Providing free pregnancy test kits to CHWs increases distribution of contraceptives: results from an impact evaluation in Madagascar

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

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. This study design implemented a randomized experiment in Eastern Madagascar among CHWs who sell injectable and oral hormonal contraceptives. Results show that providing CHWs with free pregnancy test kits increases the number of new hormonal contraceptive clients. Giving CHWs free pregnancy tests is an effective way to increase distribution of hormonal contraceptives. As pregnancy tests become increasingly affordable for health-care systems in developing countries, community-based distribution programs should consider including the tests as a low-cost addition to CHWs’ services.