternal nutrition among women from Sub-Saharan Africa, with a focus on Nigeria, and potential implications for pregnancy outcomes among immigrant populations in developed countries. J Hum Nutr Diet. 2012;25(6):534–46.CrossRef
10.
go back to reference Rowland AS, Baird DD, Long S, Wegienka G, Harlow SD, Alavanja M, Sandler DP. Influence of medical conditions and lifestyle factors on the menstrual cycle. Epidemiology. 2002;13:668–74.CrossRef Rowland AS, Baird DD, Long S, Wegienka G, Harlow SD, Alavanja M, Sandler DP. Influence of medical conditions and lifestyle factors on the menstrual cycle. Epidemiology. 2002;13:668–74.CrossRef
11.
go back to reference Morroni C, Moodley J. The role of urine pregnancy testing in facilitating access to antenatal care and abortion services in South Africa: a cross-sectional study. BMC Pregnancy Childbirth. 2006;6(1):1–7.CrossRef Morroni C, Moodley J. The role of urine pregnancy testing in facilitating access to antenatal care and abortion services in South Africa: a cross-sectional study. BMC Pregnancy Childbirth. 2006;6(1):1–7.CrossRef
12.
go back to reference Comfort AB, Chankova S, Juras R, His CN, Peterson LA, Hathi P. Providing free pregnancy test kits to community health workers increases distribution of contraceptives: results from an impact evaluation in Madagascar. Contraception. 2016;93(1):44–51.CrossRef Comfort AB, Chankova S, Juras R, His CN, Peterson LA, Hathi P. Providing free pregnancy test kits to community health workers increases distribution of contraceptives: results from an impact evaluation in Madagascar. Contraception. 2016;93(1):44–51.CrossRef
13.
go back to reference Ministry of Health, Uganda. 2014. Uganda Family Planning Costed Implementation Plan, 2015–2020. Kampala: Ministry of Health, Uganda. Ministry of Health, Uganda. 2014. Uganda Family Planning Costed Implementation Plan, 2015–2020. Kampala: Ministry of Health, Uganda.
15.
go back to reference Hartung C, Lerer A, Anokwa Y, Tseng C, Brunette W, and Borriello G. Open data kit: tools to build information services for developing regions. In Proceedings of the 4th ACM/IEEE international conference on information and communication technologies and development; 2010. pp. 1–12. Hartung C, Lerer A, Anokwa Y, Tseng C, Brunette W, and Borriello G. Open data kit: tools to build information services for developing regions. In Proceedings of the 4th ACM/IEEE international conference on information and communication technologies and development; 2010. pp. 1–12.
Metadata
Title
Effect of pregnancy tests on demand for family planning: evidence from a randomized controlled trial in Uganda
Authors
Akito Kamei
Ryoko Sato
Rebecca Thornton
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Contraception
Published in
Reproductive Health / Issue 1/2021
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-021-01279-5

Other articles of this Issue 1/2021

Reproductive Health 1/2021 Go to the issue