@article{fdi:010073106,
  title = {{D}o free caesarean section policies increase inequalities in {B}enin and {M}ali ?},
  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 = {{B}ackground: {B}enin and {M}ali introduced user fee exemption policies focused on caesarean sections ({C}-sections) in 2005 and 2009, respectively. {T}hese policies had a positive impact on access to {C}-sections and facility based deliveries among all women, but the impact on socioeconomic inequality is still highly uncertain. {T}he objective of this study was to observe whether there was an increase or a decrease in urban/rural and socioeconomic inequalities in access to {C}-sections and facility based deliveries after the free {C}-section policy was introduced. {M}ethods: {W}e used data from three consecutive {D}emographic and {H}ealth {S}urveys ({DHS}): 2001, 2006 and 2011-2012 in {B}enin and 2001, 2006 and 2012-13 in {M}ali. {W}e evaluated trends in inequality in terms of two outcomes: {C}-sections and facility based deliveries. {A}djusted odds ratios were used to estimate whether the distributions of {C}-sections and facility based deliveries favoured the least advantaged categories (rural, non-educated and poorest women) or the most advantaged categories (urban, educated and richest women). {C}oncentration curves were used to observe the degree of wealth-related inequality in access to {C}-sections and facility based deliveries. {R}esults: {W}e analysed 47,302 childbirths (23,266 in {B}enin and 24,036 in {M}ali). {I}n {B}enin, we found no significant difference in access to {C}-sections between urban and rural women or between educated and non-educated women. {H}owever, the richest women had greater access to {C}-sections than the poorest women. {T}here was no significant change in these inequalities in terms of access to {C}-sections and facility based deliveries after introduction of the free {C}-section policy. {I}n {M}ali, we found a reduction in education-related inequalities in access to {C}-sections after implementation of the policy (p-value = 0.043). {I}nequalities between urban and rural areas had already decreased prior to implementation of the policy, but wealth-related inequalities were still present. {C}onclusions: {U}rban/rural and socioeconomic inequalities in {C}-section access did not change substantially after the countries implemented free {C}-section policies. {U}ser fee exemption is not enough. {W}e recommend switching to mechanisms that combine both a universal approach and targeted action for vulnerable populations to address this issue and ensure equal health care access for all individuals.},
  keywords = {{C}aesarean section ; {L}ow-income countries ; {M}ali ; {B}enin ; {H}ealth policy ; {U}ser fees ; {H}ealth equity ; {M}aternal health ; {BENIN} ; {MALI}},
  booktitle = {},
  journal = {{I}nternational {J}ournal for {E}quity in {H}ealth},
  volume = {17},
  numero = {},
  pages = {art. 71 [12 ]},
  ISSN = {1475-9276},
  year = {2018},
  DOI = {10.1186/s12939-018-0789-x},
  URL = {https://www.documentation.ird.fr/hor/fdi:010073106},
}