@article{fdi:010062502,
  title = {{T}he free caesareans policy in low-income settings : an interrupted time series analysis in {M}ali (2003-2012)},
  author = {{F}ournier, {P}. and {D}umont, {A}lexandre and {T}ourigny, {C}. and {P}hilibert, {A}. and {C}oulibaly, {A}. and {T}raore, {M}.},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction: {S}everal countries have instituted fee exemptions for caesareans to reduce maternal and newborn mortality. {O}bjectives: {T}o evaluate the effect of fee exemptions for caesareans on population caesarean rates taking into account different levels of accessibility. {M}ethods: {T}he observation period was from {J}anuary 2003 to {M}ay 2012 in one {R}egion and covered 11.7 million person-years. {E}xemption fees for caesareans were adopted on {J}une 26, 2005. {D}ata were obtained from a registration system implemented in 2003 that tracks all obstetrical emergencies and interventions including caesareans. {T}he pre-intervention period was 30 months and the post-intervention period was 83 months. {W}e used an interrupted time series to evaluate the trend before and after the policy adoption and the overall tendency. {F}indings: {D}uring the study period, the caesarean rate increased from 0.25 to 1.5% for the entire population. {F}or women living in cities with district hospitals that provided caesareans, the rate increased from 1.7% before the policy was enforced to 5.7% 83 months later. {N}o significant change in trends was observed among women living in villages with a healthcare centre or those in villages with no healthcare facility. {F}or the latter, the caesarean rate increased from 0.4 to 1%. {C}onclusions: {A}fter nine years of implementation policy in {M}ali, the caesarean rate achieved in cities with a district hospital reached the full beneficial effect of this measure, whereas for women living elsewhere this policy did not increase the caesarean rate to a level that could contribute effectively to reduce their risk of maternal death. {O}nly universal access to this essential intervention could reduce the inequities and increase the effectiveness of this policy.},
  keywords = {{MALI}},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {9},
  numero = {8},
  pages = {e105130},
  ISSN = {1932-6203},
  year = {2014},
  DOI = {10.1371/journal.pone.0105130},
  URL = {https://www.documentation.ird.fr/hor/fdi:010062502},
}