@article{fdi:010060777,
  title = {{E}mergency obstetric care in {M}ali : catastrophic spending and its impoverishing effects on households},
  author = {{A}rsenault, {C}. and {F}ournier, {P}. and {P}hilibert, {A}. and {S}issoko, {K}. and {C}oulibaly, {A}. and {T}ourigny, {C}. and {T}raore, {M}. and {D}umont, {A}lexandre},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjective {T}o investigate the frequency of catastrophic expenditures for emergency obstetric care, explore its risk factors, and assess the effect of these expenditures on households in the {K}ayes region, {M}ali. {M}ethods {D}ata on 484 obstetric emergencies (242 deaths and 242 near-misses) were collected in 2008-2011. {C}atastrophic expenditure for emergency obstetric care was assessed at different thresholds and its associated factors were explored through logistic regression. {A} survey was subsequently administered in a nested sample of 56 households to determine how the catastrophic expenditure had affected them. {F}indings {D}espite the fee exemption policy for {C}aesareans and the maternity referral-system, designed to reduce the financial burden of emergency obstetric care, average expenses were 152 {U}nited {S}tates dollars (equivalent to 71 535 {C}ommunaute {F}inanciere {A}fricaine francs) and 20.7 to 53.5% of households incurred catastrophic expenditures. {H}igh expenditure for emergency obstetric care forced 44.6% of the households to reduce their food consumption and 23.2% were still indebted 10 months to two and a half years later. {L}iving in remote rural areas was associated with the risk of catastrophic spending, which shows the referral system's inability to eliminate financial obstacles for remote households. {W}omen who underwent {C}aesareans continued to incur catastrophic expenses, especially when prescribed drugs not included in the government-provided {C}aesarean kits. {C}onclusion {T}he poor accessibility and affordability of emergency obstetric care has consequences beyond maternal deaths. {P}roviding drugs free of charge and moving to a more sustainable, nationally-funded referral system would reduce catastrophic expenses for households during obstetric emergencies.},
  keywords = {{MALI}},
  booktitle = {},
  journal = {{B}ulletin - {OMS}},
  volume = {91},
  numero = {3},
  pages = {207--216},
  ISSN = {0042-9686},
  year = {2013},
  DOI = {10.2471/blt.12.108969},
  URL = {https://www.documentation.ird.fr/hor/fdi:010060777},
}