@article{fdi:010072738,
  title = {{R}emoving user fees to improve access to caesarean delivery : a quasi-experimental evaluation in western {A}frica},
  author = {{R}avit, {M}. and {A}udibert, {M}. and {R}idde, {V}al{\'e}ry and {L}oenzien, {M}yriam de and {S}chantz, {C}. and {D}umont, {A}lexandre},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {M}ali and {B}enin introduced a user fee exemption policy focused on caesarean sections in 2005 and 2009, respectively. {T}he objective of this study is to assess the impact of this policy on service utilisation and neonatal outcomes. {W}e focus specifically on whether the policy differentially impacts women by education level, zone of residence and wealth quintile of the household. {M}ethods {W}e use a difference-in-differences approach using two other western {A}frican countries with no fee exemption policies as the comparison group ({C}ameroon and {N}igeria). {D}ata were extracted from {D}emographic and {H}ealth {S}urveys over four periods between the early 1990s and the early 2000s. {W}e assess the impact of the policy on three outcomes: caesarean delivery, facility-based delivery and neonatal mortality. {R}esults {W}e analyse 99 800 childbirths. {T}he 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). {T}he 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). {C}onclusion {T}his 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. {I}t provides evidence that eliminating fees for caesareans benefits both women and neonates in sub{S}aharan countries.},
  keywords = {{MALI} ; {BENIN}},
  booktitle = {},
  journal = {{BMJ} {G}lobal {H}ealth},
  volume = {3},
  numero = {1},
  pages = {e000558 [11 p.]},
  ISSN = {2059-7908},
  year = {2018},
  DOI = {10.1136/bmjgh-2017-000558},
  URL = {https://www.documentation.ird.fr/hor/fdi:010072738},
}