Despite decades of investment in family planning programs across sub-Saharan Africa, access to modern contraceptives remains constrained by cost, particularly for long-acting reversible contraceptives (LARCs) such as implants and intrauterine devices (IUDs). Ghana has taken a significant step toward removing this barrier: In January 2022, the country began nationally implementing a policy that extends its National Health Insurance Scheme (NHIS) to cover selected modern contraceptive methods, including implants, IUDs, tubal ligation, and injectables. Yet, until now, there has been no rigorous, population-level evaluation of whether this policy has translated into meaningful changes in contraceptive use among Ghanaian women.
In our new paper in Studies in Family Planning, “The Impact of Ghana’s National Health Insurance Scheme’s Coverage Policy on Modern Contraceptive Use,” we present the first national quasi-experimental evaluation of this policy. Drawing on three rounds of the Ghana Demographic and Health Survey (2008, 2014, and 2022) and applying a propensity score matching combined with a difference-in-differences approach, we estimated the effect of NHIS contraceptive coverage on modern contraceptive use among women of reproductive age, comparing NHIS members to non-members before and after the policy took effect.
Our findings offer early but encouraging evidence. The NHIS contraceptive coverage policy was associated with a 2.9 percentage point increase in modern contraceptive use and a 2.3 percentage point increase in long-term method use among NHIS-covered women. Consistent with the policy’s explicit goal of shifting uptake from short-term to more effective long-term methods, we found no statistically significant effect on the use of short-term methods such as injectables. These results were consistent across multiple model specifications and sensitivity analyses, strengthening our confidence in their validity.
However, the policy did not benefit all women equally. While women in urban areas experienced a statistically significant increase in long-term method use, those in rural areas saw a smaller, nonsignificant change. This disparity is likely driven by persistent supply-side gaps in rural settings, including shortages of trained providers and irregular commodity availability — that constrain the real-world reach of an otherwise promising policy.
Ghana’s experience carries broader lessons for the growing number of low- and middle-income countries designing or expanding national health insurance systems. Eliminating out-of-pocket costs for contraception is a meaningful policy strategy: it can increase access to effective methods while providing health facilities with more predictable revenue streams, supporting commodity availability and quality of care. At the same time, demand-side financing alone is not sufficient. Sustaining this policy’s impact will require timely reimbursement of provider claims, a trained workforce capable of delivering LARCs, especially in underserved areas, and continuous monitoring to detect and address implementation gaps before they widen existing inequities.
With most women of reproductive age enrolled in the NHIS, Ghana is well-positioned to make further progress toward its 2030 family planning goals, which include increasing modern contraceptive use among married women and women in union from 30 percent to 44.4 percent. Our findings underscore that integrating reproductive health services into national health insurance frameworks is not only feasible, but demonstrably effective, and that doing so well requires sustained commitment to financing, implementation, and equity.
About the Authors
Maxwell Tii Kumbeni, Oregon State University
Elvis Junior Dun-Dery, Oregon State University
Agani Afaya, University of Health and Allied Sciences, Ghana
Eugene Osei Yeboah, Ghana Health Service
Paschal Awingura Apanga, University of Oxford