“…As a result, several social and economic consequences arise at the household level: exclusion from health care, indebtedness and high use of the informal sector [15,39,48].It is true that the presence of quali ed personnel during all deliveries is considered to be one of the most important interventions for safer births because it reduces maternal deaths and increases successful delivery of infants [41,[49][50][51]. On the other hand, as this study and several other studies have demonstrated, in poor countries, women and families who must pay out-of-pocket for the costs of care suffer in terms of their physical, mental and social states, and these distressing repercussions are linked to the unaffordable cost of the care they receive.This issue also raises questions regarding staff motivation, patient-centered care, the renewal of equipment, the supply of drugs to maintain quality, the availability of care and the improvement of conditions in the health infrastructure [52][53][54]. These issues are all the more serious because they occur at the level of state structures that normally should be supported by the government but are not su ciently supported because of the slow disbursement of budgetary allocations, which already do not meet the requirements of the Abuja Agreements [17,55,56].All in all, in an environment where seven out of ten households are poor, we believe that the Congolese State should, failing to introduce free healthcare, follow the example of several other countries [15,30,40,57,58]: create an effective and sustainable healthcare subsidy policy; favor and promote the establishment of cost-sharing and/or nancial risk systems that focus on the poorest households; and improve the quality of care and ensure that care management is based on community participation, especially that of male sexual partners, who are equally involved in conception [36,38,59].…”