Lafiya — Community-Based Family Planning in Northern Nigeria (March 2026)
This was originally posted on GiveWell.org
Organization: Lafiya
Location: Sokoto, Kebbi, Jigawa, and Kano states, Nigeria
Amount: $1 million
Approval date: March 2026
Funded by: Unrestricted funds designated for grantmaking
Summary
This grant will fund Lafiya to train nurses, midwives, and community health workers to provide family planning counselling, short-term contraceptives, and referrals for other methods in northern Nigeria, where modern contraceptive use is among the lowest in the world.1 We expect the grant to increase the number of women who can act on their decision to delay or avoid a pregnancy and allow us to learn more about the impact of community-based family planning.
Published: September 2026
The challenge this grant addresses
In the rural communities of northern Nigeria where Lafiya works,2 few women use modern contraception, even though many want to avoid or delay pregnancy. The 2023–2024 Nigeria Demographic and Health Survey found that in the states where Lafiya works,3 11%-26% of married women want to avoid pregnancy but are not using contraception,4 and 3%-11% of married women are using modern contraceptive methods.5
We think this gap may be driven in part by a lack of sufficient and reliable family planning supplies, and lack of information about family planning.6 For example, in Lafiya's operating states, stockouts appear to be widespread: depending on the commodity, an average of 23% to 45% of facilities in each state were recorded as experiencing a stockout during the two-month periods for which we had data.7
How this grant could help
Lafiya is a nonprofit founded in 2021 and incubated by AIM (Ambitious Impact) that focuses on last-mile delivery of family planning services in northern Nigeria.8 It recruits and trains midwives, nurses, and health workers, working in the communities where they live, to counsel women on family planning, distribute a limited set of contraceptives, and make referrals for other methods.9 The community-based workers, known as Lafiya Sisters, receive a small stipend and a bonus for each counselling session.10 As of early 2026, Lafiya reported working with approximately 470 Lafiya Sisters across more than 200 government health facilities in four Nigerian states.11
This grant provides unrestricted funding to support Lafiya’s work in 2027 and 2028,12 including:13
Continued and expanded delivery across Sokoto, Kebbi, Jigawa, and Kano states
Procurement of contraceptive commodities, primarily Sayana Press,14 a self-injectable long-lasting method15
Working with state governments on cost-sharing arrangements for commodities16
Monitoring and evaluation, including spot checks and reconciliation against government facility records
We think that increasing access to modern contraception in low- and middle-income countries has a range of potential benefits including averting maternal mortality from unintended pregnancies and improved health for women and children. For more on how GiveWell currently values increasing access to modern contraception see here.
Our reasoning
We think this grant could be highly cost-effective, because modern contraceptive usage is extremely limited in the areas where Lafiya works, its community-based distribution model plausibly addresses obstacles to access, and the contraceptive methods it provides are inexpensive.17 Our rough back-of-the-envelope calculation estimates that the grant is 14 times more cost-effective than our benchmark, which clears our funding threshold.18 We expect that this grant will result in approximately 260,000 additional couple-years of modern contraception.19
We think that Lafiya’s program is likely to reach women who would not otherwise have access to modern contraception and may have other benefits.20 A quasi-experimental evaluation that Lafiya commissioned found that contraceptive prevalence rose 39 percentage points more in areas where Lafiya worked and that 55% of the women reached by Lafiya reported not having used contraception previously.21 There are significant limitations in the study design (as described below), but the results are encouraging.
We also think that the grant will provide us with important information about community-based family planning delivery. Family planning is a relatively new area for our grantmaking. We expect to learn more about a number of questions, such as:
Whether Lafiya's community-based delivery model can sustain impact and cost-effectiveness at scale, or whether it seems that growth comes more and more from women who would have likely accessed family planning commodities anyway, or who had a low risk of pregnancy
How Lafiya’s community-embedded approach compares to MSI’s mobile outreach model, which uses a strategy of small teams visiting targeted communities periodically
Whether the cost-sharing agreements Lafiya is negotiating with state governments lead to commodity procurement
Monitoring and evaluation
We will assess the impact of this grant primarily by reviewing Lafiya’s own monitoring data. Lafiya operates a digital monitoring system that uses metadata to check counseling session length and location, reconciles stock against reported sessions each week, has data verification officers conduct spot checks, and triangulates its records against government facility registers each month.22
We plan to track Lafiya’s progress at signing new government cost-sharing agreements, request an update on Lafiya’s efforts to strengthen its monitoring and evaluation practices, and review the progress we make on our learning agenda. Lafiya told us it plans to commission a process evaluation, and we will request findings when they are available.23
How we could be wrong
Our key uncertainties about this grant include:
Lafiya is a new organization running a new program, and the evidence base is limited. The main evidence for its impact is a study Lafiya commissioned, which is encouraging but has only limited, noisy evidence that treatment and comparison areas followed similar trends before the program,24 was designed with Lafiya's input,25 and tested a more intensive version of the program than Lafiya may run at scale.26 We're also unsure how much of the contraception Lafiya distributes is genuinely additional, since Lafiya Sisters are paid per counselling session and may focus on the women easiest to reach, such as those already visiting health facilities, who might have accessed contraception anyway.27 Lafiya has monitoring checks in place (see above), but we don't know how reliably they detect this.
We are unsure how much of the increased contraceptive use reflects women’s genuine preferences. While Lafiya Sisters provide information about a range of methods, they mainly carry Sayana Press,28 so women who would prefer another method, particularly longer-acting methods, may have to travel elsewhere to get it. This may lead some women to accept Sayana Press even if it is not their preferred choice.29 Separately, Lafiya tracks doses distributed as a core success measure, which could create informal pressure to encourage adoption. However, Lafiya pays for each visit rather than for each dose distributed,30 which guards against the most direct incentive to encourage women to accept contraception. We plan to review Lafiya's monitoring practices during the grant period.31
Read the full article here: https://www.givewell.org/research/grants/Lafiya-Community-Based-Family-Planning-in-Northern-Nigeria-March-2026.
