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Providing Free Pregnancy Test Kits to Community Health Workers Increases Distribution of Contraceptives: Results from an Impact Evaluation in Madagascar

Alison B. Comfort, Slavea Chankova, Randall Juras, C. Natasha His, Lauren A. Peterson, Payal Hathi


September 29, 2015
To improve access to contraceptives in remote and rural areas, sub-Saharan African countries are allowing community health workers (CHWs) to distribute hormonal contraceptives. Before offering hormonal contraceptives, CHWs must determine pregnancy status but often lack a reliable way to do so. We assessed the impact of giving CHWs free pregnancy test kits on the number of new clients purchasing hormonal contraceptives from CHWs.

We implemented a randomized experiment in Eastern Madagascar among CHWs who sell injectable and oral hormonal contraceptives: 622 CHWs were stratified by region and randomly assigned at the individual level. Treatment-group CHWs were given free pregnancy tests to distribute (n analyzed=272) and control-group CHWs did not receive the tests (n analyzed=263). We estimated an ordinary least squares regression model, with the monthly number of new hormonal contraceptive clients per CHW as our primary outcome.

We find that providing CHWs with free pregnancy test kits increases the number of new hormonal contraceptive clients. Treatment-group CHWs provide hormonal contraceptives to 3.1 new clients per month, compared to 2.5 in the control group. This difference of 0.7 clients per month (95 percent CI 0.13–1.18; p=0.014), represents a 26 percent increase.
Focus Areas
Sub-Saharan Africa