Family Planning Mobile Outreach

Published: August 2026

Summary

Basics

Roughly 80 million women in low- and middle-income countries (LMICs) had unmet demand for contraception in 2024, and a further 136 million report wanting to avoid a pregnancy but are not using a modern contraceptive method (more). While some women do not want to use modern methods of contraception, others may face barriers to desired use, including geographic distance, cost, availability of an acceptable method, availability of skilled providers to administer or remove particular methods, lack of information or misinformation and social pressures.

Family planning mobile outreach programs aim to address most of these barriers. In the model we’ve considered, a small team – usually clinical providers (e.g. nurses) and a driver – visits a selected list of communities 2–4 times per year, setting up pop-up clinics either within existing lower-level health facilities or using portable structures such as tents. Ahead of each visit, community mobilizers spread awareness of the service and the value of family planning among community members. At the outreach site, providers run a group information session followed by individual counseling and free provision of a range of modern contraceptive methods including implants, IUDs, injectables, pills, and condoms. In some countries, programs also provide safe-abortion services or post-abortion care (including medical abortion). (More)

GiveWell has recommended a grant to support this intervention, to MSI Reproductive Choices, for programs in Nigeria and Sierra Leone. MSI is the only organization we have investigated in depth for this intervention to date.

How cost-effective is it?

We think mobile outreach programs are plausibly cost-effective for the following reasons:

• We estimate that a substantial fraction of contraception provided is counterfactually additional. We estimate roughly 50% of years of contraception provided by an outreach program we considered in Sierra Leone and Nigeria are additional – contraception clients would not otherwise have used. This is based on our analysis of the implementer’s client survey data (more).
• The cost of providing contraception through mobile outreach appears low relative to its value. The program we considered cost the implementer $5-7 per year of contraception provided, and cost roughly $8-9 including leveraged costs such as commodities, some of which are allocated to the program by the government. We think low program costs are plausible because a small team of clinical providers can serve many clients in a year if they visit each community a limited number of times a year and because mobile outreach can fill gaps in service delivery capacity for LARCs, which tend to be cheaper per year of contraception. (More)
• We think the value of additional voluntary contraception is substantial in LMICs. We estimate a counterfactually additional year of modern contraception would be above our current cost-effectiveness bar (6x GiveWell’s benchmark) if it can be delivered for less than $35. This is because we think voluntary contraception results in a range of benefits, including improved subjective wellbeing and health for women and children, increased resources per existing child, and increased earnings for women. We think benefits may be higher in some places where the health and economic consequences of unintended pregnancies are more negative; for example we estimate that providing an additional year of contraception in Nigeria would be above our cost-effectiveness bar if it can be delivered for less than $43. (More)

The table below illustrates our cost-effectiveness analysis using an expansion of mobile outreach in Nigeria as an example.1 This is illustrative; cost-effectiveness will vary by country, program design, and implementation quality.

What we are estimating	Best guess (rounded)	Confidence intervals (25th–75th percentile)	Implied cost-effectiveness
Grant amount (arbitrary value)	$1m
Implementer cost per couple-year of modern contraception provided	$6.74	$4–$9	10–23x
% of years of contraception provided that are counterfactually additional	50%	25–70%	7–19x
Value of an additional year of voluntary contraception (more)	0.86	0.3–1.4	5–22x
Initial cost-effectiveness estimate	~19x
Adjustment for additional program benefits and downsides	−15%	−35–0%	11–16x
Adjustment for diverting other actors’ spending into program (“leverage”)	−6%	−25–0%	11–15x
Adjustment for diverting other actors’ spending away from program (“funging”)	−10%	−25–0%	12–15x
Overall cost-effectiveness (after adjustments)	~14x

Outside-the-model considerations

We’ve also considered other factors that might not be captured explicitly in our cost-effectiveness estimate (more). Overall, we think these additional considerations moderately strengthen the case for supporting family planning mobile outreach at this time. These outside-the-model factors include:

• International donor funding for family planning has been cut and mobile outreach appears to be more reliant on donor funding, meaning the room for more funding is probably relatively high.
• Major family planning funders and experts overall seem to have a positive view of this type of program, and in particular its ability to provide modern contraception to people who benefit from it the most. Most reported that major implementers generally delivered high quality services at scale, though some noted increased risk of unwanted contraception given the emphasis on number of people using modern contraception and the provision of long-acting, provider-administered methods in particular.

How could we be wrong?

Overall, we are cautiously optimistic about the case for this intervention. However, we have not considered it in as much depth as programs we have funded for longer, and our analysis contains a number of open questions and uncertain assumptions. The most important ways our analysis could be wrong are:

• The amount of contraception provided that’s counterfactual additional may be lower than we estimate. Our estimate relies on client survey data and data about the mix of contraceptive methods provided by an implementer, as well as our own informed guesses, rather than robust evidence of the effect of mobile outreach on contraceptive use. Our interpretation of existing evidence on family planning interventions more broadly is that high-quality evidence of effects on use of modern contraception is limited and effects may vary widely across interventions and contexts. (more)
• The value of a year of contraception is highly uncertain and subjective. We think there are several ways our estimate of the value of contraception in LMICs could be wrong, including our approach to capturing autonomy benefits, our decision to assign no negative or positive value to potential lives that don’t occur due to contraception, and our estimate of the effect of additional contraception on risk of unintended pregnancies. Our 25th–75th percentile confidence interval spans a range implying the cost-effectiveness of mobile outreach programs may be below our cost-effectiveness bar to substantially above it. (more)
• The risk of unwanted or misinformed use of contraception may be higher than we estimate. While we think this risk is low in high quality mobile outreach programs and that major implementing organizations take it seriously, we think it is difficult to eliminate at scale and may be elevated in programs that visit communities infrequently and provide long-acting reversible contraceptives that can only be removed by skilled providers. We currently apply a subjective 15-20% downward adjustment to our cost-effectiveness estimate to account for the ethical concerns and negative value that would result from unwanted contraception but are highly uncertain about the size of this adjustment. (more)
• We may be underestimating costs imposed by mobile outreach on health systems that are not covered by implementers. For example, some mobile outreach programs provide services at lower-level public health facilities and use existing health workers to support service delivery or generate demand (more). While this can increase integration of mobile outreach programs into government health systems, it may also divert infrastructure and labour away from other health services. We currently assume this diversion reduces cost-effectiveness by around 6% but we are highly uncertain about this adjustment.

1. Basics

1.1 What is the problem?

Roughly 80 million women in low- and middle-income countries (LMICs) had unmet demand for contraception in 2024, and a further 136 million report wanting to avoid a pregnancy but are not using a modern contraceptive method.2 Some of this comes from supply-side constraints: geographic distance from facilities, lack of trained providers, and limited availability of specific types of contraceptives.3 LARCs like contraceptive implants and hormonal IUDs are particularly hard to access outside urban areas because they require trained clinicians to insert and remove, and lower-level health facilities often lack both the staff and supplies to provide them.4 Stated demand for contraception may also be affected by issues that can be addressed by an implementer: for example, inaccurate beliefs about pregnancy risks, or lack of knowledge of the benefits and side effects of modern contraceptives.

We think that increased voluntary uptake of modern contraception could lead to several benefits. The main benefits we model are improved health for women and children, increased earnings for women, increased resources for existing children, leading to better educational outcomes and future earnings, and improved subjective well-being for women from reduced pregnancy-related stress and greater reproductive autonomy. See our page on valuing contraception for more details.

1.2 What is the program?

The specific family planning mobile outreach program we considered sends a small team of trained providers on regular circuits to communities that would otherwise lack access to a full range of modern methods. Key features include:

• Site selection guided by data on unmet need, poverty, and distance from existing service providers, typically conducted annually in collaboration with government health authorities.5
• Community mobilization ahead of visits, conducted by community health workers and/or mobilizers, to inform residents of the upcoming clinic and encourage attendance.6
• Pop-up clinics at a local health facility or temporary site, offering a group information session followed by private individual counseling and contraceptive provision for people who choose them.7 Providers offer a range of methods including both short-term and long-term methods.8
• Post-visit follow-up pathways, typically including referral information for the nearest facility for LARC removal or side effect management between outreach visits.9

Programs vary in visit frequency (e.g., 2 to 4 times per year per community)10 and extent of integration with public health systems. More established programs may also use outreach visits to build the capacity of public sector providers at the facilities they use.11

2. How GiveWell estimates cost-effectiveness

GiveWell aims to recommend programs that save or improve lives as much as possible per dollar donated (see our page on cost-effectiveness here). To estimate this, we produce a cost-effectiveness analysis (CEA) that generates a best-guess estimate of the overall impact of a program per dollar spent. See our current CEA of a family planning mobile outreach program here.

We use moral weights to quantify the benefits of different impacts. Our baseline value of 1 is defined as the value of doubling one person's consumption for one year. The main moral weights relevant for family planning mobile outreach are:

Benefit	Moral weight
Doubling consumption for one person for one year	1
Value of one counterfactually additional year of wanted modern contraception (Nigeria)	~0.86
Value of one counterfactually additional year of wanted modern contraception (Sierra Leone)	~0.68

The values above for contraception are from GiveWell's preliminary Valuing Contraception model, which estimates the health, wellbeing, and economic benefits accruing to women and families from a year of voluntary modern contraception. These estimates are themselves highly uncertain (see Section 3.3).

We express cost-effectiveness in multiples of our benchmark. Our benchmark estimates the value per dollar from the increase in consumption that results from cash transfers, assuming a baseline annual consumption of $2.15 per day (2017 PPP).

3. How cost-effective is family planning mobile outreach?

We estimate that a well-implemented family planning mobile outreach program in regions in sub-Saharan Africa with relatively high unmet demand is roughly 10-14 times as cost-effective as our benchmark, before accounting for learning value. Our cost-effectiveness estimate is illustrated for Nigeria in the table above. Cost-effectiveness may vary substantially by setting and implementer.

The key drivers of this estimate are: (i) the cost of delivering a year of protection is low; (ii) a meaningful fraction of contraception delivered is counterfactually additional; and (iii) the value of that additional contraception is substantial in high-burden settings.

3.1 Cost of delivering a year of modern contraception

We estimate that well-run mobile outreach programs can deliver a year of contraception12 at a program cost of roughly $5–7, and at a total cost (including government-donated commodities and leveraged health worker time) of roughly $8–9 per year of contraception, or $16-18 per year of contraception that would not otherwise have occurred.

We think two factors may help lower the cost per year of modern contraception provided by mobile outreach compared to some other approaches to family planning service delivery. First, it may be more efficient to have a small mobile team serving many communities by visiting them periodically, compared to paying many providers to have a more continuous presence in each community. Second, the vast majority of years of contraception in mobile outreach programs may come from LARCs if outreach is targeted to communities where there are gaps in provision of these specific methods.13 The commodity costs of LARCs are typically lower per year of protection than short-acting methods. We estimate commodity costs of roughly $0.10–$2.75 per year of contraception for implants and copper IUDs, compared to $3.25–$4.65 for injectables or pills.14

On the other hand, we think that other factors may drive up costs in a mobile outreach program, including:

• The costs of vehicles, fuel and maintenance, especially for mobile outreach teams that need to travel long distances or in challenging terrain to reach communities with limited access
• The cost of recruiting, training, and supervising providers who are administering a range of methods at high quality while spending a lot of time travelling across different communities
• The time and effort required to address misinformation or lack of knowledge, which may mean that client volumes are sometimes low relative to the cost of reaching communities (especially in communities that have less previous exposure to family planning programs)

3.2 Counterfactual additionality

One of the most critical parameters in our cost-effectiveness estimate is the proportion of years of contraception delivered by the program that are counterfactually additional, that is, that would not have been obtained in the program's absence.

We do not have rigorous experimental evidence on this parameter for mobile outreach programs specifically.15 Instead, we estimate it using a combination of program data and judgment. See these estimates for Nigeria here and Sierra Leone here. Our methodology, informed by analysis of client exit interview data from programs operating in Nigeria and Sierra Leone, involves the following steps:

• We start with two key statistics from client exit interviews: (i) the proportion of clients who report knowing of another provider offering the same or a comparable service; and (ii) the distribution of prior family planning use (first-time users, recently lapsed, and current users).
• Knowledge of another provider is an imperfect proxy for counterfactual access – someone may know of an alternative provider but still face barriers to using that provider. We apply a discount to convert "knows of another provider" into "would have obtained contraception through that provider," applying a larger discount for first-time users (who we assume face more barriers, −50%) and a smaller discount for recent users (−20%).
• We then translate from counterfactually additional users of contraception to counterfactually additional years of contraception usage. For clients who are counterfactually additional users, we assume ~80% of their years of contraception usage are additional (rather than 100%), to account for the possibility that some would have started contraception at a later date rather than never. For clients who are not counterfactually additional users, we assume ~20% of their years of contraception usage are still additional, because receiving a LARC through the program may extend the duration of protection relative to a shorter-acting method they would otherwise have used.

Applied to exit interview data from Nigeria – where 32% of clients reported knowing of another provider offering the same service, and 48% were first-time users – this methodology implies that approximately 56% of recorded years of contraception are counterfactually additional. In Sierra Leone, where 46% of clients knew of another provider and 31% were first-time users, we estimate a similar figure of approximately 50%. Our 25th–75th percentile range for this parameter is 25–70%.

We expect counterfactual additionality to vary meaningfully with how well the program targets communities with genuinely limited alternative access to modern contraception. Programs achieving a higher proportion of first-time users and clients who cannot identify alternative providers should, all else equal, have higher counterfactual additionality.

3.3 Value of a counterfactually additional year of contraception

We use GiveWell's Valuing Contraception BOTEC to estimate the value of a counterfactually additional year of wanted modern contraception.16 In Nigeria, we estimate this at approximately 0.86 units of value, broken down roughly as follows:

• Improved health for women and newborns (~40% of value): averted maternal mortality and morbidity in settings with high maternal and infant mortality rates.
• Improved subjective wellbeing for women using contraception (~30% of value): benefits from reduced anxiety about unwanted pregnancy and greater control over reproductive choices.
• Increased resources for existing children from fewer births (~20% of value): existing children may see higher consumption, more educational investments, and/or more parental attention.
• Increased household income from higher earnings of women using contraception (~10% of value): fewer unintended pregnancies may allow women to spend more time on income-generating activities or education.

We are highly uncertain about this estimate. Our 25th–75th percentile range is 0.3–1.1 units of value – implying that uncertainty about the value of contraception alone could shift cost-effectiveness by a factor of nearly four. Our largest source of uncertainty is the number of unintended pregnancies averted per year of modern contraception, because many of the benefits flow through averted unintended pregnancies and we have imperfect evidence for this estimate. We also have qualitative uncertainties not fully captured by the model, including the full value of reproductive autonomy and the effect of increased contraception access on long-run gender equality.

These estimates translate into cost-effectiveness thresholds: in Nigeria, we estimate a year of modern contraception would be cost-effective at 6x our benchmark if delivered for $43 or less; in Sierra Leone, for $34 or less.

3.4 Additional adjustments

Our cost-effectiveness estimate includes several additional adjustments:

• Unwanted or unused contraception (−15% to −20%). We apply a downward adjustment to account for contraception that is administered but not wanted, for example due to barriers to LARC removal. We apply a larger discount in settings where LARC proportions are higher and follow-up visit frequency lower. These adjustments are uncertain.
• Switching to preferred method (+5%). A small upward adjustment for women who are not counterfactually additional users of contraception overall but who switch to a method they prefer more as a result of the outreach visit expanding their choice of methods. This adjustment is subjective, and we're uncertain about its magnitude.
• Leveraged costs (−6% to −20%). We apply a downward adjustment to reflect costs borne by the government and other actors (commodity donations, health worker time). We assume these resources have a counterfactual value of ~5x the GiveWell benchmark.
• Funging risk (−10% to −30%). We apply a downward adjustment for the risk that the program's activities are fungible with funding that would have occurred anyway – either from within the implementing organization (if it has significant reserves) or from other donors. This would vary substantially by organization and program; new teams in high-need areas with no likely alternative funder warrant a lower adjustment than existing teams at well-funded organizations.

3.5 Shortcomings and uncertainties

Our cost-effectiveness estimate is highly uncertain. Sensitivity analyses on individual parameters imply cost-effectiveness ranging from roughly 4x to 22x. The most important uncertainties are:

• To what extent the contraception provided is counterfactually additional. We haven’t found peer-reviewed RCTs or quasi-experimental evaluations of mobile outreach programs closely resembling this model appear in the published literature.17 The two RCTs most relevant to this question – one testing home-based counseling plus free transportation in urban Malawi (Karra et al. 2022) and one testing family planning vouchers in rural Burkina Faso (Dupas et al. 2025) – show mixed results and differ in important ways from mobile outreach.18 (more)
• The value of an additional year of wanted contraception. This is highly uncertain, and our model may not fully capture benefits, including reproductive autonomy, and downsides, such as unwanted side-effects. See Section 3.3 above for our model, or more on this uncertainty below.
• The amount of wanted contraception per CYP counted. Our model uses CYPs delivered as a proxy for actual years of use. For LARCs, this depends on clients wearing implants for the amount of time implied by standardized CYP factors (e.g. 4.6 years for an IUD), which are not program-specific Additionally, there is some risk of unwanted or misinformed usage of contraception, which we account for using subjective adjustments (more).

4. Additional considerations outside our cost-effectiveness model

Several factors beyond the CEA inform our view of this intervention.

There is substantially less funding available for family planning programs than in previous years. The US historically provided approximately 40% of total bilateral donor funding for family planning globally (~$600 million per year),19 and the current administration has proposed eliminating bilateral family planning assistance entirely in its last two annual budget requests.20 The Netherlands and the UK – the second and third largest government funders historically21 – have also announced general aid reductions.22 We believe this increases the counterfactual importance of philanthropic funding in the near term and makes funging risk lower than it would otherwise be for most family planning programs.

Mobile outreach has a relatively straightforward theory of change, making it easier for GiveWell to assess in an area that is new to us, compared to some other types of family planning programming. It mostly involves geographically targeted direct service delivery by program staff, with a relatively simple causal chain between activities and outcomes.

Major family planning funders view this model positively. In conversations with staff at major family planning funders, we heard positive assessments of mobile outreach as a delivery model for reaching people with limited alternative access to contraception, and for whom the value of contraception is high. We put some weight on these assessments, though note that they come from funders who have made significant commitments to similar programs.

5. How could we be wrong?

5.1 Counterfactual additionality may be lower than estimated

Our estimate of ~44% counterfactual additionality is constructed from observational data and judgment. We’re not aware of any peer-reviewed RCTs or quasi-experimental studies on the impact of a mobile outreach program, or similar programs, on modern contraceptive use.

The family planning High Impact Practices brief on mobile outreach listed several impact studies at the time we reviewed it, but we didn’t identify any that were able to attribute changes in contraception to outreach programs specifically. Recent RCTs that we’re aware of show mixed results and studied interventions that differ in important ways from mobile outreach. Dupas et al. 2025, found no statistically significant effect of a family planning program (providing vouchers to eliminate user costs) on contraceptive use in Burkina Faso, as well as no apparent effect from information interventions intended to address factors undermining demand for contraception.23 On the other hand, Karra et al. 2022 found that home-based counselling, free transportation to family planning clinics and reimbursement of contraceptive costs in urban Malawi increased contraceptive use by 6 percentage points after 2 years of the intervention.24

Our impression is that family planning products and services in LMICs are often available through multiple channels (private sector, public sector and NGOs), making it difficult to assess the impact of any one program. This means that counterfactual use is unlikely to be close to zero, unlike with some other GiveWell-funded health programs where the funded program is the main source of the treatment (e.g. seasonal malaria chemoprevention campaigns). We view the additionality parameter as the single most important area for independent evaluation to help ground our estimates.

5.2 Uncertainty about the value of a year of contraception

Our valuation of a year of contraception is highly uncertain and subjective. Our central estimate places the value of a counterfactually additional year of wanted modern contraception at roughly 0.35–1.05 units, depending on the country, drawn from GiveWell's modern-contraception valuation model. We think there are several ways this estimate could be wrong:

• Our approach may not fully capture the benefits and downsides of contraception, such as increased reproductive autonomy (aside from resultant increases in wellbeing), side-effects (both wanted and unwanted), and effects on partner wellbeing or behavior.
• The estimate depends on how many unintended pregnancies a year of contraception actually averts, a figure we estimate to be roughly 0.23–0.38, and for which empirical uncertainties remain. More details about these uncertainties can be found here.
• We do not place any value, positive or negative, on potential lives that do not occur as a result of contraception. See more on our reasoning for excluding that effect here.

5.3 Risk of unwanted or misinformed use of contraception

We think that many family planning programs create some risk of unwanted or misinformed use of contraception given challenges in providing full information and fully understanding clients’ preferences, but some mobile outreach programs may face elevated risks for structural reasons: they may deliver LARCs which are provider-administered and require a provider to remove, they visit communities only periodically (limiting access to removal and other after-care between visits), and programs focused on improving cost-efficiency may prioritize uptake over quality of counseling (possibly inadvertently).

We are very uncertain about the prevalence of different forms of misinformed or unwanted contraception usage. One reason is that survey-based measures of misinformed or unwanted contraception may understate or overstate its prevalence because of cultural and language barriers, participants not being aware they have received biased information, or participants giving an answer they think the surveyor prefers.

Senderowicz et al. 2023, which reports on a survey of women in Burkina Faso, provides some tentative evidence that overt autonomy issues, including refusal to remove a LARC at a woman's request or insertion without consent, are uncommon, with roughly 2–5% of LARC users in the survey being denied discontinuation or using contraception against their will.25 Subtler issues such as biased counseling, limited information about side effects, or LARC-first approaches that do not adequately surface client preferences, appear to be more common, with between 45–96% of contraceptive users self-reporting various indicators of informed choice depending on the specific indicator, and around 47–48% knowing a disadvantage of their specific method.26

Canning and Karra 2023 measures unwanted family planning defined by reported use of contraception despite a stated preference to have a child in the next nine months.27 This measure suggests that unwanted family planning use is quite uncommon in LMICs (2% of women at risk of getting pregnant), and possibly less common among implant users than users of condoms or traditional methods.28 However, the authors note that this metric does not take into account that some women may have non-fertility based reasons for not wanting to use contraception, and that the data they use does not include the preferences of women who have been sterilized.29

We account for unwanted or unused contraception via a 15–20% downward adjustment in our CEA, but this adjustment is highly uncertain and is not firmly grounded. Independent monitoring data would be needed to estimate its magnitude more precisely. We think that well-designed programs with robust counseling guidelines, effective client exit interviews, mystery client visits, and clinical quality audits reduce this risk, but do not necessarily eliminate it at scale.

Our process

To develop this intervention report, we:

• Conducted a shallow review of published literature on the effectiveness of family planning outreach programs, including systematic reviews and relevant RCTs.
• Spoke to external family planning researchers and funders, and academic researchers working on family planning RCTs and contraceptive autonomy measurement.
• Conducted an investigation of an implementer's programs in Nigeria and Sierra Leone, including multiple rounds of written questions and meetings with staff and review of service delivery and cost data (2023–2024) and internal counseling and informed consent guidelines.
• Reviewed an implementer's client exit interview summary statistics from a random sample of Outreach sites in Nigeria and Sierra Leone (2019–2024).
• Built a cost-effectiveness analysis drawing on that implementer's programmatic cost and service delivery data and GiveWell's Valuing Contraception BOTEC.

We have spent less time on this program than on GiveWell's Top Charity interventions. In particular, we did not: attempt a deep or systematic review of the academic literature on family planning program effectiveness; conduct a site visit; or seek external expert review of our CEA assumptions for this intervention report. We may conduct site visits and gather independent M&E data as part of grants we make to support this program, which will inform updates to this report.

Sources

Document	Source
Bain et al. 2021	Source
Canning and Karra 2023	Source
Dupas et al. 2025	Source (archive)
Family Planning High Impact Practices, Family Planning Mobile Outreach Services: Expanding Equitable Access to a Full Range of Modern Contraceptives	Source (archive)
GiveWell, Family Planning Mobile Outreach BOTEC, 2026	Source
GiveWell, Valuing Contraception	Source
GiveWell, Valuing Contraception BOTEC, 2025	Source
GiveWell, Valuing Contraception BOTEC, 2026	Source
Guttmacher, "Adding It Up 2024: Investing in Sexual and Reproductive Health in Low- and Middle-Income Countries"	Source (archive)
Karra et al. 2022	Source
KFF, "The Trump Administration’s Foreign Aid Review: Status of U.S. Family Planning and Reproductive Health Efforts"	Source (archive)
KFF, Donor Government Funding for Family Planning in 2024	Source (archive)
MSI, Summary of data, impact and cost effectiveness of outreach service delivery model in 2 MSI country programmes, 2023-2024.	Source
MSI, conversation with GiveWell, May 20, 2025	Unpublished
MSI, Delivering Cost Effective Impact: An Investment in Reproductive Health in Nigeria, 2025	Source
MSI, Delivering Cost Effective Impact: An Investment in Reproductive Health in Sierra Leone, 2025	Source
MSI, email to GiveWell, February 22, 2025	Unpublished
MSI, Grant Q&A	Unpublished
OECD, Development Co‑operation Profiles: Netherlands	Source
Senderowicz et al. 2023	Source
Shimels et al. 2025	Source
UK Parliament House of Commons Library, "UK aid: Reducing spending to 0.3% of GNI by 2027/28"	Source (archive)
UNFPA Contraceptives Price Indicator, 2022	Source (archive)
Weinberger et al. 2019	Source

• 1See our Simple CEA for Nigeria here.
• 2"Out of 928 million women of reproductive age in 128 LMICs who want to avoid pregnancy, approximately 78 million have an unmet demand for contraception." Guttmacher, Adding It Up 2024: Investing in Sexual and Reproductive Health in Low- and Middle-Income Countries, 2025. An additional 75 million report using traditional methods of contraception, and 61 million report no intent to use contraception. See Figure 1.
• 3
  • "Among immediate and extended postpartum women, barriers included limited awareness and fear of insertion pain for IUCDs, low awareness, and limited access to LARCs." Shimels et al. 2025
  • "Health systems-based barriers which were reported by 7 of the studies comprised five sub-themes; lack of privacy and confidentiality at health facilities, negative attitude of health professionals, long waiting time, poor communication between health professionals and young people, and physical inaccessibility of buildings by the persons with disability as the sub-themes." Bain et al. 2021

• 4MSI Reproductive Choices, conversation with GiveWell, May 20, 2025 (unpublished).
• 5"Outreach sites are selected in close coordination with the District Health Medical Team (DHMT) and local community leaders... MSSL holds an annual meeting during which a review of available data is done to determine areas where there are limited options for services, and communities that have been underserved." MSI, Delivering Cost Effective Impact: An Investment in Reproductive Health in Sierra Leone, 2025, p. 4

  "Site selection is a standardized process in Nigeria and conducted annually to review each outreach teams’ planned footprint to confirm that we reach communities with limited access to FP, and to explore potential areas for expansion. The process begins with a 2-day work planning meeting in collaboration with each state government…Data sources and other information/factors considered include…the data from MSIN generated heat maps, developed from secondary data sources to understand the geographic distribution of different marginalized populations (most notably, people living in poverty), to ensure the program is driving equity in access." MSI, Delivering Cost Effective Impact: An Investment in Reproductive Health in Nigeria, 2025 p. 4-5

• 6"Community Based Mobilizer and along with the designated Behavior Change Communicator (BCC) officers (both employed by MSSL), carry out pre-community engagement and mobilization activities usually a month in advance as well as two to three days prior to service delivery. Mobilizers also conduct day-of mobilization through megaphones and vehicle public address systems to ensure that the community is well informed of the team’s visit." MSI, Delivering Cost Effective Impact: An Investment in Reproductive Health in Sierra Leone, 2025, p. 5
• 7"Immediately prior to each outreach session, group education sessions, led by an outreach provider, are held…Following the group education session clients receive individual counselling in a private area by a trained provider." MSI, Delivering Cost Effective Impact: An Investment in Reproductive Health in Sierra Leone, 2025, p. 5-6
• 8"The teams provide free, quality, short-term (STM), long acting and permanent FP methods (LAPM)." MSI, Delivering Cost Effective Impact: An Investment in Reproductive Health in Nigeria, 2025, p. 4
• 9"Clients are also provided with contact center details, to both discuss concerns and/or get referral information for removals. MSI contact center teams use a database of active service delivery sites which includes MSI trained PSS facilities and MSI service delivery sites to guide client referrals to where they can access continuum of care services including LARC removals." MSI, Grant Q&A (unpublished)
• 10"MSIN Outreach teams will typically visit each site 3-4 times a year, however, there may be some instances where sites are visited less frequently, for example, if a site has very low turn-out after multiple visits we may decrease the visit frequency." MSI, Delivering Cost Effective Impact: An Investment in Reproductive Health in Nigeria, 2025, p. 5
• 11"Depending on the site and the type of outreach, there could be anywhere from 1-3 public providers supporting an outreach day. This is done increasingly as part of MSIN's capacity-building efforts to strengthen the cadre of providers in the public sector that can provide the full range of FP services." MSI, MSI, Delivering Cost Effective Impact: An Investment in Reproductive Health in Nigeria, 2025, p. 4
• 12Our valuation of contraception relates to an 'additional year of modern contraception,' but what most programs report are couple-years of protection (CYPs), which is a standardized measure of the number of contraceptives delivered. In reality, not all of the contraceptives delivered will be used, and some will be used for shorter or longer periods than the CYP calculation factors assume, so there can be a difference between 'years of modern contraception,' which implies usage, vs. 'CYPs'. Since our CEA is in an early stage, we use CYPs as a proxy for years of modern contraception.
• 1399.6% of CYPs from MSI Nigeria Outreach and 93.1% from MSI Sierra Leone Outreach come from long-acting and permanent methods (2023-2024). Source: unpublished internal analysis of MSI, Summary of data, impact and cost effectiveness of outreach service delivery model in 2 MSI country programmes, 2023-2024
• 14See the 2022 UNFPA Contraceptive Price Indicator. Copper IUDs cost $0.09/CYP, and implants cost approximately $2.75/CYP, compared to 3-month injectables at $3.25/CYP and oral contraceptive pills at $3.48–$4.64/CYP.
• 15A literature search conducted as part of the grant investigation did not identify any peer-reviewed RCTs or quasi-experimental studies on the impact of mobile outreach programs on modern contraceptive use. The High Impact Practices brief on mobile outreach lists several "impact" studies, but a spot check of these found they did not isolate the attributable impact of outreach specifically.

  Weinberger et al. 2019 found that "...There was a feeling that robust evidence existed for mobile outreach services, but only two studies that met inclusion criteria could be identified. While program data on mobile outreach exists on the volume of clients served by individual programs or in specific countries, little was found that assessed the impact of these programs on changing contraceptive use at a community or population level."

• 16See accompanying write-up for more details about our valuation of contraception
• 17A literature search conducted as part of the grant investigation did not identify any peer-reviewed RCTs or quasi-experimental studies on the impact of comparable mobile outreach programs on modern contraceptive use. The High Impact Practices brief on mobile outreach lists several "impact" studies, but a spot check of these found they did not isolate the attributable impact of outreach specifically.

  Weinberger et al. 2019 found that "...There was a feeling that robust evidence existed for mobile outreach services, but only two studies that met inclusion criteria could be identified. While program data on mobile outreach exists on the volume of clients served by individual programs or in specific countries, little was found that assessed the impact of these programs on changing contraceptive use at a community or population level."

• 18Karra et al. 2022 conducted a randomized trial in urban Malawi providing home-based counseling, free transportation to clinics, and financial reimbursement for family planning services. After two years, contraceptive use increased by 5.9 percentage points. Dupas et al. 2025 provided family planning vouchers in rural Burkina Faso and found no effect on contraceptive use, even with additional demand-side interventions.
• 19"As in the past, the U.S. was the largest donor government to family planning in 2024, accounting for 43% (US$579.6 million) of total funding." KFF, Donor Government Funding for Family Planning in 2024, 2025.
• 20"The administration’s FY 2026 budget request does not include any funding for bilateral family planning or UNFPA (final appropriation levels are determined by Congress)." KFF, The Trump Administration’s Foreign Aid Review: Status of U.S. Family Planning and Reproductive Health Efforts, 2025.
• 21"As in the past, the U.S. was the largest donor government to family planning in 2024, accounting for 43% (US$579.6 million) of total funding, followed by the Netherlands (US$194.7 million, 14%), the U.K. (US$190.0 million, 14%)." KFF, Donor Government Funding for Family Planning in 2024, 2025.
• 22
  • "In February 2025, the UK Government announced that UK aid spending will be “gradually reduced” from 0.5% of gross national income (GNI) to 0.3% of GNI in 2027." House of Commons Library, UK aid: Reducing spending to 0.3% of GNI by 2027/28, 2026.
  • "The new development aid policy of February 2025 announced a structural reduction in ODA spending of EUR 2.4 billion, starting in 2027. The cuts are expected to reduce the ODA/GNI ratio to 0.44% by 2029, compared to 0.66% under previous budget plans." OECD, Development Co‑operation Profiles: Netherlands, 2025

• 23
  • "In the spring of 2018, we recruited a baseline sample of more than 14,000 households from 499 villages that cover half of the Burkina Faso provinces…We find that the full subsidy intervention had no significant effect on fertility during the 3-year period, or on the probability and duration of modern contraceptive use, relative to the 10 percent subsidy comparison group."
  • “Second, to address the fact that baseline proxies of demand-side frictions are not exogenous, we cross-randomize information interventions … We do not find that the village-level interventions modified the effects of the full subsidy: None of the interaction terms are significant (Table 6). The main effects of the interventions themselves are also insignificant, suggesting that the interventions had no average effect. We confirm this when we estimate the effects of the demand interventions without interaction terms (Supplemental Appendix Table B3). We find similar null results for the individual edutainment treatment, which entailed showing the woman and her household members the edutainment film on a tablet computer in her home. … In the same way, the full subsidy did not lead to a larger decline in fertility for those provided accurate child mortality information. The coefficient on the interaction is small and statistically insignificant for births and pregnancies (columns 1 and 2 of Table 6). The interaction term is also small and insignificant for the contraceptive use measures (columns 3 and 4). Table 6 further shows that the intervention itself did not affect fertility or the demand for contraception (the main effects are not significant).”

  Dupas et al. 2025.

• 24
  • "A woman who was randomly assigned to the intervention arm was presented with the following services:
    1. An FP information package and up to six private counseling visits at or near her home with FP counselors, who were trained by the Ministry of Health’s Reproductive Health Directorate;
    2. A free transportation (taxi) service to a designated high-quality FP clinic with low waiting times;
    3. Free FP services at the designated clinic or financial reimbursement for any FP services received at other clinics; and
    4. Free over-the-phone consultations with a doctor and referral services, along with reimbursement for treatment costs in the event that the woman experienced any contraindications or side effects related to her use of FP."
  • "In our adjusted analysis, we find a 5.9-percentage-point (p.p.) increase [95% CI: 2.4, 9.4] in contraceptive use among women in the intervention group after 2 y of exposure to our intervention."

  Karra et al. 2022

• 25See Senderowicz et al. 2023, table 2.
• 26Senderowicz et al. 2023, table 2.
• 27“We provide estimates of unwanted family planning using Demographic and Health Survey data collected from 1,546,987 women in 56 low- and middle-income countries between 2011 and 2019. We estimate the prevalence of unwanted family planning, defined as the proportion of women who report wanting a child in the next nine months but who are using contraception.” Canning and Karra 2023.
• 28See Canning and Karra 2023, table 3.
• 29
  • "Another measurement concern is that the DHS surveys do not elicit fertility preferences from women who report being sterilized; these women are all reported as having a met need for limiting. Given the history of forced and coerced sterilizations of women worldwide (Open Society Foundations 2011), it is quite possible that some of these sterilizations were coercive and are not aligned with women's true fertility preferences. At present, we have no way of observing this potential discordance in the data."
  • "An issue that we can currently say very little about is why there is unwanted family planning…At present, no follow-up questions are asked to women with unwanted family planning, thereby making it difficult for us to ascribe causes to this discordance…The widespread use of condoms by women with unwanted family planning is also consistent with a desire to protect against HIV and other sexually transmitted diseases, while the contraceptive effect from this use may be unwanted."

  Canning and Karra 2023