Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa - Ravit, Marion; Audibert, Martine; Ridde, Valéry; de Loenzien, Myriam; Schantz, Clémence; Dumont, Alexandre (BMJ Global Health, 2018)
Introduction Mali 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. Methods We 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.
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