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ORIGINAL ARTICLE
Open Access

Increasing Uptake of Long-Acting Reversible Contraceptives in Cambodia Through a Voucher Program: Evidence From a Difference-in-Differences Analysis

Ashish Bajracharya, Lo Veasnakiry, Tung Rathavy and Ben Bellows
Global Health: Science and Practice August 2016, 4(Supplement 2):S109-S121; https://doi.org/10.9745/GHSP-D-16-00083
Ashish Bajracharya
aPopulation Council, Phnom Penh, Cambodia
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  • For correspondence: abajracharya@popcouncil.org
Lo Veasnakiry
bMinistry of Health, Department of Public Health and Information, Phnom Penh, Cambodia
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Tung Rathavy
cMinistry of Health, National Maternal and Child Health Center, Phnom Penh, Cambodia
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Ben Bellows
dPopulation Council, Lusaka, Zambia
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Figures & Tables

Tables

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    TABLE 1. Percentage Distribution of Women by Sociodemographic Characteristics in Baseline Survey, Cambodia, 2011
    Full Sample (N = 1,936)Voucher Areas (N = 961)Non-Voucher Areas (N = 975)P Value
    Age, years, mean29.229.429.1
     15–192.42.52.3.84
     20–2422.119.924.3.02
     25–2931.832.031.5.79
     30–3423.424.622.3.23
     35–3911.813.89.9.007
     40–458.57.29.7.04
    Education level
     No school17.418.016.7.46
     Primary school58.859.258.5.74
     Secondary school (up to grade 9)20.318.821.6.13
     High school (grades 10–12) or higher3.54.03.2.36
    Occupational status
     Unemployed12.513.211.8.35
     Agriculture61.359.962.7.22
     Informal9.29.78.8.52
     Formal17.017.216.7.79
    Religion
     Buddhism98.396.999.6≤.001
     Others1.73.10.4≤.001
    Household size
     0–447.353.247.7.70
     5 or more52.746.852.3.70
    No. of living children
     01.20.61.7.02
     135.333.736.9.14
     228.330.925.6.01
     3 or more35.234.835.8.67
    Wealth quintile
     Q1, Poorest20.918.523.2.01
     Q220.418.622.1.05
     Q320.322.518.1.02
     Q419.723.416.1≤.001
     Q5, Richest18.717.020.5.05
    • View popup
    TABLE 2. Contraceptive Use (%) by Type of Contraceptive Method Among Married Women of Reproductive Age, Baseline Survey, 2011
    MethodFull Sample (N = 1,936)Voucher Areas (N = 961)Non-Voucher Areas (N = 975)P Value
    None71.873.770.0.07
    Traditional4.43.94.8.35
    Modern23.822.425.2.14
     Short-acting methods21.320.622.1.44
      Pill/emergency pill11.710.612.8.13
      Male/female condoms1.00.71.2.26
      Injectables8.69.38.1.32
     LARCs1.71.41.9.30
      IUD1.10.41.6.008
      Implants0.61.00.3.08
     Permanent methods0.80.41.2.05
    • Abbreviation: IUD, intrauterine device; LARCs, long-acting reversible contraceptives.

    • Note the nested nature of the table for the modern method category: the percentages for the pill, condoms, and injectables sum to the short-acting methods percentage while the percentages for the IUD and implants sum to the LARCs percentage. Similarly, the percentages for short-acting methods, LARCs, and permanent methods sum to the modern methods percentage.

    • View popup
    TABLE 3. Current Use of Contraceptive Methods (%) by Sociodemographic Characteristics Among Married Women of Reproductive Age, Baseline Survey, 2011
    Type of Method
    Sample Size (n)NoneTraditionalModernShort-ActingLARCsPMs
    Age group, years
     15–194776.60.023.421.32.10.0
     20–2442875.52.621.921.00.90.0
     25–2961571.74.623.721.31.80.6
     30–3445369.54.426.122.32.21.6
     35–3922969.96.623.520.51.31.7
     40–4516470.16.723.220.81.80.6
    Education level
     No school33672.04.223.821.10.91.8
     Primary1,13970.33.526.223.51.90.8
     Secondary39275.36.917.816.11.50.2
     High school or higher6975.45.818.815.92.90.0
    Wealth quintile
     Q1, poorest40467.13.729.226.70.81.7
     Q239571.13.825.122.52.00.6
     Q339270.23.826.023.21.81.0
     Q438273.05.521.519.61.60.3
     Q5, richest36378.25.216.613.82.20.6
    No. of living children
     02391.30.08.78.70.00.0
     168478.13.718.217.80.40.0
     254768.64.027.424.52.70.2
     3 or more68267.55.627.022.72.12.2
    • Abbreviations: LARCs, long-acting reversible contraceptives; PMs, permanent methods.

    • View popup
    TABLE 4. Difference-in-Differences Analysis: Change in Use of Contraceptive Methods (%) Between Baseline (2011) and Endline (2013) in Voucher and Non-Voucher Areas
    MethodVoucher AreasNon-Voucher AreasDID
    Baseline (n = 961)Endline (n = 993)Baseline (n = 975)Endline (n = 993)Crude (Unadjusted)P Value (of Adjusted DID Estimatea)
    None73.763.570.062.7−2.9.41
    Traditional3.94.94.86.3−0.5.79
    Modern22.431.625.231.03.4.32
     Short-acting20.623.822.126.7−1.4.47
     modern
     LARCs1.46.71.93.53.7.002
     Permanent0.41.11.20.81.1.05
     methods
    • Abbreviations: DID, difference-in-differences; LARCs, long-acting reversible contraceptives.

    • ↵a We opted not to present the adjusted DID point estimates with these associated P values because the adjusted estimates do not have an intuitive interpretation as the crude estimates do, which are the arithmetic difference-in-differences. Adjusted DID point estimates are available upon request.

    • View popup
    TABLE 5. Adjusted Odds Ratios From the Logistic Regression Models Predicting Use of Modern Contraceptives, LARCs, and Permanent Methods
    CovariatesUse of Modern MethodsaP ValueUse of LARCs or PMsbP Value
    AOR (95% CI)AOR (95% CI)
    Area (0 = non-voucher; 1 = voucher)0.73 (0.59, 0.91).0050.55 (0.29, 1.05).07
    Year (0 = baseline; 1 = endline)1.24 (1.00, 1.53).051.11 (0.66, 1.88).69
    Interaction (area*year)1.35 (1.00, 1.81).053.32 (1.54, 7.15).002
    Age group, years (ref: 15–19)
     20–240.87 (0.52, 1.45).592.25 (0.28, 18.02).44
     25–290.71 (0.42, 1.19).192.29 (0.28, 18.44).44
     30–340.73 (0.43, 1.24).241.85 (0.23, 15.22).57
     35–390.70 (0.40, 1.23).222.16 (0.25, 18.29).48
     40–450.78 (0.43, 1.40).411.37 (0.16, 12.00).78
    Education level (ref: no school)
     Primary1.23 (1.00, 1.52).050.60 (0.39, 0.95).03
     Secondary0.92 (0.71, 1.20).540.87 (0.49, 1.52).62
     High school or higher0.74 (0.48, 1.14).171.25 (0.50, 3.11).64
    Employment status (ref: unemployed)
     Agriculture1.16 (0.96, 1.40).130.88 (0.57, 1.34).54
     Informal1.34 (1.01, 1.78).041.22 (0.66, 2.26).52
     Formal1.49 (1.16, 1.90)≤.0011.04 (0.60, 1.80).82
    No. of living children (ref: 3 or more)
     00.08 (0.02, 0.32)≤.001No observation
     10.54 (0.43, 0.68)≤.0010.23 (0.13, 0.43)≤.001
     20.96 (0.79, 1.16).650.51 (0.33, 0.78).002
    Social health protection (ref: no social health protection program)
     Health Equity Fund1.87 (1.54, 2.26)≤.0011.07 (0.68, 1.69).77
     Any other social health protection program1.47 (1.19, 1.82)≤.0011.46 (0.91, 2.34).11
    Wealth quintile (ref: Q1, poorest)
     Q20.94 (0.75, 1.17).560.99 (0.60, 1.65).98
     Q30.98 (0.78, 1.22).851.16 (0.70, 1.93).55
     Q40.90 (0.71, 1.13).350.98 (0.57, 1.71).95
     Q5, richest0.79 (0.62, 1.02).071.50 (0.83, 2.74).18
    Religion (ref: other)0.65 (0.37, 1.11).120.61 (0.22, 1.67).34
     Constant0.05 (0.01, 0.24)≤.0010.20 (0.02, 2.19).19
    • Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; LARCs, long-acting reversible contraceptives; PMs, permanent methods.

    • ↵a Among all married women in the sample.

    • ↵b Among those who used any type of contraceptive method in the last 12 months; LARCs and permanent methods grouped together for simplicity of interpretation.

    • View popup
    TABLE 6. Changes in Use of LARCs (%) Between Baseline (2011) and Endline (2013) by Selected Characteristics
    Voucher AreasNon-Voucher Areas
    Baseline (n = 961)Endline (n = 993)Baseline (n = 975)Endline (n = 993)
    All married women1.46.71.93.5
    Age group, years
     15–190.00.04.30.0
     20–245.44.70.82.8
     25–296.76.31.94.1
     30–347.07.02.33.3
     35–399.39.13.13.6
     40–458.88.62.16.4
    Education level
     No school1.111.80.64.8
     Primary0.96.02.82.9
     Secondary2.25.60.94.5
     High school or higher5.35.80.03.2
    Wealth quintile
     Q1, poorest1.18.80.43.1
     Q21.77.92.33.4
     Q30.95.12.84.3
     Q40.46.53.22.9
     Q5, richest3.05.11.53.9
    No. of living children
     00.00.00.00.0
     10.33.30.61.8
     22.07.33.64.1
     3 or more1.811.02.35.5
    • Abbreviation: LARCs, long-acting reversible contraceptives.

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Global Health: Science and Practice: 4 (Supplement 2)
Global Health: Science and Practice
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August 11, 2016
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Increasing Uptake of Long-Acting Reversible Contraceptives in Cambodia Through a Voucher Program: Evidence From a Difference-in-Differences Analysis
Ashish Bajracharya, Lo Veasnakiry, Tung Rathavy, Ben Bellows
Global Health: Science and Practice Aug 2016, 4 (Supplement 2) S109-S121; DOI: 10.9745/GHSP-D-16-00083

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Increasing Uptake of Long-Acting Reversible Contraceptives in Cambodia Through a Voucher Program: Evidence From a Difference-in-Differences Analysis
Ashish Bajracharya, Lo Veasnakiry, Tung Rathavy, Ben Bellows
Global Health: Science and Practice Aug 2016, 4 (Supplement 2) S109-S121; DOI: 10.9745/GHSP-D-16-00083
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