Access to Medicines Initiative — Contraceptive Supply in Nigeria (June 2025)

Note: This page summarizes the rationale behind a GiveWell grant to Access to Medicines Initiative at the time we recommended the grant. Access to Medicines Initiative staff reviewed this page prior to publication.

Published: November 2025

The organization

Access to Medicines Initiative (AMI) was founded in 2024 and incubated by Ambitious Impact - previously Charity Entrepreneurship.1 The organization focuses on improving contraceptive commodity supply to public health facilities in northern Nigeria, with a current focus on Katsina state.2

AMI previously conducted an initial pilot in Katsina and Sokoto states between September 2024 to May 2025.3 Through this and other earlier work, they've concluded that overall procurement of contraceptives in this context is insufficient, and that improvements to supply chains and allocation of available commodities alone won’t enable all current demand to be met.4 AMI reported that procuring and distributing additional contraceptives directly to public health facilities substantially increased uptake of most contraceptive methods (30-240% for a range of methods except IUDs, which do not seem to be in short supply).5 In addition, AMI reports that advocating and supporting state governments in Nigeria to finance and procure contraceptives could help to sustainably increase the supply of contraceptives over the longer term.6

The grant

This grant will support AMI to:7

• expand procurement and distribution of contraceptive implants and non-hormonal IUDs to all public health facilities in Katsina state, while continuing to monitor how contraceptive uptake at facilities changes in response by digitizing and analyzing health facility family planning registers;8
• conduct M&E activities to monitor contraceptive inventories (via direct observation), the capacity of health workers to deliver family planning (FP) services, including LARC insertions and removals (via a provider survey/form), the quality of FP counselling (via at least one "mystery client" visit to each facility), and possible theft of commodities (by testing a range of low-cost tracking tools);9
• support the Katsina state government to approve a policy allowing state-funded contraceptive procurement, and subsequently advocate the Katsina government to allocate a budget line for funding contraceptives;10
• travel to Nigeria and other sites to oversee program operations and attend relevant conferences.11

Budget

This grant would fill AMI’s funding gap of $159,655 for their ‘minimum’ Year 2 budget of $204,655 through to the end of March 2026. If AMI does not raise additional funding, this would result in the GiveWell-recommended grant accounting for 78% of their total funding for Year 2.12 We expect AMI will continue fundraising to establish a diversified funding base and support additional activities. If it succeeds in doing so, the GiveWell-recommended grant could account for 55% (AMI’s ‘planned’ scenario) or 41% (AMI’s ‘ideal’ scenario) of their total funding.13

The case for the grant

Improving supply of contraceptive commodities – AMI’s focus – is a particular area of interest for GiveWell within family planning

This is because:

• We think there are large, chronic funding gaps for family planning commodities, which are likely to be exacerbated by foreign aid cuts. We’ve consistently heard during our conversations with experts and stakeholders in the space that in previous years there have been funding gaps for family planning commodities in low and middle-income countries (LMICs), in the order of at least $100m a year.14 In addition, around $60m of annual funding for family planning commodities funded by the U.S. government are at risk if the government reduces its foreign aid funding.15
• We’ve heard from multiple existing funders and implementers of family planning programs that improving family planning commodity supply and supply chains should be a priority area for additional funding within family planning.16 We think this broadly makes sense, because:
• There are reports from multiple academic papers that contraceptives are commonly stocked out in LMICs.17
• It's our understanding from investigating this space that other types of funding for family planning programming generally rely on availability of commodities in order to yield benefits.

We think that providing funding to AMI and following their progress will help us learn more about challenges in contraceptive supply and supply chains in the states they work in. AMI was incubated by Ambitious Impact, and we’ve generally had a positive impression of Ambitious Impact-incubated organisations in terms of their alignment with GiveWell regarding transparency, truth-seeking and a focus on cost-effectiveness.

Increasing supply of contraceptives in places where there is insufficient supply is plausibly above our cost-effectiveness bar

We think it’s likely that paying for the cost of procuring a mix of modern contraceptives and distributing them to health facilities is around or above our cost-effectiveness bar, currently 10 times ('10x') the cost-effectiveness of direct cash transfers,18 in settings like northern Nigeria.

Family planning commodities are cheap relative to our estimate of the benefits of an additional year of contraception in LMICs. The commodity cost of a year of modern contraception, averaged across a range of hormonal, non-hormonal, short-acting and long-acting methods, is roughly $3.19 Our current valuation of contraception suggests that an additional year of (wanted) modern contraception would pass our 10x bar in Nigeria if it can be generated at a cost of $26, though we are highly uncertain about our overall valuation.20 The $3 commodity cost is not directly comparable to the $26 threshold, because not all units of contraception procured and delivered will result in counterfactually additional use of contraception, and because there are non-commodity costs involved. However, the difference between these values provides an indication that supplying contraceptives in this context is plausibly above our bar.

AMI's monitoring and evaluation will help us understand to what extent contraceptive uptake increases when availability of commodities is no longer a constraint

We have heard other funders and implementing organisations cite stockouts and limited supplies of contraceptives as a barrier to increased use of modern contraception.21 However, it’s unclear to what extent increased commodity availability alone will increase uptake given demand-side factors are also sometimes cited as explanations for low contraception usage in contexts such as Nigeria (where the modern contraceptive prevalence rate is around 15%, according to Track20).22

In Year 1, AMI monitored how uptake of contraceptives responded to a short-term increase in the supply of contraceptives, and found a large relative increase in uptake of commodities, particularly condoms and implants.23 In Year 2, AMI plans to investigate whether the magnitude of these increases generalizes over location and time. They will do this by:

• Procuring and delivering implants, IUDs and associated consumables to facilities in sufficient quantities (such that supply of commodities is not a constraint) for a longer period of time – eight months instead of two. 24
• Supplying facilities in all 34 LGAs in Katsina state, rather than just two.25

In order to estimate how contraceptive uptake changes, AMI plans to:

• Capture data that is routinely recorded on health facility daily registers, as well as inventory cards and stock registers to monitor how uptake responds to changes in supply. 26
• Roughly infer the effect of their intervention on uptake by looking at how this data changes during the period in which they are supporting commodity supply, relative to a 6-12 month history of the same data.27

Risks and reservations

Higher risks with funding an early-stage organization

We think there’s an elevated risk that AMI will face unexpected challenges and won't be able to execute its plans because they are very early in their organizational development and have less of a track record than organizations we typically fund. We think this risk is acceptable given the size of this grant. We plan to learn more about this risk by checking in with AMI during the grant period.

In addition, GiveWell has funded only a small number of very early-stage organizations to date, so there’s a chance that we aren’t accounting for some unforeseen risks in our approach as a funder. We plan to continue reviewing our approach to funding of early-stage organizations as we gain more experience in this area.

Near-term focus on increasing supply of only long-acting methods may increase risk of subtle coercion and unwanted contraception

AMI plans to focus initially on increasing the supply of Long-Acting Reversible Contraceptives, or LARCs (e.g., contraceptive implants and IUDs). AMI has several reasons for this, including: indicative evidence that implants are one of the most undersupplied methods; that how demand responds to supply is more uncertain with LARCs than with short-acting methods over the longer run; and that with a limited budget it is most feasible to guarantee sufficient supply for implants and IUDs.28 Providing sufficient supply – i.e., enough to meet full demand and avoid stockouts – is a core part of AMI’s program, since they aim to estimate how much demand is currently unmet purely because of constrained commodity availability.29

We think there's potentially increased risk of people being steered towards LARCs, even if this isn’t consistent with their preferences (a form of ‘subtle coercion’30 ) and causes them to face challenges in discontinuing contraception, if AMI’s program makes LARCs much more available than other methods. This is because i) we speculate that some providers may provide biased counselling to encourage clients to take up whichever methods are available, regardless of whether these methods are actually acceptable for clients, and ii) we believe there is a higher risk of coercion and unwanted contraception with LARCs because they provide contraception for multiple years and must be inserted and removed by a healthcare provider.

We think this potential risk is acceptable because:

• AMI plans to monitor and mitigate coercion risks via the following methods, which we believe are reasonable and sufficient given their current scale of operation: i) expanded "mystery shopper" exercises to check for coercion during provider-client interactions, aiming for at least one visit per facility per year;31 ii) continuing to track facility-level data on implant removals and conducting provider surveys to assess whether providers have been trained on removals;32 and iii) providing necessary supplies for removing implants as part of the planned distribution of commodities.33
• AMI thinks these risks are currently small, because i) their own monitoring to date suggests that most providers don’t show a bias towards particular methods, ii) that many women appear to walk away empty-handed if their preferred method is not in stock, and iii) that most facilities in Katsina state that have recorded inserting implants this year have also recorded removing implants.34 Our understanding is that these indicators aren't perfect but together suggest acceptable risk levels, especially since AMI will reduce the larger risk of people being unable to access desired contraceptives due to stock-outs. We think coercion risks are further mitigated by AMI's focus on existing health facilities with trained LARC providers rather than mobile clinics, reducing the risk that clients don't know where to go for removal or face increased travel distances.

• AMI has told us they plan to provide a wider range of methods over the longer-term, and that this could occur as early as the coming year if they are successful in securing a partnership they are exploring with another NGO focused on family planning.35

AMI’s near-term M&E strategy has limitations which mean it probably won’t provide a conclusive estimate of the effect of reducing supply constraints on uptake of contraception

We think that AMI's Year 2 M&E strategy will be limited in internal validity given a few characteristics of their plan. These characteristics are:

• The lack of a comparison group: AMI will estimate the effect of their supply activities by analyzing changes over time in a single group rather than using a comparison group.36 Despite the threat to internal validity, we think this is considered acceptable given their pilot showed large effects (90% increase for implants37 ) that should be detectable in time series data.
• Reliance on health facility registers to measure contraceptive uptake: The health facility data may be inaccurate due to manual updating by staff and could be confounded by improved record-keeping in response to AMI's involvement. We will thus ask AMI how they plan to mitigate these data quality risks.
• Looking only at uptake at public health facilities: Analyzing only public health facility uptake data could mask switching from pharmacies and other access points.

We think the above are acceptable risks in light of AMI’s longer-term plan to estimate these effects using a randomized control trial (RCT).38

Plans for follow up

• We'll have periodic check-ins with AMI where we'll assess progress on planned activities, focusing on contraceptive procurement and delivery, state-level financing advocacy, supply chain insights, and service quality monitoring.
• Towards the end of the grant period we'll review the monitoring data and analysis of the program, as well as assess their funding situation, to inform future family planning funding decisions.

Internal forecasts

For this grant, we are recording the following forecasts:

Confidence	Prediction	By time
70%	AMI will secure additional funding to reach their 'planned' budget through March 2026	End of March 2026
65%	AMI will deliver at least 30,000 implants to health facilities in Katsina by March 2026	End of March 2026
35%	Katsina state will pass legislation enabling state-level contraceptive procurement by March 2026	End of March 2026

Our process

• We first learned about AMI through Ambitious Impact, where co-founder Miri Muntean had authored research reports on family planning interventions.
• We reconnected with AMI in March 2025 after meeting AMI at a conference. We asked them about their pilot results and expansion plans. We then evaluated the case for funding and potential implementation risks by requesting further information from AMI and conducting our own research. Given the relatively small size of this grant, we did not seek external input on AMI’s intervention or the case for making this grant.

Relationship disclosures

Sarah Eustis-Guthrie, a GiveWell staff member who co-founded a charity that was incubated by Ambitious Impact, is friends with Miri Muntean, one of the co-founders of Access to Medicines Initiative. Sarah was not involved in any discussions or decision-making regarding this grant.

Sources

Sources for AMI page

Document	Source
Access to Medicines Initiative	Source (archive)
Adefalu et al, 2019	Source
Ahmed, 2021	Source
Ambitious Impact	Source (archive)
AMI blog, Concluding our pilot	Source (archive)
AMI, “Why Implants” (unpublished)	unpublished
AMI, Budget 2025/2026	unpublished
AMI, EA Forum post, “Introducing Access to Medicines Initiative: Year One Results, Year Two Strategy, and Current Funding Gap”	Source
AMI, Proposal: Increasing contraceptive supply in public health facilities in Katsina State, Nigeria, June 2025	Source (archive)
AMI, Year 2 Cost-Effectiveness Analysis	unpublished
CHAI, Family Planning Market Report, November 2024	Source
Gates Institute, The Future of Family Planning Data, April 2025	Source
GiveWell, Valuing Contraception BOTEC, April 2025	Source
Karimi et al 2021	Source
Muhoza et al 2021	Source
Track20, Nigeria	Source
UNFPA contraceptive price indicator, 2022	Source
Valuing Contraception in GiveWell’s Cost-Effectiveness Analysis	Source

• 1

  "We graduated from Charity Entrepreneurship’s Incubation Program in late April 2024, and received a seed grant to start the Access to Medicines Initiative." Access to Medicines Initiative, home page.

• 2

  "Building on our promising pilot results, we aim to conduct a state-wide distribution of contraceptives to all public health facilities offering family planning services in Katsina State." AMI, Proposal: Increasing contraceptive supply in public health facilities in Katsina State, Nigeria, June 2025

• 3

  "From September 2024 to May 2025, Access to Medicines Initiative ran a pilot study across 137 primary and secondary health facilities in Katsina and Sokoto states in Northern Nigeria." AMI blog, Concluding our pilot.

• 4

  "In diagnosing supply chain issues, our central question was whether there was truly a shortage or if existing supply was simply misallocated. Significant redistribution is warranted, as some large facilities are frequently oversupplied. However, the central bottleneck is total volume." AMI blog, Concluding our pilot.

• 5
  • "In facilities that received additional contraceptives, women consumed
    • 70% more oral contraceptives
    • 30% more contraceptive injections
    • 240% more condoms
    • 90% more contraceptive implants."
  • "We saw significant increases from all commodities excluding IUDs. Due to low demand and relatively few stock issues, IUD consumption shifts were dominated by outliers. While the shift was technically positive, we do not believe it is likely to be attributable to our work."

  AMI blog, Concluding our pilot.

• 6

  "Our vision for the future is that state governments sustainably fund contraceptives, guided by improved data systems within primary health facilities. AMI pursues this shift by (1) partnering with government officials to enact relevant legislation, (2) matching public investment to ease the transition, and (3) digitising and analysing data so governments can make evidenced-based decisions and allocate their limited funding cost-effectively." See AMI blog, Concluding our pilot.

• 7

  “In our second year of operation, we will be scaling up our work considerably. We plan to

  • Donate 50,000 contraceptive implants, covering the gap between expected supply and demand in Katsina state for 8 months
  • Help Katsina state pass contraceptive procurement legislation
  • Expand our monitoring, data management, and theft-prevention programs.”

  AMI, Proposal: Increasing contraceptive supply in public health facilities in Katsina State, Nigeria, June 2025

• 8

  See more details here, in AMI’s proposal

• 9

  See more details here, in AMI’s proposal

• 10

  See more details here, in AMI’s proposal

• 11

  See more details here, in AMI’s proposal

• 12

  AMI, Budget 2025/2026 (unpublished).

  $159,655 / $204,655 = 0.78

• 13

  $159,655 / $289,795 ('planned scenario') = 0.55

  $159,655 / $393,305 ('ideal scenario') = 0.41

• 14

  This understanding comes from conversations with other funders and implementers in the family planning space (unpublished).

• 15
  • “USAID’s total contraceptive procurement value in FY2023 [was $59M], a five-year high for the FY2019-23 period.” CHAI, Family Planning Market Report, November 2024, p. 8
  • “RHSC estimates that the U.S. government represents about 24% of the total, or about $61 million dollars per year, on average, out of around $250 million per year on family planning product procurement. If we add the usual 20% for freight costs on top, that is a total of about $73 million per year spent by the U.S. on procurement.” Gates Institute, The Future of Family Planning Data, April 2025, p. 13

• 16

  This understanding comes from conversations with other funders and implementers in the family planning space (unpublished).

• 17
  • Muhoza et al 2021: “Consistent with other studies, our findings showed limited availability for long-acting reversible contraceptives (LARCs), including IUDs and implants, with great variability between countries (Grindlay et al., 2016; Thanel et al., 2018). The findings further showed that LARCs were generally more readily available and distributed through the public sector as compared to the private sector. LARCs are highly effective forms of reversible birth control as evidenced by the large proportion of CYPs they provided in our study despite the consistently high levels of stockouts and lower numbers of client visits that they were subject to.”
  • Karimi et al 2021: “Public health supply chains are channels through which health commodities are distributed among end clients. In developing countries, significant resource constraints hamper the effective and efficient delivery of health commodities, leading to supply chain failures such as “stock‐outs.” While the prevalence of commodity stock‐outs is well‐acknowledged, there is little by way of systematic and rigorous empirical research that sheds light on the factors that drive such stock‐outs in developing countries.”

• 18

  This estimate of the value per dollar donated to direct cash transfer programs is out of date as of 2024. We are continuing to use this outdated estimate for now to preserve our ability to compare across programs, while we reevaluate the benchmark we want to use to measure and communicate cost-effectiveness.

  See GiveWell’s Cost-Effectiveness Analyses webpage for more information about how we use cost-effectiveness estimates in our grantmaking.

• 19

  UNFPA contraceptive price indicator, 2022 - see last column on ‘Annual cost per CYP [couple-year of protection]’. Aside from female condoms ($59 per CYP) which AMI does not plan to provide, the CYP ranges from $0.09 for IUDs to $4.64 for emergency pills. $3 is a rough average based on eyeballing these figures.

• 20
  • See GiveWell, Valuing Contraception BOTEC, April 2025.
  • “Our preliminary best guess implies that programs counterfactually providing a year of modern contraception for under ~$20 would meet our cost-effectiveness threshold. We’re highly uncertain about this estimate because it requires difficult judgment calls and several empirical uncertainties.” See Valuing Contraception in GiveWell’s Cost-Effectiveness Analysis for more details.

• 21

  This understanding comes from external conversations with other relevant funders and implementers in the family planning space (unpublished).

• 22

  Research indicates that religious beliefs, cultural myths, misinformation, low education levels, and spousal opposition consistently emerge as key demand-side barriers to contraceptive use in Nigeria. (Ahmed, 2021; Adefalu et al, 2019) In addition, a general preference not to space/limit births, or to not use modern contraception could also explain low levels of use.

• 23

  “With our data collection and analysis complete, we can now report our final pilot results. In facilities that received additional contraceptives, we saw dramatic increases in consumption compared to baseline consumption levels. This was not true for our control groups, which on average remained the same or even decreased in consumption, depending on the commodity.
  In facilities that received additional contraceptives, women consumed

  • 70% more oral contraceptives
  • 30% more contraceptive injections
  • 240% more condoms
  • 90% more contraceptive implants.” AMI blog, Concluding our pilot

• 24

  “A core focus of this study is to investigate how contraceptive uptake changes when consistent supply is available in public facilities. In our pilot, we observed a dramatic spike in consumption in facilities that received additional commodities - a clear signal of unmet demand. However, we anticipate that this surge will taper and eventually stabilize once supply becomes reliable. … We plan to run the study for 8 months, which we believe is essential for generating precise measurements and adapting our data systems to real-world supply chain conditions. This timeline allows us to account for strong seasonal variations that significantly affect both demand and service delivery, such as road inaccessibility during the rainy season, and fluctuations in provider and client behavior during religious holidays. A shorter intervention would reduce costs, but at the expense of missing these operational realities and limiting the depth of our learning.” AMI, Proposal: Increasing contraceptive supply in public health facilities in Katsina State, Nigeria, June 2025

• 25
  • On the pilot: “We selected six Local Government Areas (LGAs) in Katsina and three in Sokoto, enrolling all health facilities providing family planning services within them — a total of 137 facilities (74 in Katsina, 63 in Sokoto). These pilot LGAs account for roughly 10–20% of the total population in each state.” AMI, EA Forum post, “Introducing Access to Medicines Initiative: Year One Results, Year Two Strategy, and Current Funding Gap”
  • “Our geographic scope will remain statewide across Katsina state. In previous distributions, we observed that the state government adjusts its own commodity allocations based on anticipated contributions from other actors. For example, LGAs that received commodities from us in our last round were allocated smaller quantities from state stores. This had minimal effect at our pilot scale, but will become more significant as we grow. Full-state coverage avoids distorting allocation dynamics, ensures comparability across LGAs, and strengthens our ability to coordinate with state-level systems.” AMI, Proposal: Increasing contraceptive supply in public health facilities in Katsina State, Nigeria, June 2025

• 26

  AMI, Proposal: Increasing contraceptive supply in public health facilities in Katsina State, Nigeria, June 2025:
  “The core of our monitoring and evaluation (M&E) system relies on the paper registers mandated by Nigerian legislation, which are kept in every public health facility. To collect this data, we hire M&E officers in each Local Government Area (LGA) where we operate. These officers visit all participating facilities regularly to:

  • Photograph all relevant family planning registers
  • Take inventory of available contraceptives
  • Administer a standardised M&E form with the facility’s family planning provider, which includes verifying their ability to administer various methods, such as implants and IUDs

  Our headquarters team then digitises and analyses this data to track consumption and inform our program.
  The most critical data source is the Health Facility Daily Family Planning Register, where providers record every individual consultation. These entries include not only the date and method administered or given to take home, but also identifying and clinical information such as the client's name, card number, address or phone number, age, weight, blood pressure, and referral status. This level of detail makes falsification more difficult, and—while we currently rely on fairly simple pattern checking to flag potential irregularities—we may introduce more direct verification in the future, such as client follow-ups and cross-referencing.
  We also collect data from inventory cards and stock registers at the facility level, as well as at LGA and state medical stores, to monitor the flow of government-distributed commodities from the federal Basket Fund and track fluctuations in availability.”

• 27

  “At the start of our engagement in each facility, we collect and digitise all historic register data, typically covering the 6–12 months prior to our intervention. This allows us to compare average monthly consumption before and during our program.” AMI, Proposal: Increasing contraceptive supply in public health facilities in Katsina State, Nigeria, June 2025

• 28

  “We have chosen implants as our primary method focus for year two for a few reasons. First, we saw a particularly large increase in implant consumption across regions and deliveries (on average 90%), suggesting that implants are one of the areas where consumption particularly increased. Implanon is also the first commodity cited by government officials as needing a lot of external support. The only other commodity with a larger relative increase was male condoms. However, the actual magnitude of the increase in condoms was fairly small, resulting in only ~10 CYP [couple-years of protection] out of the 1144 CYP we provided in our pilot. In contrast, implant consumption made up around 80% of the CYP. Because we expect implants will be the largest driver of our impact down the line, we do not believe it would be appropriate to exclude them from our year two work.
  In addition, we believe that our results will be most stress tested by a long term method. For short term methods such as pills and injections, consumption in a given month is likely to recur in the near future, as the method’s effect will end and patients will have to return for another dose. However, with long term methods, such as implants, women will not return before the three year mark unless they want to get it removed. This means that spikes in consumption of long acting methods are more likely to be temporary, so it is more necessary to measure consumption of long acting methods over the long term.” AMI, “Why Implants” (unpublished)

• 29

  “As we decide what to prioritize in Year 2, we're acutely aware of how noisy our estimates still are, and in this phase, we place a very high value on generating clearer information. More information on our reasoning - and why we selected Implanon in our initial plans - is available here [link removed], but one key takeaway is that while increasing consumption at any level is valuable in itself, we believe that accurately assessing unmet demand requires us to get as close as possible to eliminating stockouts. As such, for any method, it would be unwise to provide less than what is required to meet demand, even though this forces a trade-off between budget size and method diversity. Eliminating stockouts has strategic value both for our internal planning and for our longer-term goals of:

  • Advocating for increased government procurement, and
  • Providing technical assistance to optimize public sector supply chains.

  Although our main focus is currently on direct deliveries, we hope that over time, the policy and systems work will account for an increasing share of our impact.” AMI, email to GiveWell, June 11, 2025 (unpublished)

• 30

  Recent qualitative research suggests that across a range of family planning programs (including services provided in public health facilities) service providers sometimes constrain women’s choices to use modern contraception, particularly long-acting reversible contraceptives (LARCs), in both subtle and more overt ways. Senderowicz (2019) interviewed 49 women of reproductive age in an anonymized African country in 2017 and found that “respondents reported a range of non-autonomous experiences including biased or directive counseling, dramatically limited contraceptive method mix, scare tactics, provision of false medical information, refusal to remove provider-dependent methods, and the non-consented provision of long-acting methods. The results show that, rather than a binary outcome, coercion sits on a spectrum and need not involve overt force or violence, but can also result from more quotidian limits to free, full, and informed choice.” A systematic review (Boydell and Smith, 2023) also found evidence of coercive practices in relation to encouraging uptake of long-acting reversible contraceptive methods. This research pre-dates AMI’s activities.

• 31

  “We are also expanding our mystery shopper program. We hire women from local communities to visit facilities posing as clients and submit a structured report after each visit. These reports cover the consultation experience, provider behavior, methods offered, any charges encountered, and the quality of counseling. Our goal is for every facility to receive at least one mystery shopper visit, with up to five visits for facilities where data irregularities or other concerns arise. This helps us ensure services are delivered free of charge and without coercion.” AMI, Proposal: Increasing contraceptive supply in public health facilities in Katsina State, Nigeria, June 2025

• 32

  “To collect this data, we hire M&E officers in each Local Government Area (LGA) where we operate. These officers visit all participating facilities regularly to: … Administer a standardised M&E form with the facility’s family planning provider, which includes verifying their ability to administer various methods, such as implants and IUDs.” AMI, Proposal: Increasing contraceptive supply in public health facilities in Katsina State, Nigeria, June 2025

• 33

  “The other major potential barrier to implant removal is the necessary consumables. Unsurprisingly, facilities that frequently run out of implants also frequently run out of the supplies for removing implants. In our distributions, we provide all of the necessary supplies to insert and remove implants as a part of our intervention. Thus, where supplies are the limiting factor, our work should counterfactually increase the number of implant removals.” AMI, “Why Implants” (unpublished)

• 34

  “Because our work is confined to supply, any overt coercion would arise from provider behaviour. Based on our work so far, including “mystery shopper” visits from workers posing as customers, healthcare providers seem to provide guidance on the basis of patient situation rather than showing bias towards one method over another… Beyond overt coercion, there is a risk of implant use substituting other contraceptive methods simply because it is one of the only methods available. We have data demonstrating that many women walk away empty handed even when other methods are available…Based on our data, among facilities in Katsina state that have inserted more than 5 implants, around two thirds of them have reported removing an implant this calendar year. Due to low demand for removals relative to expectation (many women don’t even get it removed after the three years are up), we believe this significantly underestimates the actual capacity for implant removal…Among facilities that do offer implant removal, we have anecdotal evidence suggesting that there is no provider bias against removals.” AMI, “Why Implants” (unpublished).

• 35

  “We’re planning to focus on Implanon, which continues to show high unmet demand and is highly cost-effective, though we may add a few other methods.” AMI, email to GiveWell, May 22, 2025 (unpublished)

• 36

  “In our pilot, we also tracked a control group of facilities that received M&E visits but no donated commodities. We did not see any significant increases in consumption in these facilities, though some facilities did see decreases. In Year 2, however, all public family planning facilities in Katsina State will receive commodities, so we will rely on historic comparison rather than contemporaneous controls.” AMI, Proposal: Increasing contraceptive supply in public health facilities in Katsina State, Nigeria, June 2025

• 37

  "We provided additional contraceptives to one third of facilities, resulting in dramatic increases in uptake such as a 90% average increase in contraceptive implant use." AMI, Proposal: Increasing contraceptive supply in public health facilities in Katsina State, Nigeria, June 2025

• 38

  AMI is planning for potential RCT costs in Year 4. AMI, Year 2 Cost-Effectiveness Analysis (unpublished).