ArticleInternational journal of women's health2019
Out-of-pocket expenditure for home and facility-based delivery among rural women in Zambia: a mixed-methods, cross-sectional study.
Article in International journal of women's health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- The Cost and Cost-Effectiveness of Childbirth Settings: A Systematic Review.Applied health economics and health policy · 2025Pooled it
- The hidden financial burden of healthcare: a systematic literature review of informal payments in Sub-Saharan Africa.Wellcome open research · 2021Pooled it
- Using Open Public Meetings and Elections to Promote Inward Transparency and Accountability: Lessons From Zambia.International journal of health policy and management · 2022Trial
- Assessing the costs of antenatal care in Eastern Ethiopia: implications for improving the free maternity services policy.Health policy and planning · 2026Article
- Qualitative application of the diffusion of innovation theory to maternity waiting homes in rural Zambia.Implementation science communications · 2025Article
- Universal health coverage for women of reproductive ages: a survey-based comprehensive assessment of service utilisation and health expenditure in Tanzania.BMJ public health · 2025Article
- Out-of-Pocket Expenditure for Antenatal Care Amid Free Health Care Provision: Evidence From a Large Pregnancy Cohort in Rural Sri Lanka.Global health, science and practice · 2023Article
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- Cost of childbirth in Upper West Region of Ghana: a cross-sectional study.BMC pregnancy and childbirth · 2022Article
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- If we build it, will they come? Results of a quasi-experimental study assessing the impact of maternity waiting homes on facility-based childbirth and maternity care in Zambia.BMJ global health · 2021Article
- 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.BMC health services research · 2021Article
- Role of Savings and Internal Lending Communities (SILCs) in improving household wealth and financial preparedness for birth in rural Zambia.Health policy and planning · 2021Article
- Continuum of maternity care in Zambia: a national representative survey.BMC pregnancy and childbirth · 2021Article
- User fee policies and women's empowerment: a systematic scoping review.BMC health services research · 2020Article
- The predictive power of health system environments: a novel approach for explaining inequalities in access to maternal healthcare.BMJ global health · 2019Article
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeOut-of-pocket expenses associated with facility-based deliveries are a well-known barrier to health care access. However, there is extremely limited contemporary information on delivery-related household out-of-pocket expenditure in sub-Saharan Africa. We assess the financial burden of delivery for the most remote Zambian women and compare differences between delivery locations (primary health center, hospital, or home).
methodsWe conducted household surveys and in-depth interviews among randomly selected remote Zambian women who delivered a baby within the last 13 months. Women reported expenditures for their most-recent delivery for delivery supplies, transportation, and baby clothes, among others. Expenditures were converted to US dollars for analysis.
resultsOf 2280 women sampled, 2223 (97.5%) reported spending money on their delivery. Nearly all respondents in the sample (95.9%) spent money on baby clothes/blanket, while over 80% purchased delivery supplies such as disinfectant or cord clamps, and a third spent on transportation. Women reported spending a mean of USD28.76 on their delivery, with baby clothes/blanket (USD21.46) being the main expenditure and delivery supplies (USD3.81) making up much of the remainder. Compared to women who delivered at home, women who delivered at a primary health center spent nearly USD4 (p<0.001) more for their delivery, while women who delivered at a level 1 or level 2 hospital spent over USD7.50 (p<0.001) more for delivery.
conclusionThese expenses account for approximately one third of the monthly household income of the poorest Zambian households. While the abolition of user fees has reduced the direct costs of delivering at a health facility for the poorest members of society, remote Zambian women still face high out-of-pocket expenses in the form of delivery supplies that facilities should provide as well as unofficial policies/norms requiring women to bring new baby clothes/blanket to a facility-based delivery. Future programs that target these expenses may increase access to facility-based delivery.
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