How costly is the first prenatal clinic visit? Analysis of out-of-pocket expenditure in rural Sri Lanka - a country with free maternal health care

Abstract

Background This study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare. Methods The study design was a cross-sectional study, and the study setting was 22 Medical Officers of Health (MOOH) areas in Anuradhapura District, Sri Lanka. Data of 1389 pregnant women were analyzed using descriptive statistics and non-parametric tests. Results The mean OOPE of the first prenatal clinic visit was USD 8.12, which accounted for 2.9 and 4.5% of the household income and expenditure, respectively. Pregnant women who used only government-free health services (which are free of charge at the point of service delivery) had an OOPE of USD 3.49. A significant correlation was recorded between household expenditure (rs = 0.095, p = 0.002) and the number of pregnancies (rs = − 0.155, p < 0.001) with OOPE. Education level less than primary education is positively contributed to OOPE (p < 0.05), and utilizing government-free maternal health services lead to a decrease in the OOPE for the first prenatal clinic visit (p < 0.05). Conclusion Despite having free maternal services, the OOPE of the first prenatal clinic visit is high in rural Sri Lanka. One-fifth of pregnant women utilize private health services, and pregnant women who used only government-free maternal health services also spend a direct medical cost for medicines/micronutrient supplements.

Out-of-pocket Expenditure for Antenatal Care Instills amidst Free Health Care Provision: Evidence from a Large Pregnancy Cohort in Rural Sri Lanka

“…The ndings suggest that the OOPE is higher in households with higher monthly household income and expenditure. This nding is in line with the previous evidence indicating the positive association between income level and the ability to pay for healthcare reported in the studies carried out in Sri Lanka (40) and India (32,52,63,70). Further, there was a negative relationship between the number of previous pregnancies and the magnitude of the OOPE.…”

“…Further, there was a negative relationship between the number of previous pregnancies and the magnitude of the OOPE. It is due to the experience gained in previous pregnancies that may have led to better nancial management, as con rmed in the studies done in Sri Lanka (40) and India (31). Also, it could be assumed that the lower OOPE occurs for subsequent pregnancies due to less anxiety, concern, and lack of time to pay attention to health seeking.…”

“…The presence of OOPE while accessing the government free healthcare services and national-level free health programmes is reported in Sri Lanka (40), Bangladesh (3,60), India (5,61), and Nepal (3,62). However, the fact that OOPE in the direct medical OOPE is higher than the non-medical OOPE is challenging the aims of the healthcare system in Sri Lanka, as the direct medical OOPE should be at a minimum level (11,34,52,63,64) since the country provides free healthcare services at the time of service delivery, and considered to have a well-developed maternal care package which has been instrumental in leading the country to the 4 th phase of the obstetric transition (36,65).…”

The magnitude of out‐of‐pocket expenditure for antenatal care in low and middle‐income countries: A systematic review and meta‐analysis

“…Only 13/137 (9.5%) countries reported scientific evidence on OOPE during pregnancy in LMICs. 10 (31.3%) studies were from the African region, [18][19][20]22,23,[45][46][47][48][49] 21 (65.6%) studies originated from the SEAR (countries including Myanmar, India, Bangladesh, and Sri Lanka) 10,11,14,16,17,21,28,[50][51][52][53][54][55][56][57][58][59][60][61][62][63] and 1 (3.1%) study belongs to the region of the Americas 64 (Table 1). No studies have originated from the Eastern Mediterranean, European, and Western Pacific regions.…”

Impact of COVID-19 pandemic on health service utilisation and household economy of pregnant and postpartum women: a cross-sectional study from rural Sri Lanka

“…However, the COVID-19 pandemic caused a higher prevalence of anxiety and depression among pregnant women, requiring additional support from the family and field health officers 24. This could be worse if the household economy were affected, since the income status was associated with the pregnancy expenditure25 26 and pregnancy nutritional status 27. Available evidence indicates that the COVID-19 pandemic created an economic meltdown at the household level and the Sri Lankan economy 28…”