ArticleContraception2026
Informal and out-of-pocket payments for public-sector contraceptive care in remote Madagascar.
Article in Contraception, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors.
Funding
Abstract
objectivesInformal payments at public facilities can undermine contraceptive access, yet little is known about how often women pay out of pocket (OOP) for family planning-or how much. STUDY
designWe conducted a descriptive analysis using data collected in 2023 from Alaotra Mangoro, Atsinanana, and Vatovavy Fitovinany in Madagascar. We triangulated: (1) a population-based survey of women aged 15-49 [n = 1199]; analytic subsample: current modern method users who obtained methods in the prior 12 months from public facilities [n = 219] or community health workers (CHWs) [n = 91]; (2) client exit interviews with women seeking contraception at public facilities [n = 118]; (3) CHWs interviews on typical charges [n = 214]; and (4) 107 facility audits. Outcomes were any OOP payment and the amount paid. Population-survey respondents were also asked if any payment was "unofficial."
resultsAmong facility-sourced users in the population survey, 86% reported paying OOP (median USD 0.56; range 0-1.8). Amounts varied by method (higher for implants, lower for pills). Among CHW-sourced users, 99% paid with amounts broadly similar to facilities overall. In client exit interviews, 53% of clients reported paying, with amounts also lower (median USD 0.11). About 40% of facility-sourced users perceived their payment as unofficial; reports of "unofficial" payments were lower among CHW users.
conclusionsInformal payments for contraception appear common and non-trivial in remote Madagascar, despite free-of-charge contraception policy in public-sector facilities. Program responses could include transparent fee charters, strengthened supervision and grievance mechanisms, and routine monitoring of OOP payments across facilities to safeguard contraceptive autonomy. IMPLICATIONS: Informal and out-of-pocket payments create significant financial barriers to family planning, even under free-of-charge contraception policies in public-sector facilities. To ensure equitable access and support contraceptive autonomy, policy efforts should prioritize accountability mechanisms, including standardized fee disclosure, routine verification of client payments, and rigorous supervision of community-level service delivery.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.