Study Overview
Access to modern family planning impacts women's health, education, and economic well-being. Persistent barriers to accessing long-acting methods, such as price and lack of information, limit adoption. This study highlights the potential of a novel payment and incentive structure for pharmacies, a key access point for contraceptives for young women in particular, to improve access to subcutaneous depot medroxyprogesterone acetate (DMPA-SC). By targeting incentives to either patients or providers through a low-cost digital tool, the intervention aims to enhance contraceptive choice cost-effectively with potential for scale. We randomized 137 pharmacies in Kenya into three intervention arms, varying patient copay, pharmacy profit, or pharmacy cost to stock DMPA-SC, plus a status quo control group that conducted pharmacy operations as usual. All pharmacies used an app-based platform for sales and inventory tracking, and a digital tool to manage family planning sales, through which client discounts for DMPA-SC, pharmacy cost to stock DMPA-SC, or pharmacy profit for DMPA-SC were experimentally varied in the intervention arms. We used double/debiased machine learning for adjusted models, with the primary outcome being uptake of DMPA-SC, and secondary outcomes being couple-years of protection, and an analysis of price and information mechanisms.
Study Results
We analyzed data from 26,883 family planning visits (C = 7605, T1 = 7774, T2 = 5009, T3 = 6495) between August 2022 and May 2023. Providing consumer discounts and provider incentives through a pharmacy-facing intervention increases adoption of DMPA-SC by 14 percentage points (control mean: 0.03), while decreasing use of short-acting methods by 13 percentage points (control mean: 0.92), compared to a control group. Interventions alleviated both price and information barriers to access through a 100% price pass through in the consumer discount arm and an increase in comprehensive counseling by 68 percentage points in the provider-side arms, all compared to the status quo control group. Targeted incentives increase couple-years of protection (CYP) for $2.56–$12.50 per CYP.
Intervention Partner: Maisha Meds
Impacts on Policy and Practice: Pharmacy-based interventions that reduce price and information barriers of DMPA-SC can expand women's contraceptive options, with implications for choosing longer-acting methods. Pharmacies are crucial access points for family planning in Kenya and globally. Understanding how pharmacy-specific interventions influence access to modern methods can generate evidence on this understudied and important care setting.