title: How User Fees Influence Contraception in Low and Middle Income Countries: A Systematic Review.
abstract: 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.
authors.affiliation: Catherine Korachais is Researcher in the Department of Public Health at the Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Catherine
authors.initials: C
authors.lastname: Korachais
authors.affiliation: Elodie Macouillard is independent consultant.
authors.forename: Elodie
authors.initials: E
authors.lastname: Macouillard
authors.affiliation: Bruno Meessen is Professor of Health Economics in the Department of Public Health at the Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Meessen
mesh_terms: D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000191:economics* / Q000706:statistics & numerical data; D005193:Family Planning Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D005251:Fees, Medical / Q000706:statistics & numerical data; D006801:Humans