What Do We Really Know About the Impact of Price Changes on Contraceptive Use?

It is concluded in the review of studies on the impact of pricing on contraceptive use that the validity of research findings is related to research method problems. It is suggested that the best research methods rely on experimental studies that assess changes in method- and source-substitution patterns due to pricing changes. Key research components are identified as the selection of random service delivery points and designation of control or experimental programs and data collection on the distribution of all methods and other program distribution of contraception. Reference is made to Lewis review of the literature on the impacts of user fees in family planning. This article provides a review of new studies published since Lewiss review. Three econometric studies in Thailand and Indonesia concluded that demand for contraception was not responsive to price changes. It is pointed out that modeling might not be useful in predicting the real impact of price changes. Problems arise from the data being cross-sectional. All three studies required data on the price of the method used and the prices of methods not used. It is argued that not all users would know the prices of other methods. Conversion of actual method prices paid into prices per couple-month of protection is problematic for methods such as sterilization with a high one time cost. Reference is made to four other studies that indicate that price changes did impact on demand for family planning. The shortcomings of these studies are identified as the lack of clarity in differentiating price effects from clinic effects and the lack of controls for changing patterns of usage or method or provider substitution effects. Studies of total market impact may not distinguish between other important distribution channels and price changes.