Unintended Pregnancy Prevention

The Center on Gender Equity and Health is evaluating a multimedia social and behavior change (SBC) intervention in Kano and Kaduna states in Nigeria to assess its impact, cost-efficiency and how it works. The intervention, led by BBC Media Action, uses radio, TV, other media, community outreach and SBC approaches to increase women's and couples' ability to make and act on reproductive and family planning decisions. Over a three-year period (2025- 2028), we will use a mixed-methods prospective longitudinal cohort study design to meet the research objectives. This includes estimating the impact of the intervention on use and intent to use modern contraception (alone, when combined with other family planning programs, and among non-users), exploring the pathways through which the intervention increases contraceptive use, estimating the cost-efficiency of the intervention and, evaluating the sustainability of the intervention. Data will be collected from three states - Kano and Kaduna (intervention states) and Nasarawa (comparison state). Through this evaluation, we aim to contribute to the family planning and mass media SBC fields by strengthening the evidence on the impact of a multimedia SBC intervention as well as the additional impact of combining the intervention with family planning service delivery interventions.

Protocol Summary: Sweden has high unintended pregnancy rates, increasing unmet contraceptive needs, and the highest repeat abortion rate in the European Union. Effective contraceptive counseling can improve satisfaction, empower correct use, and increase uptake of long-acting reversible contraceptives (LARC), potentially reducing unintended pregnancies. Research has explored ways to enhance contraceptive counseling, focusing on increasing LARC use. Interventions that improve access, remove financial barriers, and enhance method-specific knowledge-especially regarding effectiveness-have led to higher LARC adoption and fewer unintended pregnancies and abortions. The COVID-19 pandemic significantly increased tele-health use for contraceptive counseling. Studies suggest tele-health expands appointment availability, reduces geographic barriers, and improves access to reproductive care, particularly in low-resource populations. However, few studies have examined tele-health's impact on contraceptive counseling, uptake, and satisfaction compared to in-person visits, particularly in Sweden. Before tele-health can be established as a viable family planning option, its counseling quality and impact on LARC adoption must be assessed. Study Aims: To determine whether the choice of LARC after tele-health (video) counseling is comparable to in-person counseling with a midwife, using structured contraceptive counseling in both groups. To assess whether LARC uptake three months post-counseling is similar between women who received tele-health vs. in-person counseling. This study will provide valuable insights into tele-health's role in contraceptive counseling and its potential to improve access to family planning services.