Informal and out-of-pocket payments for public-sector contraceptive care in remote Madagascar

The authors investigate the prevalence and impact of informal and out-of-pocket payments for contraceptive care in public-sector facilities in remote Madagascar, despite existing policies for free contraception. Their findings reveal that a significant majority of women reported making such payments, with amounts varying by method, indicating that financial barriers persist and may undermine access to family planning services. The study suggests that policy improvements, including transparent fee structures and enhanced oversight, are necessary to protect contraceptive autonomy and ensure equitable access.