ObjectivesOut-of-pocket (OOP) payment for modern contraception is an understudied component of healthcare financing in countries like Kenya, where wealth gradients in met need have prompted efforts to expand access to free contraception. This study aims to examine whether, among public sector providers, the poor are more likely to receive free contraception and to compare how OOP payment for injectables and implants—two popular methods—differs by public/private provider type and user’s sociodemographic characteristics.Design, setting and participantsSecondary analyses of nationally representative, cross-sectional household data from the 2014 Kenya Demographic and Health Survey. Respondents were women of reproductive age (15–49 years). The sample comprised 5717 current modern contraception users, including 2691 injectable and 1073 implant users with non-missing expenditure values.Main outcomeRespondent’s self-reported source and payment to obtain their current modern contraceptive method.MethodsWe used multivariable logistic regression to examine predictors of free public sector contraception and compared average expenditure for injectable and implant. Quintile ratios examined progressivity of non-zero expenditure by wealth.ResultsHalf of public sector users reported free contraception; this varied considerably by method and region. Users of implants, condoms, pills and intrauterine devices were all more likely to report receiving their method for free (pConclusionsMore attention is needed to targeting subsidies to the poorest and ensuring government facilities are equipped to cope with lost user fee revenue.
