User-centered approaches to contraceptive counseling: Experimental evidence from urban Malawi

We test how two user-centered approaches to counseling shape women’s contraceptive preferences and behavior: (1) tailored counseling that presents contraceptive methods based on women’s stated preferences; and (2) prompting women with the choice to invite male partners to counseling. A total of 782 women were randomized to receive tailored or standard counseling, cross-randomized with the prompt to invite their partners. Following counseling, women were offered free transport and access to a family planning clinic for one month. Women who received tailored counseling were less likely to be concordant between their stated preferred method and method use, both intertemporally and contemporaneously. Women who were prompted with partner invitations were less likely to change their stated preferred method but more likely to be concordant between their stated preferred method following counseling and method use at follow-up. While both approaches aimed to facilitate user-centered contraceptive decision-making, neither necessarily yielded strictly preferred outcomes for women. • We test two user-centered counseling approaches in a randomized trial in Malawi. • Tailored counseling shifts stated contraceptive preferences but lowers concordance. • Partner invitations reduce preference changes and raise intertemporal concordance. • Male involvement improves follow-through but may crowd out women’s own preferences. • Findings reveal trade-offs to designing family planning programs to enhance agency.