Ability to pay and impoverishment among women who give birth at a University Hospital in Kathmandu, Nepal

Abstract

Pregnant women giving birth in Nepal need to use out-of-pocket payment for delivery care services due to a lack of insurance policies. The objective of this study was to examine the ability of pregnant Nepalese women to pay for delivery care services and the effects of the current household health expenditure on impoverishment due to hospital-based delivery services, especially normal delivery (ND) and caesarean section (CS). A cross-sectional study was conducted from May to August 2009 at Tribhuvan University Teaching Hospital. Ability to pay was defined as the current health spending being less than 5% of annual household income. Poverty occurred when a household's per capita income fell to less than US$1 per day. Impoverishment was considered as poverty headcount and normalised poverty gap. On average, the percentage of annual household income spent on current delivery care was 5.9% in the ND group and 9.7% in the CS group. The CS group had a stronger impoverishment effect resulting in a high per cent change of payment-induced poverty headcount by 78.1% and poverty gap by 97.3% compared to 7.7 and 24.1% in the ND group, respectively. There is a strong need to develop a well-prepared financial system to prevent the issue of poverty and impoverishment.

Prevalence of Stress among Pregnant Women Attending Antenatal Care in a Tertiary Maternity Hospital in Kathmandu

“…A significant number of the respondents (43%) belong to the ethnic community which has inhabited Kathmandu valley from the very 15 th century [23,24]. Level of education was lower than the findings of the recent study done in this area [25]. Most of the educated women are working and working women find it difficult during office hours to queue up in the general ANC clinic that generally takes 4-5 hours per visit.…”

Change of childbirth preference after delivery among nulliparous Chinese women and their partners

“…The change in preference from vaginal delivery to cesarean among women with high couple's monthly income may be explained by their willingness or ability to pay for services that they believe are better . As labor and delivery are stressful conditions for women, psychological factors can conceivably facilitate a change in preference.…”

“…The change in preference from vaginal delivery to cesarean among women with high couple's monthly income may be explained by their willingness or ability to pay for services that they believe are better. 28 As labor and delivery are stressful conditions for women, 29 psychological factors can conceivably facilitate a change in preference. These factors can reflect the women's desire for more comprehensive, reassuring and high-quality obstetric care, 9 which echoes the reasons given by the women for their preference of cesarean, for example, ability to be free from labor pain and greater safety for both mother and baby.…”

Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa

“…25,26 The cost of emergency caesarean sections can be catastrophic for households. 25,26 Although user fee exemptions have been one of the key strategies to increase access to delivery care in subSaharan Africa, 27 their impact on caesarean delivery rates has yet to be rigorously evaluated.…”

“…25,26 The cost of emergency caesarean sections can be catastrophic for households. 25,26 Although user fee exemptions have been one of the key strategies to increase access to delivery care in subSaharan Africa, 27 their impact on caesarean delivery rates has yet to be rigorously evaluated. While such fee exemptions may have contributed to the rises seen in caesarean delivery rates in countries such as Ghana and Senegal, 28,29 such rises cannot be categorically attributed to the exemptions.…”