Abstract
We examine the effect of Ghana’s National Health Insurance Scheme’s (NHIS) contraceptive coverage policy on modern contraceptive use among women in the country. We analyzed three rounds of Ghana Demographic and Health Survey data (2008–2022), using 2008–2014 as the pre-intervention period and 2022 as the post-intervention period. A propensity score matching was applied to the pre-intervention data to enhance comparability between intervention (NHIS) and control (non-NHIS) groups, before applying the difference-in-differences estimator. Multivariable linear probability models were used to estimate the effects. We also performed a placebo and sensitivity analysis to assess the validity and robustness of findings. Among the 26,713 weighted sample, 71.6 percent were in the intervention group and 28.4 percent in the control group. The NHIS contraceptive coverage policy significantly increased modern and long-term contraceptive use by 2.9 and 2.3 percentage points, respectively. We observed heterogeneous effects, with significantly higher increases in long-term method use among women in urban areas and smaller, nonsignificant increases among those in rural areas. Our findings underscore the potential for health insurance in enhancing access to and utilization of modern contraceptive methods. Sustained financing, timely provider reimbursement, and continuous monitoring are necessary to ensure reliable service availability and long-term policy sustainability.