La césarienne dans le contexte de gratuité au Bénin

IntroductionMali and Benin introduced a user fee exemption policy focused on caesarean sections in 2005 and 2009, respectively. The objective of this study is to assess the impact of this policy on service utilisation and neonatal outcomes. We focus specifically on whether the policy differentially impacts women by education level, zone of residence and wealth quintile of the household.MethodsWe use a difference-in-differences approach using two other western African countries with no fee exemption policies as the comparison group (Cameroon and Nigeria). Data were extracted from Demographic and Health Surveys over four periods between the early 1990s and the early 2000s. We assess the impact of the policy on three outcomes: caesarean delivery, facility-based delivery and neonatal mortality.ResultsWe analyse 99 800 childbirths. The free caesarean policy had a positive impact on caesarean section rates (adjusted OR=1.36 (95% CI 1.11 to 1.66; P≤0.01), particularly in non-educated women (adjusted OR=2.71; 95% CI 1.70 to 4.32; P≤0.001), those living in rural areas (adjusted OR=2.02; 95% CI 1.48 to 2.76; P≤0.001) and women in the middle-class wealth index (adjusted OR=3.88; 95% CI 1.77 to 4.72; P≤0.001). The policy contributes to the increase in the proportion of facility-based delivery (adjusted OR=1.68; 95% CI 1.48 to 1.89; P≤0.001) and may also contribute to the decrease of neonatal mortality (adjusted OR=0.70; 95% CI 0.58 to 0.85; P≤0.001).ConclusionThis study is the first to evaluate the impact of a user fee exemption policy focused on caesarean sections on maternal and child health outcomes with robust methods. It provides evidence that eliminating fees for caesareans benefits both women and neonates in sub-Saharan countries.

show abstract

“… 39 Even if the free policy was not totally effective, the monetary burden was less important for women after the reform. 40 …”

Section: Discussionmentioning

confidence: 99%

Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Second, this study did not consider the level of implementation of the free C-section policy in both countries. Previous studies showed that the cost of C-sections was still high in many hospitals in Benin after the policy was introduced [ 15 ] and that 91% of women still paid for their C-sections in a rural area of Mali during the period 2008–2011 [ 51 ]. The impact of this policy on socioeconomic inequalities might have been more important than the observed impact if C-sections were truly free for every woman.…”

Section: Discussionmentioning

confidence: 99%

“…In April 2009, the government of Benin introduced a national user fee exemption policy concerning all C-sections in selected public and private hospitals that offer emergency obstetric care. Hospitals receive 100,000 CFA (US$166) per C-section, which covers pre-operative laboratory tests, medications, surgery kits, blood, hospitalization for 7 days and transportation to a hospital if the woman is referred [ 15 , 16 ]. The state is the principal financer of the reform [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Do free caesarean section policies increase inequalities in Benin and Mali?

Ravit

Audibert

Ridde

et al. 2018

Int J Equity Health

View full text Add to dashboard Cite

BackgroundBenin and Mali introduced user fee exemption policies focused on caesarean sections (C-sections) in 2005 and 2009, respectively. These 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. The 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.MethodsWe used data from three consecutive Demographic and Health Surveys (DHS): 2001, 2006 and 2011–2012 in Benin and 2001, 2006 and 2012–13 in Mali. We evaluated trends in inequality in terms of two outcomes: C-sections and facility based deliveries. Adjusted 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). Concentration curves were used to observe the degree of wealth-related inequality in access to C-sections and facility based deliveries.ResultsWe analysed 47,302 childbirths (23,266 in Benin and 24,036 in Mali). In Benin, we found no significant difference in access to C-sections between urban and rural women or between educated and non-educated women. However, the richest women had greater access to C-sections than the poorest women. There 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.In Mali, we found a reduction in education-related inequalities in access to C-sections after implementation of the policy (p-value = 0.043). Inequalities between urban and rural areas had already decreased prior to implementation of the policy, but wealth-related inequalities were still present.ConclusionsUrban/rural and socioeconomic inequalities in C-section access did not change substantially after the countries implemented free C-section policies. User fee exemption is not enough. We 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.

show abstract

“…Among these health policies is the free caesarean section, which was started in Benin in 2009 [8]. In practice, hospitals are paid a fat fee of CFA francs 100.000 (US$152.08) per caesarean section [9]. Tis measure helped bring the caesarean delivery rate to 5.1% and the participation rate by qualifed health personnel to 78.0% in Benin in 2019 [3].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Caesarean Expenditures of Households in Benin

Gnimassou,

Filiz

2023

Health & Social Care in the Community

View full text Add to dashboard Cite

After years of effort, sub-Saharan Africa has seen little improvement in maternal and neonatal health indicators. Providing all women with access to emergency obstetric care is an accepted effective strategy to reduce maternal and neonatal mortality. In many African countries such as Benin, the cost of health care is a major obstacle to access obstetric care. The aim of this study was to evaluate the caesarean section expenditures of households in Benin and to determine the strategies for obtaining the necessary resources to meet the caesarean section expenditures of the households. Three hospitals and 505 households in the Littoral region were sampled, and data were collected by applying a questionnaire to the people accompanying the woman to the hospital. The socioeconomic status of the households was evaluated using a wealth index created by principal component analysis. Factors significantly associated with expenditure were determined using multivariate linear regression analysis. Despite the free caesarean section policy in effect, households spend a median of US$180.60 (IQR: 148.13–222.35) for a caesarean section, of which 76.0% are direct costs, 17.0% are indirect costs, and 7.0% are opportunity costs. Expenditures vary considerably depending on the residence area of the household, the presence of complications, the presence of health insurance, the socioeconomic class of the households, the education level, and working status of the woman. Finally, households use 11 strategies to obtain funds to pay for the caesarean costs. While poor households resort to foreign aid, asset sales, and/or current spending cuts, the rich use their income and/or savings to cover their caesarean section expenses. The results favour the adoption of a mechanism for direct exemption of the costs of caesarean sections payable by the poorest households, in addition to the current free caesarean policy.

show abstract

La césarienne dans le contexte de gratuité au Bénin

Cited by 6 publications

References 16 publications

Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa

Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa

Do free caesarean section policies increase inequalities in Benin and Mali?

Evaluation of Caesarean Expenditures of Households in Benin

Contact Info

Product

Resources

About