ArticleBMJ global health2018
Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa.
Article in BMJ global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa: a systematic review.Global health promotion · 2020Pooled it
- Evaluating the effects of the free healthcare policy on clinical visits and malaria among children in Burkina Faso: a modeling study of past trends and future forecasts.Global health research and policy · 2025Article
- A Systematic Review of Government-Led Free Caesarean Section Policies in Low- and Middle-Income Countries from 2009 to 2025.Healthcare (Basel, Switzerland) · 2025Review
- Effect of the COVID-19 Lockdown on Mobile Payments for Maternal Health: Regression Discontinuity Analysis.JMIR public health and surveillance · 2024Article
- Inequalities in use of hospitals for childbirth among rural women in sub-Saharan Africa: a comparative analysis of 18 countries using Demographic and Health Survey data.BMJ global health · 2024Article
- Financing for equity for women's, children's and adolescents' health in low- and middle-income countries: A scoping review.PLOS global public health · 2024Article
- Health insurance coverage and access to child and maternal health services in West Africa: a systematic scoping review.International health · 2023Article
- How a supply-side intervention can help to increase caesarean section rates in Burkina Faso facilities-Evidence from an interrupted time-series analysis using routine health data.Tropical medicine & international health : TM & IH · 2023Article
- User Fee Exemption Policy Significantly Improved Adherence to Maternal Health Service Utilization in Bahir Dar City, Northwest Ethiopia: A Comparative Cross-Sectional Study.ClinicoEconomics and outcomes research : CEOR · 2023Article
- Healthcare Professionals' Knowledge and Beliefs on Antibiotic Prophylaxis in Cesarean Section: A Mixed-Methods Study in Benin.Antibiotics (Basel, Switzerland) · 2022Article
- Using experience to create evidence: a mixed methods process evaluation of the new free family planning policy in Burkina Faso.Reproductive health · 2022Article
- Perspectives of stakeholders of the free maternity services for mothers in western Kenya: lessons for universal health coverage.BMC health services research · 2022Article
- The status of emergency obstetric and newborn care in post-conflict eastern DRC: a facility-level cross-sectional study.Conflict and health · 2021Article
- Impact of free maternity policies in Kenya: an interrupted time-series analysis.BMJ global health · 2021Article
- A review of prospective pathways and impacts of COVID-19 on the accessibility, safety, quality, and affordability of essential medicines and vaccines for universal health coverage in Africa.Globalization and health · 2021Review
- The impact of introducing ambulance and delivery fees in a rural hospital in Tanzania.BMC health services research · 2021Observational
- Removal of user fees and system strengthening improves access to maternity care, reducing neonatal mortality in a district hospital in Lesotho.Tropical medicine & international health : TM & IH · 2019Article
- Do free caesarean section policies increase inequalities in Benin and Mali?International journal for equity in health · 2018Article
- Impact of fee subsidy policy on perinatal health in a low-resource setting: A quasi-experimental study.PloS one · 2018Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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.
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