@article{fdi:010064849,
  title = {{T}he hidden costs of a free caesarean section policy in {W}est {A}frica ({K}ayes region, {M}ali)},
  author = {{R}avit, {M}. and {P}hilibert, {A}. and {T}ourigny, {C}. and {T}raore, {M}. and {C}oulibaly, {A}. and {D}umont, {A}lexandre and {F}ournier, {P}.},
  editor = {},
  language = {{ENG}},
  abstract = {{T}he fee exemption policy for {E}m{ONC} in {M}ali aims to lower the financial barrier to care. {T}he objective of the study was to evaluate the direct and indirect expenses associated with caesarean interventions performed in {E}m{ONC} and the factors associated with these expenses. {D}ata sampling followed the case control approach used in the large project (deceased and near-miss women). {O}ur sample consisted of a total of 190 women who underwent caesarean interventions. {D}ata were collected from the health workers and with a social approach by administering questionnaires to the persons who accompanied the woman. {H}ousehold socioeconomic status was assessed using a wealth index constructed with a principal component analysis. {T}he factors significantly associated with expenses were determined using multivariate linear regression analyses. {W}omen in the {K}ayes region spent on average 77,017 {FCFA} (163 {USD}) for a caesarean episode in {E}m{ONC}, of which 70 % was for treatment. {D}espite the caesarean fee exemption, 91 % of the women still paid for their treatment. {T}he largest treatment-related direct expenses were for prescriptions, transfusion, antibiotics, and antihypertensive medication. {N}ear-misses, women who presented a hemorrhage or an infection, and/or women living in rural areas spent significantly more than the others. {A}lthough abolishing fees of {E}m{ONC} in {M}ali plays an important role in reducing maternal death by increasing access to caesarean sections, this paper shows that the fee policy did not benefit to all women. {T}here are still barriers to {E}m{ONC} access for women of the lowest socio-economic group. {T}hese included direct expenses for drugs prescription, treatment and indirect expenses for transport and food.},
  keywords = {{E}m{ONC} ; {C}aesarean section ; {M}aternal health ; {F}ee exemption ; {E}xpenses of care ; {W}est {A}frica ; {MALI}},
  booktitle = {},
  journal = {{M}aternal and {C}hild {H}ealth {J}ournal},
  volume = {19},
  numero = {8},
  pages = {1734--1743},
  ISSN = {1092-7875},
  year = {2015},
  DOI = {10.1007/s10995-015-1687-0},
  URL = {https://www.documentation.ird.fr/hor/fdi:010064849},
}