Pregnancy Incidence and Prevention Among Zambian Female University Students

Aim: 

(1) To design and pilot a mobile-phone-based high-frequency survey platform to measure sexual behavior and contraceptive use among young women. The app will be used to gather weekly data on sexual behavior and contraception use in a highly anonymized, private forum. By developing an appealing, user-friendly mobile app, we will both increase participant adherence and the accuracy of this sensitive data. We will also be able to gather data at a much higher frequency than is practical with in-person surveys, allowing the measurement of how contraception use varies across partners and encounters, which will reveal which barriers are materially important to use. (2) To launch this survey to 1,000 female undergraduates at the University of Zambia and collect weekly data for 12 months, beginning in fall 2018. This population is important and under-studied: they are women with a high demonstrated value of education, and thus high opportunity cost of pregnancy. Nonetheless, focus groups suggest barriers to contraception use still persist in this group, but little is known about the actual incidence of unintended pregnancy, or it’s consequences. This weekly survey, consisting of 5-10 questions about last sexual encounter, including method of contraceptive (for users), and barriers to usage (for non-users), pregnancy if it occurs, and subsequent outcomes, will allow us to generate high frequency data on women’s contraceptive choices and outcomes. We will recruit women in their dorms using female surveyors at the beginning of the term. Each week, women will be prompted by the application to fill out the survey, and their responses will be sent to the researchers on a secure server. (3) To analyze these data to better understand the extent to which pregnancy can be a barrier to tertiary education among this population, and to document potential barriers to contraceptive use. The unique, high frequency data on sexual encounters, pregnancy, and contraceptive use across different encounters collected through the app will provide several new insights, providing evidence that could be used in the optimal design of policy and contraception-promoting interventions. Multiple observations across encounters and partners for a given woman will help disentangle the quantitative importance of different barriers to contraceptive use, including those that are woman-specific (which require access or informational interventions, partner-specific (and could be addressed by bargaining interventions, or example), or encounter-specific (which might be addressed by greater access to long-acting methods). The longitudinal nature of the data will allow us to document the incidence of pregnancy in this important population, as well as the frequency of unintended pregnancy. Moreover, we will use the fine timing of the data to document the extent to which pregnancy could be causing dropout, as well as other outcomes following pregnancy. 

Abstract: 

This project focuses on quantitatively documenting the causes and consequences of early fertility among Zambian university students. To close the gender gap in educational attainment in Sub-Saharan Africa (SSA), it is critical to make progress on understanding both the causes and consequences of early fertility. However, while contraception access has increased throughout SSA, qualitative evidence shows barriers on the demand side persist. There is little causal evidence on whether delaying first births through contraceptive access can increase young women’s educational attainment and other socio-economic outcomes, and what evidence there is shows a somewhat limited effect on the general population, perhaps because other barriers to educational completion make the opportunity of pregnancy low. Thus, we focus on a population that has demonstrated a high demand for education and ability to overcome some of the structural barriers to educational completion. We aim to measure the incidence of (and desire for) pregnancy for this group, to see if there is a burden of unintended pregnancy even among this high achievement group. We will also quantitatively document the importance of various barriers to contraception access and consistent use, which will inform the design of effective interventions to increase use. Finally, we will document the consequences of unintended pregnancy, including drop out or unsafe abortion, using an innovative high-frequency survey that allows inference of suggestive causality via its longitudinal design. The long-term goal of this study is to run a randomized evaluation to measure the causal effect of contraceptive access and information on educational and SES outcomes. The insights gained into behavior, contraceptive use, and consequences of pregnancy will inform the design of that intervention, and this survey platform will act as one of the main data collection components of the larger study. 

Funded By: 
NICHD
Award Dates: 
July 1, 2018 - June 30, 2019
PARC Grant Year: 
Year 25