Improving Uptake of Antenatal Care Services in Rural Côte d'Ivoire
NCT ID: NCT07341581
Last Updated: 2026-01-22
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
NA
1290 participants
INTERVENTIONAL
2026-01-16
2027-02-28
Brief Summary
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The investigators plan to conduct a randomized-controlled experiment of supply- and demand-side solutions to increase uptake of recommended antenatal care services in rural Côte d'Ivoire, where there are currently substantial gaps in service coverage. Despite Côte d'Ivoire's "free maternity care" policy, many recommended services - including ultrasounds and laboratory tests - continue to carry costs for patients. On the supply side, the study will evaluate the impact of providing key services (including ultrasounds, laboratory testing, and iron and folic acid supplements) for free to pregnant women (in line with Côte d'Ivoire's policy of free provision). On the demand side, the study will evaluate the impact of providing information about antenatal care recommendations to pregnant women (alone or with their partners), and of providing a financial planning session to pregnant women or their partners, or both together. The study will evaluate the impacts of these interventions on the uptake of recommended antenatal care services.
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Detailed Description
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One of the primary reasons why increases in coverage have not yielded the desired improvements in health outcomes is the low quality of health care services provided in many health facilities in LMICs. These quality gaps appear to be particularly large for women of lower socioeconomic status, who not only tend to attend lower quality health facilities than wealthier or more educated women, but also tend to receive lower quality care within the same health facilities. In many settings, antenatal care is associated with substantial financial cost, which means that obtaining high quality care can involve complex intrahousehold bargaining and decision-making. Women have more access to information about these services, but men generally make the financial decisions. If men are unaware of the magnitude and timing of financial needs, securing adequate financial resources may be difficult.
In Taabo, Côte d'Ivoire, the investigators recently completed a mixed-methods pilot study examining the reasons for gaps in the quality of antenatal care. They found that, while 91% of women attended at least one antenatal care visit, only 44% had the recommended minimum 4 visits. Many also missed out on important recommended services. They found that only 79% of women received at least 1 and only 17% of women received at least 2 ultrasounds over the course of their pregnancies. Only 73% had any laboratory testing (e.g., a blood test to check for anemia). Only 60% reported taking iron and folic acid supplements 30 days per month during their pregnancy. In qualitative interviews, women identified the cost of services as a critical barrier affecting their uptake. Despite Côte d'Ivoire's "free maternity care" policy, many recommended services - including ultrasounds and laboratory tests - continue to carry costs for patients. Qualitative interviews with women raised several potential pathways through which antenatal care service costs could affect uptake. Firstly, in some cases, the services may be unaffordable for some women and their partners. Secondly, a lack of clarity around service prices - particularly in the context of a publicized "free maternity care policy" - makes it challenging for women and their partners to plan for their antenatal care expenditures. Finally, husbands (or male partners) are the main financial decision-makers in many households in the study setting, and they are not always willing to provide resources to cover the costs of antenatal care services.
The investigators plan to conduct a randomized-controlled experiment of supply- and demand-side solutions to increase uptake of recommended antenatal care services. On the supply side, the study will evaluate the impact of providing key services (including ultrasounds, laboratory testing, and iron and folic acid supplements) for free to pregnant women, in line with Côte d'Ivoire's national "free maternity care" policy. On the demand side, the study will evaluate the impact of providing information about antenatal care recommendations to pregnant women (alone or with their partners), and of providing a financial planning session to pregnant women or their partners, or both together. The study will evaluate the impacts of these interventions on the uptake of recommended antenatal care services.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
* (1) Control (Information video only for pregnant women)
* (2) Information video + financial planning for pregnant women only
* (3) Information video + financial planning for couples together
Following randomization to a one of the above groups, 10% of women in each group will be randomized to receive vouchers to cover the costs of a set of key antenatal health care services.
OTHER
SINGLE
Study Groups
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1a) Information video only
Participants in this arm will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire.
Information video
Participants will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire. In arms (1a-1b) and (2a-2b), this video will be shown only to the pregnant woman. In arms (3a-3b), this video will be shown to the pregnant woman together with her partner.
1b) Information video + Vouchers
Participants in this arm will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire.
They will also receive vouchers to cover the costs of a set of key antenatal health care services.
Information video
Participants will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire. In arms (1a-1b) and (2a-2b), this video will be shown only to the pregnant woman. In arms (3a-3b), this video will be shown to the pregnant woman together with her partner.
Vouchers
This intervention consists of vouchers for a pre-defined set of antenatal care services. Pregnant women who are randomized to receive this intervention will be given vouchers for one ultrasound, one "bilan prenatal" (a recommended set of prenatal laboratory tests in Côte d'Ivoire), and a 6-month supply of iron \& folic acid supplements (with dosage based on their health care provider's recommendation). The study team will establish agreements with local health facilities to provide services in exchange for these vouchers, with reimbursement by the study team.
2a) Information video + financial planning
Participants in this arm will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire.
They will also receive a financial planning session facilitated by a member of the study team.
Information video
Participants will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire. In arms (1a-1b) and (2a-2b), this video will be shown only to the pregnant woman. In arms (3a-3b), this video will be shown to the pregnant woman together with her partner.
Financial planning session
In this intervention, a member of the study team will facilitate a structured discussion about planning for the expenses of health care services and related transportation costs over the course of pregnancy. The discussion will follow a series of questions and prompts set up as a survey form in ODK (attached to this protocol). The study team member will also share a list of the local prices of recommended antenatal care services. In arms (2a-2b), this intervention is delivered only to pregnant women. In arms (3a-3b), this intervention is delivered to pregnant women together with their partners.
2b) Information video + financial planning + vouchers
Participants in this arm will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire.
They will also receive a financial planning session facilitated by a member of the study team.
Finally, they will also receive vouchers to cover the costs of a set of key antenatal health care services.
Information video
Participants will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire. In arms (1a-1b) and (2a-2b), this video will be shown only to the pregnant woman. In arms (3a-3b), this video will be shown to the pregnant woman together with her partner.
Financial planning session
In this intervention, a member of the study team will facilitate a structured discussion about planning for the expenses of health care services and related transportation costs over the course of pregnancy. The discussion will follow a series of questions and prompts set up as a survey form in ODK (attached to this protocol). The study team member will also share a list of the local prices of recommended antenatal care services. In arms (2a-2b), this intervention is delivered only to pregnant women. In arms (3a-3b), this intervention is delivered to pregnant women together with their partners.
Vouchers
This intervention consists of vouchers for a pre-defined set of antenatal care services. Pregnant women who are randomized to receive this intervention will be given vouchers for one ultrasound, one "bilan prenatal" (a recommended set of prenatal laboratory tests in Côte d'Ivoire), and a 6-month supply of iron \& folic acid supplements (with dosage based on their health care provider's recommendation). The study team will establish agreements with local health facilities to provide services in exchange for these vouchers, with reimbursement by the study team.
3a) Information video + financial planning with partners
Participants in this arm will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire. They will view it a first time alone, and a second time with their partners.
They will also receive a financial planning session facilitated by a member of the study team, together with their partners.
Information video
Participants will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire. In arms (1a-1b) and (2a-2b), this video will be shown only to the pregnant woman. In arms (3a-3b), this video will be shown to the pregnant woman together with her partner.
Financial planning session
In this intervention, a member of the study team will facilitate a structured discussion about planning for the expenses of health care services and related transportation costs over the course of pregnancy. The discussion will follow a series of questions and prompts set up as a survey form in ODK (attached to this protocol). The study team member will also share a list of the local prices of recommended antenatal care services. In arms (2a-2b), this intervention is delivered only to pregnant women. In arms (3a-3b), this intervention is delivered to pregnant women together with their partners.
3b) Information video + financial planning with partners + vouchers
Participants in this arm will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire. They will view it a first time alone, and a second time with their partners.
They will also receive a financial planning session facilitated by a member of the study team, together with their partners.
Finally, they will also receive vouchers to cover the costs of a set of key antenatal health care services.
Information video
Participants will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire. In arms (1a-1b) and (2a-2b), this video will be shown only to the pregnant woman. In arms (3a-3b), this video will be shown to the pregnant woman together with her partner.
Financial planning session
In this intervention, a member of the study team will facilitate a structured discussion about planning for the expenses of health care services and related transportation costs over the course of pregnancy. The discussion will follow a series of questions and prompts set up as a survey form in ODK (attached to this protocol). The study team member will also share a list of the local prices of recommended antenatal care services. In arms (2a-2b), this intervention is delivered only to pregnant women. In arms (3a-3b), this intervention is delivered to pregnant women together with their partners.
Vouchers
This intervention consists of vouchers for a pre-defined set of antenatal care services. Pregnant women who are randomized to receive this intervention will be given vouchers for one ultrasound, one "bilan prenatal" (a recommended set of prenatal laboratory tests in Côte d'Ivoire), and a 6-month supply of iron \& folic acid supplements (with dosage based on their health care provider's recommendation). The study team will establish agreements with local health facilities to provide services in exchange for these vouchers, with reimbursement by the study team.
Interventions
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Information video
Participants will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire. In arms (1a-1b) and (2a-2b), this video will be shown only to the pregnant woman. In arms (3a-3b), this video will be shown to the pregnant woman together with her partner.
Financial planning session
In this intervention, a member of the study team will facilitate a structured discussion about planning for the expenses of health care services and related transportation costs over the course of pregnancy. The discussion will follow a series of questions and prompts set up as a survey form in ODK (attached to this protocol). The study team member will also share a list of the local prices of recommended antenatal care services. In arms (2a-2b), this intervention is delivered only to pregnant women. In arms (3a-3b), this intervention is delivered to pregnant women together with their partners.
Vouchers
This intervention consists of vouchers for a pre-defined set of antenatal care services. Pregnant women who are randomized to receive this intervention will be given vouchers for one ultrasound, one "bilan prenatal" (a recommended set of prenatal laboratory tests in Côte d'Ivoire), and a 6-month supply of iron \& folic acid supplements (with dosage based on their health care provider's recommendation). The study team will establish agreements with local health facilities to provide services in exchange for these vouchers, with reimbursement by the study team.
Eligibility Criteria
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Inclusion Criteria
* Aged 15 years or older
* Live in the area served by the Taabo Health \& Demographic Surveillance System
* Estimated gestational age of less than 6 completed months of pregnancy
* Aged 15 and older
* Married to or currently the main romantic partner of a woman who is enrolled in the study
15 Years
FEMALE
No
Sponsors
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Centre Suisse de Recherches Scientifiques en Cote d'Ivoire
OTHER
Swiss National Science Foundation
OTHER
Swiss Tropical & Public Health Institute
OTHER
Responsible Party
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Locations
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Centre Suisse de Recherches Scientifiques en Cote d'Ivoire
Taabo, , Côte d’Ivoire
Countries
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Facility Contacts
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Other Identifiers
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2025-40
Identifier Type: -
Identifier Source: org_study_id
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