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Stud Fam Plann. 2016 Dec;47(4):341-356. doi: 10.1111/sifp.12005. Epub 2016 Nov 17.

How User Fees Influence Contraception in Low and Middle Income Countries: A Systematic Review.

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Catherine Korachais is Researcher in the Department of Public Health at the Institute of Tropical Medicine, Antwerp, Belgium.
Elodie Macouillard is independent consultant.
Bruno Meessen is Professor of Health Economics in the Department of Public Health at the Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.


Accessible and quality reproductive health services are critical for low- and middle-income countries (LMICs). After a decade of waning investment in family planning, interest and funding are growing once again. This article assesses whether introducing, removing, or changing user fees for contraception has an effect on contraceptive use. We conducted a search of 14 international databases. We included randomized controlled trials, interrupted-time series analyses, controlled before-and-after study designs, and cohort studies that reported contraception-related variables as an outcome and a change in the price of contraceptives as an intervention. Four studies were eligible but none was at low risk of bias overall. Most of these, as well as other studies not included in the present research, found that demand for contraception was not cost-sensitive. We could draw no robust summary of evidence, strongly suggesting that further research in this area is needed.

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