The introduction of cost-sharing strategies, such as user-fees, for health care in developing countries has received increasing attention due to declining Government expenditure on health and reduced donor funding. Many developing country Governments face the dilemma of introducing fees for health care while maintaining contraceptive prevalence rates. This study conducted 16 focus group discussions with poor communities in urban and rural areas of Malawi, to identify their views on the affordability of contraception and the perceived impact of user fees on family planning use. The results show that amongst poor communities the long term health benefits of contraception are considered to be greater than a marginal increase in the cost of methods; therefore the introduction of modest fees is likely to have little impact on contraceptive prevalence. Those most likely to be affected by user fees are rural residents, for whom targeted assistance may be required to maintain contraceptive use.