ArticleMaternal and child health journal2015
The Hidden Costs of a Free Caesarean Section Policy in West Africa (Kayes Region, Mali).
Article in Maternal and child health journal, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
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Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Cost of Utilising Maternal Health Services in Low- and Middle-Income Countries: A Systematic Review.International journal of health policy and management · 2021Pooled it
- Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review.Systematic reviews · 2017Pooled it
- A Systematic Review of Government-Led Free Caesarean Section Policies in Low- and Middle-Income Countries from 2009 to 2025.Healthcare (Basel, Switzerland) · 2025Review
- Unraveling the hidden expenses of free delivery services: a cross-sectional analysis of the public health facilities of the Harari Region, Ethiopia.BMC health services research · 2025Article
- Healthcare Professionals' Knowledge and Beliefs on Antibiotic Prophylaxis in Cesarean Section: A Mixed-Methods Study in Benin.Antibiotics (Basel, Switzerland) · 2022Article
- The true costs of cesarean delivery for patients in rural Rwanda: Accounting for post-discharge expenses in estimated health expenditures.International journal for equity in health · 2022Article
- Article
- Inequalities in prevalence of birth by caesarean section in Ghana from 1998-2014.BMC pregnancy and childbirth · 2022Article
- Economic consequences of caesarean section delivery: evidence from a household survey in Tanzania.BMC health services research · 2021Article
- Women's progression through the maternal continuum of care in Guinea: Evidence from the 2018 Guinean Demographic and Health Survey.Tropical medicine & international health : TM & IH · 2021Article
- Effects of free maternal policies on quality and cost of care and outcomes: an integrative review.Primary health care research & development · 2021Review
- Sexual and reproductive health services in universal health coverage: a review of recent evidence from low- and middle-income countries.Sexual and reproductive health matters · 2020Review
- Patient and health system costs of managing pregnancy and birth-related complications in sub-Saharan Africa: a systematic review.Health economics review · 2020Review
- Toward a complete estimate of physical and psychosocial morbidity from prolonged obstructed labour: a modelling study based on clinician survey.BMJ global health · 2020Article
- Why do women deliver where they had not planned to go? A qualitative study from peri-urban Nairobi Kenya.BMC pregnancy and childbirth · 2020Article
- Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data.International journal for equity in health · 2019Article
- Health Facility Cost of Cesarean Delivery at a Rural District Hospital in Rwanda Using Time-Driven Activity-Based Costing.Maternal and child health journal · 2019Article
- Do free caesarean section policies increase inequalities in Benin and Mali?International journal for equity in health · 2018Article
- Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa.BMJ global health · 2018Article
- Spanning maternal, newborn and child health (MNCH) and health systems research boundaries: conducive and limiting health systems factors to improving MNCH outcomes in West Africa.Health research policy and systems · 2017Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The fee exemption policy for EmONC in Mali aims to lower the financial barrier to care. The objective of the study was to evaluate the direct and indirect expenses associated with caesarean interventions performed in EmONC and the factors associated with these expenses. Data sampling followed the case control approach used in the large project (deceased and near-miss women). Our sample consisted of a total of 190 women who underwent caesarean interventions. Data were collected from the health workers and with a social approach by administering questionnaires to the persons who accompanied the woman. Household socioeconomic status was assessed using a wealth index constructed with a principal component analysis. The factors significantly associated with expenses were determined using multivariate linear regression analyses. Women in the Kayes region spent on average 77,017 FCFA (163 USD) for a caesarean episode in EmONC, of which 70 % was for treatment. Despite the caesarean fee exemption, 91 % of the women still paid for their treatment. The largest treatment-related direct expenses were for prescriptions, transfusion, antibiotics, and antihypertensive medication. Near-misses, women who presented a hemorrhage or an infection, and/or women living in rural areas spent significantly more than the others. Although abolishing fees of EmONC in Mali plays an important role in reducing maternal death by increasing access to caesarean sections, this paper shows that the fee policy did not benefit to all women. There are still barriers to EmONC access for women of the lowest socio-economic group. These included direct expenses for drugs prescription, treatment and indirect expenses for transport and food.
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