IDEAS home Printed from https://ideas.repec.org/p/hal/journl/hal-01682919.html

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

Author

Listed:
  • 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)

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.

Suggested Citation

  • Marion Ravit & Martine Audibert & Valery Ridde & Myriam de Loenzien & Clémence Schantz & Alexandre Dumont, 2018. "Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa," Post-Print hal-01682919, HAL.
    • Handle: RePEc:hal:journl:hal-01682919
    DOI: 10.1136/bmjgh-2017-000558
    Note: View the original document on HAL open archive server: https://hal.science/hal-01682919v1
    as

    Download full text from publisher

    File URL: https://hal.science/hal-01682919v1/document
    Download Restriction: no
    File URL: https://libkey.io/10.1136/bmjgh-2017-000558?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Cristina Cirillo & Raquel Tebaldi, 2016. "Social Protection in Africa: inventory of non-contributory programmes," Joint Publications 004, International Policy Centre.
    2. repec:wbk:wbpubs:25030 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Martine Audibert & Emmanuel Bonnet & Alexandre Dumont & A. N'Landu & Bertille Raffalli & Andrainolo Ravalihasy & M. Ravit & Valéry Ridde & Flore Apolline Roy, 2019. "Impacts du forfait obstétrical en Mauritanie sur l'offre, le recours et les inégalités d'accès aux soins : synthèse du rapport final," Post-Print hal-03834803, HAL.
    2. Selidji Caroline Tossou, 2025. "Who benefits the most? Direct and indirect effects of a free cesarean section policy in Benin," Papers 2510.03658, arXiv.org.
    3. Lama Bou-Karroum & Domenico G Iaia & Fadi El-Jardali & Clara Abou Samra & Sabine Salameh & Zeina Sleem & Reem Masri & Aya Harb & Nour Hemadi & Nadeen Hilal & Layal Hneiny & Sahar Nassour & Mehr Gul Sh, 2024. "Financing for equity for women’s, children’s and adolescents’ health in low- and middle-income countries: A scoping review," PLOS Global Public Health, Public Library of Science, vol. 4(9), pages 1-49, September.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Richard Freund & Marta Favara & Catherine Porter & Jere Behrman, 2024. "Social Protection and Foundational Cognitive Skills during Adolescence: Evidence from a Large Public Works Program," The World Bank Economic Review, World Bank, vol. 38(2), pages 296-318.
    2. Djuikom, Marie Albertine & van de Walle, Dominique, 2022. "Marital status and women’s nutrition in Africa," World Development, Elsevier, vol. 158(C).
    3. Amponsah, Emefa Akua, 2018. "The Ghana School Feeding Programme, Home Environment and Learning Outcomes," Miscellaneous Publications 358824, University of Ghana, Institute of Statistical Social & Economic Research (ISSER).

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:hal:journl:hal-01682919. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: CCSD (email available below). General contact details of provider: https://hal.archives-ouvertes.fr/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.