The option that an individual will receive if she or he does not make an active choice.

Defaults are most useful in the presence of status-quo bias, habits, complexity, or limited attention, because individuals gravitate toward the option that is presented by default, even when another available choice might have been more beneficial.

While default effects can be negative, for example when defaults are set through convenience or as a barrier to action (Just & Wansink, 2009), the careful design of a default can have positive consequences (Johnson & Goldstein, 2003; Abadie & Gay, 2006). Choice architecture is the careful design or presentation of the choices available to individuals to ensure that they can end up making (relatively) beneficial decisions—even when susceptible to behavioral biases. Appropriate defaults have been shown to mitigate the effects of status quos bias and choice avoidance (Choi et al., 2004) – for example through automatic enrollment in 401(k) pensions plans, which can improve savings behavior (Madrian & Shea, 2001).

While choice architecture has not been thoroughly tested in the context of RH, establishing pro-social defaults may help providers overcome gaps in knowledge or biases toward the most familiar medical practices and procedures. Defaults can be implemented through heuristics, like checklists based on hierarchies of contraceptive efficacy and side effects that are applied regardless of a checklistpatient’s age or marital status. Approaches like these may increase the quality of care and encourage greater patient take up of services, where needed.

Default interventions can also help patients with limited attention by reducing the cognitive burden or complexity of acting on a decision about health care or contraception, but this has not been tested. Just as organ donations have increased in opt-out European countries (Johnson & Goldstein, 2003; Abadie & Gay, 2006), women may be more likely to take up a contraceptive method if it is offered as a default. However, any such intervention will need to be carefully designed to avoid unwittingly creating coercive targets or perverse incentives for providers.


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