Who pays and how much? A cross-sectional study of out-of-pocket payment for modern contraception in Kenya

Emma Radovich, Mardieh L. Dennis, Edwine Barasa, Francesca L. Cavallaro, Kerry L. M. Wong, Josephine Borghi, Caroline A. Lynch, Mark Lyons-Amos, Timothy Abuya, Lenka Benova

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Objectives: Out-of-pocket (OOP) payment for modern contraception is an understudied component of healthcare financing in countries like Kenya, where wealth gradients in met need have prompted efforts to expand access to free contraception. This study aims to examine whether, among public sector providers, the poor are more likely to receive free contraception and to compare how OOP payment for injectables and implants-two popular methods-differs by public/private provider type and user's sociodemographic characteristics.

Design, setting and participants: Secondary analyses of nationally representative, cross-sectional household data from the 2014 Kenya Demographic and Health Survey. Respondents were women of reproductive age (15-49 years). The sample comprised 5717 current modern contraception users, including 2691 injectable and 1073 implant users with non-missing expenditure values.

Main outcome: Respondent's self-reported source and payment to obtain their current modern contraceptive method.

Methods: We used multivariable logistic regression to examine predictors of free public sector contraception and compared average expenditure for injectable and implant. Quintile ratios examined progressivity of non-zero expenditure by wealth.

Results: Half of public sector users reported free contraception; this varied considerably by method and region. Users of implants, condoms, pills and intrauterine devices were all more likely to report receiving their method for free (p

Conclusions: More attention is needed to targeting subsidies to the poorest and ensuring government facilities are equipped to cope with lost user fee revenue.

Original languageEnglish
Article number022414
JournalBMJ Open
Issue number2
Number of pages11
Publication statusPublished - 2019




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