IntroductionLittle rigorous evidence exists on how health service utilization varies across socioeconomic groups after a user fee exemption policy has been implemented, and the evidence that does exist is mixed. In this paper, we estimate the distribution of caesarean section deliveries across socioeconomic groups following Mali’s implementation of a fee exemption policy for caesareans in 2005.MethodsWe conducted a patient survey in 2010 to collect socioeconomic data from 2,477 women who had caesareans in a representative sample of 25 facilities across all regions of Mali. We used these data along with data from the most recent Demographic and Health Survey to construct a wealth index and classify women into population-based wealth groupings. We compared the wealth distribution of women delivering via caesarean section to that of a nationally representative sample of women giving birth.ResultsWe found that wealthier women make up a disproportionate share of those having free caesareans, five years after implementation of the fee exemption policy. Women in the richest two quintiles accounted for 58 percent of all caesareans, while women in the poorest two quintiles accounted for 27 percent of all caesareans. Fewer women in the poorest two-fifths of the population are receiving caesareans than what we would expect given their share in the population of women giving birth.ConclusionsWhile fee exemptions remove important financial barriers to accessing priority maternal health services, they are insufficient to ensure equal access among wealth groups.

This article evaluates the effects of involving men in family planning counseling in Jordan using a randomized experiment. We randomly assigned a sample of 1,247 married women to receive women-only counseling, couples counseling, or no counseling. We measured the effects of each type of counseling on family planning use, knowledge, attitudes, and spousal communication about family planning. Compared to no counseling, couples counseling led to a 54 percent increase in uptake of modern methods. This effect is not significantly different from the 46 percent increase in modern method uptake as a result of women-only counseling. This outcome may be due, in part, to lower rates of compliance with the intervention among those assigned to couples counseling compared to women-only counseling. To realize the possible added benefits of involving men, more tailored approaches may be needed to increase men's participation.

From 2011 to 2015, a diarrhea management program in Ghana targeting pharmaceutical suppliers, private-sector providers, and caregivers successfully increased caregiver use of oral rehydration salts (ORS) with zinc to treat diarrhea in children under 5, from 0.8% to 29.2%, and reduced antibiotic use (which is generally inappropriate for treatment of non-bloody diarrhea) from 66.2% to 38.2%.

BackgroundProvider misconceptions and biases about contraceptive methods are major barriers to family planning access for women in low- and middle-income countries, including Jordan. Evidence-Based Medicine (EBM) programs aim to reduce biases and misconceptions by providing doctors with the most up-to-date scientific evidence on contraceptive methods.MethodsWe evaluate the effects of an EBM program conducted in Jordan on private providers’ knowledge, attitudes, and practices. Family planning providers randomly assigned to a treatment group were invited to attend a roundtable seminar on the injectable contraceptive Depot Medroxy Progesterone Acetate (DMPA), and to receive two 15 min one-on-one educational visits that reinforce the messages from the seminar.ResultsThere was low compliance with the EBM program. The study fails to detect an impact on providers’ knowledge of DMPA’s side effects or on reported clinical practices. There is suggestive evidence of a positive impact on providers’ attitudes toward and confidence in prescribing the contraceptive to their patients. There is also evidence of positive selection into program participation.ConclusionsWe conclude that EBM may not be effective as a stand-alone program targeting a family planning method with a high level of provider and consumer bias. Evidence of positive selection into program participation underscores the importance of randomization to avoid overestimating the true effects of interventions.Trial registrationAEA RCT Registry, AEARCTR0000539, 11/3/2014Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1101-z) contains supplementary material, which is available to authorized users.

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