Background
Methods
Intervention – the Tiko platform in India
Effect of COVID-19 pandemic on the intervention
Study sites
ANC and FP related indicator | Jaipur Urban | Ajmer Urban | Agra Urban | India Urban | India Total |
---|---|---|---|---|---|
Women with 10 or more years of schooling | 50.1% | 51.1% | 48.2% | 51.5% | 35.7% |
Women aged 20–24 years married before age 18 years | 22.1% | 15.1% | 11.7% | 17.5% | 26.8% |
Total unmet need for FP among married women | 15.3% | 8.9% | 8.5% | 12.1% | 12.9% |
Married women currently using any contraceptive method | 63.8% | 72.0% | 63.0% | 57.2% | 53.5% |
Married women currently using any modern contraceptive method | 61.1% | 64.9% | 43.6% | 51.3% | 47.8% |
Mothers who had at least 4 ANC visits (for the last birth in last 5 years) | 67.8% | 61.5% | 56.8% | 66.4% | 51.2% |
Mothers who consumed iron folic acid for 100 days or more when they were pregnant | 38.6% | 13.2% | 22.3% | 40.8% | 30.3% |
Institutional Births | 92.7% | 90.2% | 85.8% | 88.7% | 78.9% |
Institutional Births at Public Facility | 53.3% | 59.8% | 24.0% | 46.2% | 52.1% |
Impact identification strategy
Statistical methods
Primary outcomes and target population
Primary Outcome | Target population / Denominator | Numerator |
---|---|---|
Current prevalence of contraceptive use | Married Rafikis enrolled on the platform | Those who reported to be using any family planning or birth control method whether permanent or temporary at the time of the survey |
Current prevalence of modern temporary-contraceptive use | Those who reported to be using, at the time of the survey, temporary and modern contraceptive products such as IUD, injectable, emergency pills, implants, pills, condoms, and diaphragms, but not sterilization, hysterectomy, withdrawal, standard days or lactation amenorrhea methods | |
Proportion of women who received at least 4 ANC check-ups during their last pregnancy | Married Rafikis enrolled on the platform and those who delivered a child after 1 January 2019 so that the child would have been conceived and delivered during the period when Tiko platform was functional | Those who reported making 4 or more ANC check-up visits to doctors when pregnant with the index child |
Proportion of women who consumed at least 100 IFA tablets during their last pregnancy | Those who reported consuming at least 100 doses/tablets of IFA when pregnant with the index child | |
Proportion of women who received PNC check-up within 6 weeks of the birth of a child | Those who reported receiving health check-up by a doctor for the index child and themselves within 6 weeks of the delivery |
Sampling
Data collection
Ethics and approvals
Results
Sample characteristics
Non-Users | Users | |
---|---|---|
N | 503 | 1011 |
Age of Rafikis | ||
18–20 | 5.8% | 5.8% |
21–25 | 40.4% | 45.0% |
26–30 | 21.1% | 20.9% |
30 + | 32.8% | 28.3% |
Education Level of Rafikis | ||
No education | 48.7% | 40.7% |
Primary or lower | 20.5% | 20.8% |
Secondary or lower | 21.9% | 26.9% |
Higher | 8.9% | 11.7% |
Access to Smartphone for Rafikis | 57.7% | 65.4% |
Fertility history related of Rafikis | ||
Pregnant at the time of the survey | 8.2% | 12.2% |
Have children | 86.7% | 87.1% |
Whether child was born during after 1 January 2019 | 33.4% | 45.9% |
Exposure to and engagement with the Tiko platform
Impact of the Tiko platform on family planning
Outcomes | N | Non- Users Mean | Unadjusted Effect | Adjusted Effect |
---|---|---|---|---|
Primary Outcomes | ||||
Current contraceptive prevalence rate among married women | 1514 | 26.6% | 3.9 pp [p-value 0.146] | 6.5 pp [p-value 0.023] |
Modern contraceptive prevalence rate among married women | 1514 | 9.5% | 8.0 pp [p-value < 0.001] | 9.4 pp [p-value < 0.001] |
Secondary Outcomes | ||||
Current prevalence of specific family planning methods | ||||
Intrauterine Device (IUD) (modern) | 1514 | 0.6% | 1.3 pp [p-value 0.123] | 1.6 pp [p-value 0.110] |
Injectables (modern) | 1514 | 0.6% | 1.5 pp [p-value 0.044] | 1.8 pp [p-value 0.030] |
Pills (modern) | 1514 | 1.0% | 2.5 pp [p-value 0.025] | 3.0 pp [p-value 0.017] |
Male condoms (modern) | 1514 | 7.2% | 1.9 pp [p-value 0.284] | 2.0 pp [p-value 0.307] |
Female condoms / diaphragms (modern) | 1514 | 0.0% | 0.3 pp [p-value 0.462] | 0.4 pp [p-value 0.323] |
Standard Days Method (traditional) | 1514 | 8.5% | -3.3 pp [p-value 0.019] | -3.0 pp [p-value 0.055] |
Withdrawal method (traditional) | 1514 | 4.2% | -2.0 pp [p-value 0.077] | -2.0 pp [p-value 0.107] |
Lactation amenorrhea (traditional) | 1514 | 2.6% | 0.6 pp [p-value 0.550] | 0.3 pp [p-value 0.808] |
Female sterilization (permanent) | 1514 | 6.0% | -1.5 pp [p-value 0.245] | -0.4 pp [p-value 0.762] |
Hysterectomy (permanent) | 1514 | 1.4% | -0.4 pp [p-value 0.488] | -0.1 pp [p-value 0.832] |
Money spent on contraceptive methods over the past 24 months by current users (INR) | 449 | 363 | -25.6 [p-value 0.873] | 7.1 [p-value 0.965] |
Outcomes | n | Comparison Mean | Unadjusted Change in the User Group | Adjusted Change in User Group |
---|---|---|---|---|
Primary Outcomes | ||||
Received 4 or more ANC check-ups during pregnancy | 634 | 18.3% | 11.2 pp [p-value 0.007] | 11.3 pp [p-value 0.007] |
Consumed 100 or more IFA does during pregnancy | 634 | 27.2% | 11.6 pp [p-value 0.006] | 11.8 pp [p-value 0.006] |
Received postnatal check-up in the first 6 weeks of birth | 602$ | 50.9% | 7.9 pp [p-value 0.076] | 7.5 pp [p-value 0.091] |
Secondary Outcomes | ||||
Obtained any ANC during Pregnancy | 634 | 97.6% | -0.3 pp [p-value 0.883] | 0 pp [p-value 0.998] |
Location of ANC | ||||
Tiko doctors | 615 | 0.0% | 39.2 pp [p-value 0.000] | 39.0 pp [p-value 0.000] |
Other private doctors | 615 | 50.9% | -16.6 pp [p-value 0.000] | -17.0 pp [p-value 0.000] |
Government facility | 615 | 69.1% | -0.4 pp [p-value 0.925] | 0.1 pp [p-value 0.991] |
IFA Receipt and Consumption | ||||
Received free IFA supply | 615 | 80.0% | 4.7 pp [p-value 0.231] | 4.8 pp [p-value 0.217] |
Purchased IFA supplements | 615 | 28.5% | 13.6 pp [p-value 0.003] | 13.4 pp [p-value 0.004] |
Location of PNC | ||||
Tiko doctors | 342 | 0.0% | 23.9 pp [p-value 0.000] | 23.6 pp [p-value 0.000] |
Other private doctors | 342 | 27.7% | 11.4 pp [p-value 0.111] | 12.3 pp [p-value 0.090] |
Government facility | 342 | 72.3% | -4.5 pp [p-value 0.500] | -5.2 pp [p-value 0.443] |
At Home | 342 | 10.8% | 6.3 pp [p-value 0.147] | 6.1 pp [p-value 0.158] |
Expenditure of ANC, delivery and PNC | ||||
Money spent on ANC check-ups, IFA and nutrient supplements during the pregnancy (INR) | 615 | 3462 | -300 [p-value 0.454] | -296 [p-value 0.462] |
Total money spent on delivery and postnatal care (INR) | 602 | 4101 | -528 [p-value 0.683] | -520 [p-value 0.686] |
Effect modification with CHW as pro-agent
Non CHW | CHW | All | |
---|---|---|---|
N | 32 | 68 | 100 |
Average Age (years) | 31.1 | 38.0 | 35.8 |
Education | |||
No Education | 3.1% | 1.5% | 2.0% |
Primary or Lower Education | 12.5% | 5.9% | 8.0% |
Secondary or Lower Education | 37.5% | 64.7% | 56.0% |
Higher Education | 46.9% | 27.9% | 34.0% |
Married | 65.6% | 91.2% | 83.0% |
Caste Category | |||
SCST | 31.3% | 39.7% | 37.0% |
OBC | 21.9% | 42.6% | 36.0% |
Open | 46.9% | 17.6% | 27.0% |
Works as reseller of health products after purchase from stockists | 75.0% | 73.5% | 74.0% |
Current Contraceptive Use (any) | Current ‘Modern’ Contraceptive Use | Consumed 100 or more IFA tablets during last pregnancy | Received 4 or more ANC check-ups during last pregnancy | Received PNC check-up during the first 6 weeks of birth | |
---|---|---|---|---|---|
N for Unadjusted and Adjusted Modelsa | Unadjusted: 1514 Adjusted: 1322 | Unadjusted: 1514 Adjusted: 1322 | Unadjusted: 634 Adjusted: 609 | Unadjusted: 634 Adjusted: 609 | Unadjusted: 602 Adjusted: 579 |
Non-User Mean | 26.9% | 9.5% | 27.2% | 18.3% | 50.9% |
Unadjusted Effect with non-CHW Pro-agent | 0.5% [p-value 0.885] | 6.1% [p-value 0.016] | 0.7% [p-value 0.892] | 2.2% [p-value 0.639] | 6.1% [p-value 0.296] |
Unadjusted Effect with Pro-agent as CHW | 6.7% [p-value 0.013] | 12.7% [p-value 0.000] | 5.9% [p-value 0.175] | 6.6% [p-value 0.095] | 8.9% [p-value 0.064] |
Adjusted Effect with non-CHW Pro-agent | 3.9% [p-value 0.282] | 5.4% [p-value 0.074] | -5.9% [p-value 0.296] | -2.6% [p-value 0.601] | 14.1% [p-value 0.025] |
Adjusted Effect with Pro-agent as CHW | 11.2% [p-value 0.000] | 15.0% [p-value 0.000] | 5.9% [p-value 0.177] | 6.4% [p-value 0.098] | 8.1% [p-value 0.091] |