Targeting Financial and Information Barriers Boosts Long-Acting Contraception Uptake in Kenya, New Study Finds

A new large-scale randomized trial published in The Lancet shows that reducing financial and information barriers can expand women's contraceptive choices in Kenya's private pharmacies at a cost that compares favorably to similar family planning programs. 

The study was led by Emory University's Rollins School of Public Health in partnership with University of California, Berkeley; Stanford University; and health care technology company Maisha Meds. The researchers randomized 137 private pharmacies into three intervention arms across 21 Kenyan counties and analyzed more than 26,000 family planning transactions over eight months. 

What They Found

In the control group, just 3% of family planning visits resulted in a purchase of subcutaneous depot medroxyprogesterone acetate (DMPA-SC or "the shot"), an option for long-acting contraception that facilitates administration by a broader set of providers and users. All three interventions significantly increased uptake:

• The consumer subsidy intervention, which offered clients a 60% discount, increased DMPA-SC uptake by 13 percentage points.
• The pharmacy cost reduction intervention, which provided pharmacies free stock of DMPA-SC and allowed them to keep the price charged to consumers as profit, increased uptake by 12 percentage points.
• The pharmacy incentive intervention, which combined free stock of DMPA-SC with an additional $0.50 USD per sale, increased uptake by 14 percentage points.
• Each additional couple-year of contraceptive protection generated by the interventions cost between $2.56 and $12.50 depending on the arm — more cost-effective than comparable family planning programs with similar objectives.

The findings suggests that when incentivized directly, providers change their counseling to give more information to patients about new long-term contraception methods such as DMPA-SC, which are more expensive up-front than short-term options but more cost-effective long-term.

"We found that both patient and provider incentives work to expand access to long-acting contraceptives in pharmacies – but they work in different ways: patient incentives work by reducing prices, and provider incentives work by changing counseling behaviors," said Maria Dieci, PhD, lead author and assistant professor in the Department of Health Policy and Management at Rollins. 

Why This Matters

Private pharmacies are a crucial but understudied access point for reproductive health care worldwide, particularly for young women, because they offer convenient and widely used services outside of the public‑sector. This study offers strong evidence that targeted incentives in this setting can meaningfully expand women's contraceptive choices by reducing barriers of pricing, information, and awareness to positively influence access.

"The fact that digital pharmacy‑based interventions can reduce financial and informational barriers to contraceptive access cost-effectively is what makes this approach both innovative and scalable,” said Dieci.