Unintended pregnancies are a persistent global challenge with significant health, financial, and social consequences that disproportionately impact those with the least. Despite significant strides in increasing the availability of contraceptive services, 49% (111 million) of all pregnancies are unintended each year in low- and middle-income countries (LMICs), preventing women from having the opportunity to choose when and how they would start or grow their family, increasing poverty and scarcity for those already resource-constrained, and widening historical gender inequality.
Through 17 projects in nine countries across Africa and Asia, our Global Health team has used behavioral science to understand and address the behavioral factors that contribute to unintended pregnancies, with the ultimate goal of helping women and their families make family planning choices in ways that align with their goals. We’ve synthesized these cross-cutting insights and identified six key behavioral principles critical for designing effective family planning programs.
Behavioral Principle 1: Identity and norms. Social and gender norms shape identities while also guiding and constraining individual behavior. Identity—and its effect on choices—is not singular or static. We can harness untapped opportunities for contraceptive use to align with, rather than challenge or undermine, core aspects of an individual’s identity and the norms of their community.
Example: In some contexts, social sanctions for not having children or having too few children are highly visible. Demonstrating how family planning use is consistent with good motherhood and desired family size may help assuage concerns about the possible social costs.
“Living in this world, the benefit is having a baby.” – WOMAN
Behavioral Principle 2: Ambiguity. Diffuse responsibilities and discomfort combine to make conversations about childbearing and contraception rare. If we can create spaces for open communication and joint decision making, existing alignments can surface and alignment can increase over time.
Example: Male partners may be viewed as deciders, but don’t initiate conversations, so it’s not clear who should or can bring up a conversation about childbearing or family planning. If men and women can be made to feel more confident broaching the topic, alignments in their preferences may more readily come to light.
“Families do not discuss when to have children.” – MAN
Behavioral Principle 3: Attention. Distractions and competing priorities mean that family planning often falls outside of the “tunnel” of the here and now. Understanding what else competes for a client’s or health worker’s attention can help us better ensure that women are able to fully consider the options available to them and follow through on their intentions.
Example: Clients may receive information about family planning during health visits where other topics are prioritized. If health workers can view and describe family planning as connected to the primary purpose of a client’s visit, they may be more successful.
“Even when we discuss family planning during antenatal care …
women forget or say ‘you didn’t tell me.’” – HEALTH WORKER
Behavioral Principle 4: Risk perception. Quirks in the way our brains process information and assess risk lead myths to be particularly durable and influential. By understanding where myths originate and what perpetuates them, we can design more effective approaches to counter misconceptions.
Example: Stories of negative consequences are often widely shared and easy to recall, even when they are false. If similarly memorable success stories of family planning use can be widely shared, those stories will come more easily to mind and exert a counterbalancing effect on perceptions of risk.
“[My sister-in-law has a] 7-year old child but up to now, they are unsuccessfully
trying to get another child. She took the pills then some people argued that
they were the cause.” – YOUNG WOMAN
Behavioral Principle 5: Choice architecture. The order, timing, volume, type, and framing of information clients are offered influences whether they use contraception and which method they choose. While no approach is truly neutral, we can guide clients to make autonomous, well-informed choices.
Example: Health workers may overestimate clients’ readiness to make an informed choice after group counseling. By reinforcing the value of one-on-one discussion and supporting health workers to have effective conversations within their time constraints, clients are more likely to receive the counseling needed to make a truly informed choice.
“l would say no [we could not ask questions after counseling] because
at that time the doctor was busy with other people.” – WOMAN
Behavioral Principle 6: Frictions. For many clients, the process to adopt and use a contraceptive method is rife with frictions. Some, like transportation costs or inconvenient service hours, are easy to spot, while others remain less obvious. By unpacking when, where, and how frictions arise, we can reduce barriers to accessing services.
Example: Short acting family planning methods present hassles. If we reduce some of the challenges that impede sustained use through community-based distribution of contraceptive methods or user-friendly reminders, we can further support women to consistently use their chosen method.
“It is a thing of remembering [to take the pill]. Sometimes I remember
to have it; sometimes I forget to take it.” – WOMAN
Together, we can continue to use the power of behavioral science to understand family planning challenges more deeply and build bold new solutions that accelerate progress toward the parallel aims of improving access and respecting agency and autonomy.
Learn more about the behavioral science principles critical to family planning programs and examples of how they could be applied in our report “Advancing Access and Autonomy.” This report is also available in French.