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Does free maternity care improve uptake and save lives? Quasi-experimental evidence from Kenya

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  • Kovacs, Roxanne

Abstract

Many assume that user-fees deter healthcare-seeking in low- and middle-income countries and are therefore partially responsible for high mortality rates. This paper estimates the causal effect of a national user-fee removal programme in Kenya on healthcare seeking and mortality, using a difference-in-differences design exploiting variation in treatment intensity across local communities. Results indicate a small increase in the uptake of antenatal care but no average effects on facility delivery, mortality or the quality of healthcare. Several potential mechanisms are examined and findings suggest heterogeneous treatment effects based on the physical accessibility of care as well as community-level preferences regarding household decision-making.

Suggested Citation

  • Kovacs, Roxanne, 2026. "Does free maternity care improve uptake and save lives? Quasi-experimental evidence from Kenya," World Development, Elsevier, vol. 200(C).
    • Handle: RePEc:eee:wdevel:v:200:y:2026:i:c:s0305750x25003717
    DOI: 10.1016/j.worlddev.2025.107285
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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior

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