{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:18:48Z","timestamp":1791933528807,"version":"4.3.4"},"reference-count":34,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,12,18]]},"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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\u2014two popular methods\u2014differs by public\/private provider type and user\u2019s sociodemographic characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>Secondary analyses of nationally representative, cross-sectional household data from the 2014 Kenya Demographic and Health Survey. Respondents were women of reproductive age (15\u201349 years). The sample comprised 5717 current modern contraception users, including 2691 injectable and 1073 implant users with non-missing expenditure values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome<\/jats:title>\n                    <jats:p>Respondent\u2019s self-reported source and payment to obtain their current modern contraceptive method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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&lt;0.001) compared with injectable users. The poorest were as likely to pay for contraception as the wealthiest users at public providers (OR: 1.10, 95%\u2009CI: 0.64 to 1.91). Across all providers, among users with non-zero expenditure, injectable and implant users reported a mean OOP payment of Kenyan shillings (KES) 80 (US$0.91), 95%\u2009CI: KES 78 to 82 and KES 378 (US$4.31), 95%\u2009CI: KES 327 to 429, respectively. In the public sector, expenditure was pro-poor for injectable users yet weakly pro-rich for implant users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>More attention is needed to targeting subsidies to the poorest and ensuring government facilities are equipped to cope with lost user fee revenue.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-022414","type":"journal-article","created":{"date-parts":[[2019,2,20]],"date-time":"2019-02-20T13:53:15Z","timestamp":1550670795000},"page":"e022414","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":28,"title":["Who pays and how much? A cross-sectional study of out-of-pocket payment for modern contraception in Kenya"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8975-8015","authenticated-orcid":false,"given":"Emma","family":"Radovich","sequence":"first","affiliation":[{"name":"Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mardieh L","family":"Dennis","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwine","family":"Barasa","sequence":"additional","affiliation":[{"name":"Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9641-8780","authenticated-orcid":false,"given":"Francesca L","family":"Cavallaro","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4400-2257","authenticated-orcid":false,"given":"Kerry LM","family":"Wong","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Borghi","sequence":"additional","affiliation":[{"name":"Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline A","family":"Lynch","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Lyons-Amos","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Abuya","sequence":"additional","affiliation":[{"name":"Population Council Kenya, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenka","family":"Benova","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK"},{"name":"Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerpen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,2,20]]},"reference":[{"key":"2025121604194859000_9.2.e022414.1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czt073"},{"key":"2025121604194859000_9.2.e022414.2","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1186\/s12913-015-1000-3","article-title":"Community-level effect of the reproductive health vouchers program on out-of-pocket spending on family planning and safe motherhood services in Kenya","volume":"15","author":"Obare","year":"2015","journal-title":"BMC Health Serv Res"},{"key":"2025121604194859000_9.2.e022414.3","unstructured":"Initiative HP . 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