ArticleInternational journal for equity in health2015
Inequity in costs of seeking sexual and reproductive health services in India and Kenya.
Article in International journal for equity in health, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 15 citations in OpenAlex.
- One size does not fit all: income-sensitive thresholds for catastrophic health expenditure.Health policy and planning · 2026Article
- Forbidden Conversations: A Comprehensive Exploration of Taboos in Sexual and Reproductive Health.Cureus · 2024Review
- Priority-setting to integrate sexual and reproductive health into universal health coverage: the case of Malaysia.Sexual and reproductive health matters · 2020Article
- Investing in the health of girls and women: a best buy for sustainable development.BMJ (Clinical research ed.) · 2020Article
- Social and behavioural research prospects for sexually transmissible infection prevention in the era of advances in biomedical approaches.Sexual health · 2020Article
- Decomposition of changes in socioeconomic inequalities in catastrophic health expenditure in Kenya.PloS one · 2020Article
- Self care interventions for sexual and reproductive health and rights: costs, benefits, and financing.BMJ (Clinical research ed.) · 2019Article
- Who pays and how much? A cross-sectional study of out-of-pocket payment for modern contraception in Kenya.BMJ open · 2019Article
- Minding the gaps: health financing, universal health coverage and gender.Health policy and planning · 2017Article
- Financial burden of survivors of medically-managed myocardial infarction and its association with selected social determinants and quality of life in a lower middle income country.BMC cardiovascular disorders · 2017Article
- A descriptive analysis of health practices, barriers to healthcare and the unmet need for cervical cancer screening in the Lower Napo River region of the Peruvian Amazon.Women's health (London, England)Article
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Authors and funding
10 authors at 4 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThis study aims to assess inequity in expenditure on sexual and reproductive health (SRH) services in India and Kenya. In addition, this analysis aims to measure the extent to which payments are catastrophic and to explore coping mechanisms used to finance health spending.
methodsData for this study were collected as a part of the situational analysis for the "Diagonal Interventions to Fast Forward Enhanced Reproductive Health" (DIFFER) project, a multi-country project with fieldwork sites in three African sites; Mombasa (Kenya), Durban (South Africa) and Tete (Mozambique), and Mysore in India. Information on access to SRH services, the direct costs of seeking care and a range of socio-economic variables were obtained through structured exit interviews with female SRH service users in Mysore (India) and Mombasa (Kenya) (n = 250). The costs of seeking care were analysed by household income quintile (as a measure of socio-economic status). The Kakwani index and quintile ratios are used as measures of inequitable spending. Catastrophic spending on SRH services was calculated using the threshold of 10% of total household income.
resultsThe results showed that spending on SRH services was highly regressive in both sites, with lower income households spending a higher percentage of their income on seeking care, compared to households with a higher income. Spending on SRH as a percentage of household income ranged from 0.02 to 6.2% and 0.03-7.5% in India and Kenya, respectively. There was a statistically significant difference in the proportion of spending on SRH services across income quintiles in both settings. In India, the poorest households spent two times, and in Kenya ten times, more on seeking care than the least poor households. The most common coping mechanisms in India and Kenya were "receiving [money] from partner or household members" (69%) and "using own savings or regular income" (44%), respectively.
conclusionHighly regressive spending on SRH services highlights the heavier burden borne by the poorest when seeking care in resource-constrained settings such as India and Kenya. The large proportion of service users, particularly in India, relying on money received from family members to finance care seeking suggests that access would be more difficult for those with weak social ties, small social networks or weak bargaining positions within the family - although this requires further study.
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