Removing user fees to improve access to caesarean delivery : a quasi-experimental evaluation in western Africa - fdi:010072738 - Horizon

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Ravit M., Audibert M., Ridde Valéry, Loenzien Myriam de, Schantz C., Dumont Alexandre. (2018). Removing user fees to improve access to caesarean delivery : a quasi-experimental evaluation in western Africa. BMJ Global Health, 3 (1), e000558 [11 p.]. ISSN 2059-7908

Fichier PDF disponible http://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers18-05/010072738.pdf

Lien direct chez l'éditeur doi:10.1136/bmjgh-2017-000558

Titre
Removing user fees to improve access to caesarean delivery : a quasi-experimental evaluation in western Africa
Année de publication2018
Type de documentArticle référencé dans le Web of Science WOS:000429769800021
AuteursRavit M., Audibert M., Ridde Valéry, Loenzien Myriam de, Schantz C., Dumont Alexandre.
SourceBMJ Global Health, 2018, 3 (1), p. e000558 [11 p.]. p. e000558 [11 p.] ISSN 2059-7908
RésuméIntroduction Mali and Benin introduced a user fee exemption policy focused on caesarean sections in 2005 and 2009, respectively. The objective of this study is to assess the impact of this policy on service utilisation and neonatal outcomes. We focus specifically on whether the policy differentially impacts women by education level, zone of residence and wealth quintile of the household. Methods We use a difference-in-differences approach using two other western African countries with no fee exemption policies as the comparison group (Cameroon and Nigeria). Data were extracted from Demographic and Health Surveys over four periods between the early 1990s and the early 2000s. We assess the impact of the policy on three outcomes: caesarean delivery, facility-based delivery and neonatal mortality. Results We analyse 99 800 childbirths. The free caesarean policy had a positive impact on caesarean section rates (adjusted OR=1.36 (95% CI 1.11 to 1.66; P=0.01), particularly in non-educated women (adjusted OR=2.71; 95% CI 1.70 to 4.32; P=0.001), those living in 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). The policy contributes to the increase in the proportion of facility-based delivery (adjusted OR=1.68; 95% CI 1.48 to 1.89; P=0.001) and may also contribute to the decrease of neonatal mortality (adjusted OR=0.70; 95% CI 0.58 to 0.85; P=0.001). Conclusion This study is the first to evaluate the impact of a user fee exemption policy focused on caesarean sections on maternal and child health outcomes with robust methods. It provides evidence that eliminating fees for caesareans benefits both women and neonates in subSaharan countries.
Plan de classementSanté : aspects socioculturels, économiques et politiques [056] ; Démographie [108]
Descr. géo.MALI ; BENIN
LocalisationFonds IRD [F B010072738]
Identifiant IRDfdi:010072738
Lien permanenthttp://www.documentation.ird.fr/hor/fdi:010072738

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