# Randomized Controlled Trial to Address Unintended Pregnancy Rates in Low Resource Settings

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $624,144

## Abstract

ABSTRACT
Unintended pregnancy is a major contributor to maternal and infant mortality in low-income countries (LICs).
More than 300,000 women and 2.7 million newborns die every year in LICs due to complications from
childbirth and pregnancy. Nearly half of the 200 million pregnancies occurring annually in LICs are unintended.
High numbers of unintended pregnancy are primarily the result of non-use of contraception. Non-use of
contraception is more likely to occur among potential users who experience poor provider care. Providers who
are frequently absent, solicit informal payments from clients, and deny methods to unmarried or nulliparous
women are a major barrier to women seeking family planning. Yet, removing these barriers is difficult due to
low supervision and accountability in under-resourced public facilities. Such findings highlight the need for
interventions that increase quality of care via alternative mechanisms for monitoring providers. The social
accountability approach solicits citizen feedback with the goal of improving provider performance and service
delivery. To date, there is limited rigorous evidence on the effectiveness of social accountability interventions to
increase contraceptive use and on the conditions necessary for successful and sustainable scale-up of these
interventions. Further, no prior study has rigorously assessed social accountability in a setting where Universal
Health Coverage (UHC) is already operating. Based on these knowledge gaps, we propose to evaluate the
impact of two social accountability interventions using rigorous methods. We propose this study in Kenya,
which rolled out UHC in late 2018 and where one out of every 42 women will die from complications related to
pregnancy and childbirth. This study seeks a) to implement the Community Score Card and the Citizen Report
Card, b) to evaluate the impact of each of these interventions on contraceptive use, quality of care, and
community engagement within communities in Kisumu County, Kenya, and c) to assess the potential for
sustainability in additional counties in Kenya, using implementation science methods. To evaluate the impact of
the Community Score Card and the Citizen Report Card on our outcomes of interest, a three-armed cluster
randomized controlled trial will be conducted in Kisumu, Kenya, with all public-sector facilities randomly
assigned to one of three study arms: 1. Community Score Card intervention, 2. Citizen Report Card
intervention, or 3. control sites. Outcomes will be assessed via pre- and post-intervention surveys at the
individual (n=2268) and facility levels (n=129). Implementation science methods will be used to assess the
quality, scalability, and replicability of both the Community Score Card and the Citizen Report Card for uptake
by the public-sector healthcare system. Specifically, in-depth interviews will be conducted with community
members and service providers (n=30), and focus groups (n=4) will be conducted with key inter...

## Key facts

- **NIH application ID:** 10835900
- **Project number:** 5R01HD101453-04
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** KATHERINE M TUMLINSON
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $624,144
- **Award type:** 5
- **Project period:** 2021-05-19 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10835900

## Citation

> US National Institutes of Health, RePORTER application 10835900, Randomized Controlled Trial to Address Unintended Pregnancy Rates in Low Resource Settings (5R01HD101453-04). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10835900. Licensed CC0.

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