Do free caesarean section policies increase inequalities in Benin and Mali?

Marion Ravit, Martine Audibert (), Valery Ridde (), Myriam de Loenzien (), Clémence Schantz () and Alexandre Dumont
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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: Department of Social and Preventive Medicine - CRCHUM - Montreal School of Public Health, CEPED - UMR_D 196 - Centre population et développement - IRD - Institut de Recherche pour le Développement - UPD5 - Université Paris Descartes - Paris 5
Myriam de Loenzien: IRD - Institut de Recherche pour le Développement, 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

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Abstract: Background: Benin and Mali introduced user fee exemption policies focused on caesarean sections (C-sections) in2005 and 2009, respectively. These policies had a positive impact on access to C-sections and facility based deliveriesamong all women, but the impact on socioeconomic inequality is still highly uncertain. The objective of this study wasto observe whether there was an increase or a decrease in urban/rural and socioeconomic inequalities in access toC-sections and facility based deliveries after the free C-section policy was introduced.Methods: We used data from three consecutive Demographic and Health Surveys (DHS): 2001, 2006 and 2011–2012 inBenin and 2001, 2006 and 2012–13 in Mali. We evaluated trends in inequality in terms of two outcomes: C-sections andfacility based deliveries. Adjusted odds ratios were used to estimate whether the distributions of C-sections and facilitybased deliveries favoured the least advantaged categories (rural, non-educated and poorest women) or the mostadvantaged categories (urban, educated and richest women). Concentration curves were used to observe the degreeof wealth-related inequality in access to C-sections and facility based deliveries.Results: We analysed 47,302 childbirths (23,266 in Benin and 24,036 in Mali). In Benin, we found no significantdifference in access to C-sections between urban and rural women or between educated and non-educated women.However, the richest women had greater access to C-sections than the poorest women. There was no significantchange in these inequalities in terms of access to C-sections and facility based deliveries after introduction of the freeC-section policy.In Mali, we found a reduction in education-related inequalities in access to C-sections after implementation of thepolicy (p-value = 0.043). Inequalities between urban and rural areas had already decreased prior to implementation ofthe policy, but wealth-related inequalities were still present.Conclusions: Urban/rural and socioeconomic inequalities in C-section access did not change substantially after thecountries implemented free C-section policies. User fee exemption is not enough. We recommend switching tomechanisms that combine both a universal approach and targeted action for vulnerable populations to address thisissue and ensure equal health care access for all individuals.

Keywords: Caesarean section; Low-income countries; Mali; Benin; Health policy; User fees; Health equity; Maternal health (search for similar items in EconPapers)
Date: 2018-12
Note: View the original document on HAL open archive server: https://hal.science/hal-01811304v1
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Published in International Journal for Equity in Health, 2018, 17 (1), ⟨10.1186/s12939-018-0789-x⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-01811304

DOI: 10.1186/s12939-018-0789-x

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