Examining Reproductive Health Services of Women, Female Youth, and Female Refugees in Northern Jordan with a Behavioral Economics Lens

Examining Reproductive Health Services of Women, Female Youth, and Female Refugees in Northern Jordan with a Behavioral Economics Lens
Authors: Heath Prince, PhD (University of Texas, Austin); Yousef Khader, PhD (Jordan University for Science and Technology); Yara Halasa, PhD (Brandeis University); Nihaya al-Sheyab, PhD (Jordan University for Science and Technology); and Kelley Ready, PhD (University of Texas, Austin)
Publication Type: Working Paper, 12pp.

Executive Summary:
Our study begins from the premise that favorable attitudes toward modern family planning methods (MFPM) among Jordanian and Syrian women do not always translate into behavioral changes, and that the availability and cost of MFPM are not factors in the apparent stall in Jordan’s total fertility rate. Accordingly, our intervention focuses on changing behavior through Behavioral Economics (BE)-based interventions, with the expectation that these interventions contribute to bringing attitudes and behavior into closer alignment.

Our results are positive and statistically, and perhaps socially, significant. Our BE-influenced revisions to the counseling guide used by mid-wives to counsel women on family planning appears to have contributed to a 6.3 percentage point reduction in pregnancy rates over the control group, while text messaging appears to have the potential to add to this decline—marginal improvements from text messaging are positive, but statistically insignificant. While considerably lower than pregnancy rates in the control group, the percentages of women in the two intervention groups who became pregnant did not differ significantly at 3, 6, and 9 months.

We were also interested in whether, and to what extent, our interventions could contribute to increases in the persistence in the use of family planning methods. The rate of family planning use among women in the two intervention groups was significantly higher than that among women in the control group at all follow up times. However, use of family planning at all follow up points did not differ between intervention groups.

The results of our study suggest that simple BE-inspired interventions can be effective methods for reducing Jordan’s fertility rate. Randomly assigning clinics to control and intervention arms ensured that the outcomes are attributable to the interventions. The differences in terms of persistence in the use of MFPM and the reduction in pregnancies are substantial and statistically significant. Additional research is required to understand more fully why the marginal impact of the text messaging was, at best, small and statistically insignificant, despite high rates of satisfaction reported.

Our study has significant policy relevance given its findings of the potential efficacy of cost-effective counseling and text-based interventions to improve maternal health promotion and reduce maternal health risks. We believe that these findings merit consideration for replication of the project on a larger scale and over a somewhat longer time-period to assess the long-term impacts of BE interventions on the persistence in use of MFPM, as well as on fertility rates.