%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Fournier, P.
%A Dumont, Alexandre
%A Tourigny, C.
%A Philibert, A.
%A Coulibaly, A.
%A Traore, M.
%T The free caesareans policy in low-income settings : an interrupted time series analysis in Mali (2003-2012)
%D 2014
%L fdi:010062502
%G ENG
%J Plos One
%@ 1932-6203
%K MALI
%M ISI:000340742100068
%N 8
%P e105130
%R 10.1371/journal.pone.0105130
%U https://www.documentation.ird.fr/hor/fdi:010062502
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers17-03/010062502.pdf
%V 9
%W Horizon (IRD)
%X Introduction: Several countries have instituted fee exemptions for caesareans to reduce maternal and newborn mortality. Objectives: To evaluate the effect of fee exemptions for caesareans on population caesarean rates taking into account different levels of accessibility. Methods: The observation period was from January 2003 to May 2012 in one Region and covered 11.7 million person-years. Exemption fees for caesareans were adopted on June 26, 2005. Data were obtained from a registration system implemented in 2003 that tracks all obstetrical emergencies and interventions including caesareans. The pre-intervention period was 30 months and the post-intervention period was 83 months. We used an interrupted time series to evaluate the trend before and after the policy adoption and the overall tendency. Findings: During the study period, the caesarean rate increased from 0.25 to 1.5% for the entire population. For 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. No significant change in trends was observed among women living in villages with a healthcare centre or those in villages with no healthcare facility. For the latter, the caesarean rate increased from 0.4 to 1%. Conclusions: After nine years of implementation policy in Mali, 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. Only universal access to this essential intervention could reduce the inequities and increase the effectiveness of this policy.
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