Exploring User-Centered Counseling in Contraceptive Decision-Making: Evidence from a Field Experiment in Urban Malawi
Mahesh Karra1, Kexin Zhang2
1Frederick S. Pardee School of Global Studies, Boston University, 2Boston University

Family planning programs have increasingly begun to adopt user-centered approaches to counseling, but little is known about how they shape women’s preferences and choices. In this study, we implement a randomized controlled trial among 782 women to explore how women's contraceptive decision-making process is shaped by the number and types of contraceptive methods presented to her and the presence of husband during counseling. Each woman was randomized to one of the four treatment arms and received a particular counseling session, following which they were offered free transport and family planning services for a one-month period. Our findings show that targeted counseling made women less likely to realize their stated ideal method and less satisfied with their current method at follow-up. Women from husband invitation group were less likely to change their ideal method, more likely to switch methods over time, and more likely to realize their ideal method at follow-up.