Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa

Marion Ravit (marion.ravit@gmail.com), Martine Audibert (martine.audibert@udamail.fr), Valery Ridde (valery.ridde@ird.fr), Myriam de Loenzien (myriam.de-loenzien@ird.fr), Clémence Schantz (clemence.schantz@ird.fr) and Alexandre Dumont
Additional contact information
Marion Ravit: CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPD5 - Université Paris Descartes - Paris 5
Martine Audibert: CERDI - Centre d'Études et de Recherches sur le Développement International - UCA [2017-2020] - Université Clermont Auvergne [2017-2020] - CNRS - Centre National de la Recherche Scientifique
Valery Ridde: Ecole de Santé Publique [Montreal, Canada] - UdeM - Université de Montréal, CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPCité - Université Paris Cité
Myriam de Loenzien: CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPD5 - Université Paris Descartes - Paris 5
Clémence Schantz: CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPD5 - Université Paris Descartes - Paris 5
Alexandre Dumont: CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPD5 - Université Paris Descartes - Paris 5

Post-Print from HAL

Abstract: Introduction Mali and Benin introduced a user feeexemption policy focused on caesarean sections in 2005and 2009, respectively. The objective of this study is toassess the impact of this policy on service utilisation andneonatal outcomes. We focus specifically on whether thepolicy differentially impacts women by education level,zone of residence and wealth quintile of the household.Methods We use a difference-in-differences approachusing two other western African countries with no feeexemption policies as the comparison group (Cameroonand Nigeria). Data were extracted from Demographic andHealth Surveys over four periods between the early 1990sand the early 2000s. We assess the impact of the policy onthree outcomes: caesarean delivery, facility-based deliveryand neonatal mortality.Results We analyse 99 800 childbirths. The freecaesarean policy had a positive impact on caesareansection rates (adjusted OR=1.36 (95% CI 1.11 to 1.66;P≤0.01), particularly in non-educated women (adjustedOR=2.71; 95% CI 1.70 to 4.32; P≤0.001), those livingin rural areas (adjusted OR=2.02; 95% CI 1.48 to 2.76;P≤0.001) and women in the middle-class wealth index(adjusted OR=3.88; 95% CI 1.77 to 4.72; P≤0.001). Thepolicy contributes to the increase in the proportion offacility-based delivery (adjusted OR=1.68; 95% CI 1.48 to1.89; P≤0.001) and may also contribute to the decreaseof neonatal mortality (adjusted OR=0.70; 95% CI 0.58 to0.85; P≤0.001).Conclusion This study is the first to evaluate the impactof a user fee exemption policy focused on caesareansections on maternal and child health outcomes withrobust methods. It provides evidence that eliminating feesfor caesareans benefits both women and neonates in sub-Saharan countries.

Date: 2018
Note: View the original document on HAL open archive server: https://hal.science/hal-01682919v1
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

Published in BMJ Global Health, 2018, 3 (1), pp.e000558. ⟨10.1136/bmjgh-2017-000558⟩

Downloads: (external link)
https://hal.science/hal-01682919v1/document (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01682919

DOI: 10.1136/bmjgh-2017-000558

Access Statistics for this paper

More papers in Post-Print from HAL
Bibliographic data for series maintained by CCSD (hal@ccsd.cnrs.fr).