Journal Article

Free access to a broad contraceptive method mix and women’s contraceptive choice: Evidence from sub‐Saharan Africa

Financial barriers may restrict women's ability to use their preferred contraceptive methods, especially long‐acting reversible contraceptives (LARC). Providing free access to a broad contraceptive method mix, including both LARC and short‐acting reversible contraceptives (SARC), may increase contraceptive use, meet women's various fertility needs, and increase their agency in contraceptive decisions. Linking facility and individual data from eight countries in sub‐Saharan Africa, we use a propensity score approach combined with machine learning techniques to examine how free access to a broad contraceptive method mix affects women's contraceptive choice. Free access to both LARC and SARC was associated with an increase of 3.2 percentage points (95 percent confidence interval: 0.006, 0.058) in the likelihood of contraceptive use, driven by greater use of SARC. Among contraceptive users, free access did not prompt women to switch to LARC and had no effect on contraceptive decision‐making. The price effects were larger among older and more educated women, but free access was associated with lower contraceptive use among adolescents. While free access to contraceptives is associated with a modest increase in contraceptive use for some women, removing user fees alone does not address all barriers women face, especially for the most vulnerable groups of women.

Published in a peer-reviewed journal of the Population Council.