Concluding Our Pilot

Final Results and Cost-Effectiveness Based on GiveWell's Report

We’re excited to announce the successful conclusion of our pilot, share the impact we achieved, highlight our projected cost-effectiveness, and outline our plans for the future.

TL;DR

Contraceptives improve women’s health, support autonomy, catalyse economic growth, and save lives. Despite many women wanting to use contraceptives, Nigerian public health facilities frequently run out of stock, resulting in unintended pregnancies and preventable maternal deaths.

Access to Medicines Initiative (AMI) is working to resolve Nigeria’s contraceptive crisis. For an in depth look into our work, please see our previous posts.

We ran a pilot across 137 health facilities in Katsina and Sokoto states. We sought to measure how contraceptive use changes with improved supply, diagnose supply chain breakdowns, and refine practical solutions. 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. Our diagnostic work shows that overall supply is far short of demand, so supply chain improvements and redistribution alone are not enough.

Our vision is that state governments sustainably fund contraceptives, guided by improved data systems within public health facilities. We will pursue this shift in year 2 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. Using GiveWell’s new framework for valuing contraception, we estimate the long-term cost-effectiveness of our approach is $2,400 per life saved, with an overall impact of 55 times direct cash transfers.

Over the next year, we plan to:

• Donate 50,000 contraceptive implants, covering an entire state for 8 months, measuring our impact over a longer period of time and generating necessary evidence for state-funded procurement

• Help Katsina state pass contraceptive procurement legislation and allocate a dedicated budget line in their 2026 budget

• Expand our monitoring, data management, and theft-prevention programs

Based on our current model, we estimate a cost-effectiveness of 20x cash in Year 2, including all costs, based on the impact of our commodity distribution alone.

The Problem

Nearly 28.5% of global maternal deaths occur in Nigeria, despite being home to less than 3% of the world’s people. This is driven by a staggeringly high maternal mortality rate of around 1,000 deaths per 100,000 live births, almost 100 times higher than the average for high income countries. Approximately 29% of pregnancies in Nigeria are unintended, and 6 out of 10 women of reproductive age have an unmet need for contraception. Meeting this need could save 11,000 lives every single year.

Many excellent organisations have expanded awareness and helped to dismantle cultural barriers to contraceptive use. However, their impact is often constrained by a more basic challenge: public health facilities frequently run out of contraceptives. In our pilot, we found that 80% of facilities are missing at least two types of contraceptives. When the shelf is empty, women must either accept unsuitable methods or go without contraception entirely, leading to unintended pregnancies and serious health risks.

When contraceptives are available when women need them, their lives and the lives of their families transform profoundly. Free from the burden of unintended pregnancies, women can choose when and whether to have children, enabling them to pursue education, advance their career, or take care of their existing family. These benefits extend to broader society through significant economic development. Most importantly, contraceptive access saves lives. According to GiveWell, high-quality family planning programs can compare favorably with the most effective global health interventions in terms of lives saved and DALYs averted.

Pilot Results and Cost-Effectiveness

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.

This pilot had three goals:

• Diagnose the specific problems in Nigeria’s public contraceptive supply chain and understand which ones matter most.

• Measure how much contraceptive uptake increases with improved availability.

• Refine promising cost-effective solutions to improve the supply chain.

To gain insights into the supply chain, we collected consumption, stock, and delivery data from each participating facility throughout the duration of the pilot. We also provided additional contraceptives to roughly one third of facilities to determine how much consumption increases when supply is increased. You can learn more about our pilot methodology in our previous post.

With our data collection and analysis complete, we can now report our final pilot results.¹ In facilities that received additional contraceptives, we saw dramatic increases in consumption compared to baseline consumption levels.² This was not true for our control groups, which on average remained the same or even decreased in consumption, depending on the commodity.³

In facilities that received additional contraceptives, women consumed

• 70% more oral contraceptives

• 30% more contraceptive injections

• 240% more condoms

• 90% more contraceptive implants

We estimate our work resulted in over 1,100 additional Couple Years of Protection (CYP), which is the equivalent of protecting 1,100 women for 1 year each. Using GiveWell’s new model for valuing contraception, we prevented over 360 unintended pregnancies and saved 2 lives.

In their report, GiveWell indicated that any intervention that delivers CYP in Nigeria for less than $26 meets their cost-effectiveness bar.⁴ Our new model puts our long-term cost at less than $5 per CYP. Using GiveWell’s calculations, this is equivalent to

• $15 per unintended pregnancy averted

• $2,400 per life saved

• 55 times the impact of direct cash transfers

Year 2 Plans

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. Federal procurement meets only a fraction of total demand.

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.

Policy Advocacy

At the policy level, we’re supporting state governments to shift from donor-dependent procurement to domestic contraceptive funding. This strategy is endorsed by the Federal Ministry of Health and many major partners.

In Katsina, we plan to co-organise a legislative workshop to approve the necessary policy to allow state-funded procurement. We have already secured the buy-in from relevant state stakeholders, including the Executive Secretary of the Primary Health Care Development Agency, and the State Commissioner for Health. In addition, our local implementation partner has already facilitated this in another Nigerian state, bringing the expertise and credibility necessary to shape this process.

Once this policy is passed we will advocate for the state to commit to funding contraceptives in their budget for the next fiscal year.

Providing Contraceptives

In the next year, AMI will scale our model to over 500 health facilities, providing contraceptives to an entire state for a period of at least 8 months. In addition to greatly increasing our impact, this larger scale will enable us to stress test our pilot results and ensure that they generalise.

During this study we will focus primarily on Implanon, a 3-year implant that offers 2.5 CYPs per dose with over 99% efficacy. At $0.65 per CYP, Implanon is the most cost-effective option of all methods that saw significant increases in consumption in our pilot. In addition to being more cost-effective, its long duration means Implanon is less sensitive to temporary stockouts. In contrast, short-acting methods such as condoms, pills, and injectables require frequent resupply, and even brief disruptions can lead to gaps in protection and increased risk of unintended pregnancy.

We plan to continue to provide auxiliary consumables, such as surgical gloves, disinfectant, and pregnancy tests, to ensure that all procedures inserting and removing the commodities we donate are conducted safely.

Data Systems

A key goal of year two will be refining our data systems to support our increasing scale. Throughout our pilot, we hired a part-time M&E worker to review paper data collected from the supply chain to digitise our data. We are currently in the process of automating our data digitisation system using computer vision to massively speed up this process and significantly reduce the costs.

We will also be scaling up our “mystery shoppers” program, where we hire women from local communities to visit facilities as customers. This enables us to ensure contraceptives are offered for free and counselling is done without coercion. In addition, we are experimenting with low cost theft tracking and mitigation measures, ranging from stamps and stickers to RFID tags.

Year 2 Cost-Effectiveness

Much of year two will be focused on investment, setting up policy and data management systems for future work. However, even if we only count our direct impact within year two, we still expect our cost-effectiveness to be high. We plan to provide 50,000 implants across an entire state, providing over 22,000 years of protection and saving 43 lives. We anticipate a cost-effectiveness of $13 per CYP, which corresponds to $6,600 per life saved, or 20x direct cash transfers.

Get Involved

We would welcome the opportunity to discuss how your support could help us unlock public funding and ensure no woman is sent away from a health facility empty handed. We also welcome any feedback or advice you would like to offer.

To get involved, you can

• Book a meeting with Miri Muntean or Evan LaForge at EAG London

• Come to Miri’s office hours after her lightning talk at EAG London

• Send us an email at contact@accessmedicines.org to ask any questions you may have

• Subscribe to our newsletter to watch the supply chain transform in real time

• Donate to AMI to help us secure state funding for contraceptives in Katsina state and provide contraceptive protection for tens of thousands of families

1. In addition to completing our data collection, we have also refined our analysis methodology.

First, we have improved our outlier filtering mechanism, better excluding (e.g.) outreach events within facilities conducted by external organizations and facilities with major staffing shifts that would otherwise skew the results. Previously, while most outliers were still excluded, there was still significant noise in our data from the few outliers that remained.

Second, we have improved our methodology to ensure our intervention period is aligned with facility stock levels of the commodities we provided. Previously, we used a regional approximation for the period of measurement, which undercounted additional consumption in facilities with the greatest change.

2. 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.

3. As a result of USAID, many entire states lacked either the contraceptives or the infrastructure to conduct planned deliveries. This unsurprisingly resulted in a reduction in consumption in many facilities. We did not adjust for this in our intervention groups, so our endline impact may be even greater than our stated estimate.

4. The primary benchmark GiveWell has shared is $20 per CYP. However, this is a generalised metric to cover all low and middle income countries. They also calculated regional estimates, and for Nigeria the threshold was $26 per CYP.