| Titre : | Do free caesarean section policies increase inequalities in Benin and Mali? (2018) |
| Auteurs : | Marion Ravit, Auteur ; Martine Audibert, Auteur ; Valery Ridde, Auteur ; Myriam De Loenzien, Auteur ; Clémence Schantz, Auteur ; Alexandre Dumont, Auteur |
| Type de document : | Article : Revues - Articles |
| Dans : | International Journal for Equity in Health (vol.17 n°1, 2018-12) |
| Langues: | Anglais |
| Catégories : |
[Eurovoc] ÉDUCATION ET COMMUNICATION > éducation > politique de l'éducation [Eurovoc] GÉOGRAPHIE > Afrique > Afrique subsaharienne > Afrique occidentale > Mali [Eurovoc] GÉOGRAPHIE > géographie économique > pays de l'UEMOA > Benin [Eurovoc] GÉOGRAPHIE > géographie économique > pays de l'UEMOA > Mali [Eurovoc] QUESTIONS SOCIALES > famille > famille > maternité [Eurovoc] QUESTIONS SOCIALES > santé > politique de la santé |
| Tags : | health policy ; Benin ; user fees ; health equity ; maternal health ; Mali ; low-income countries ; caesarean section |
| Résumé : | Background: Benin and Mali introduced user fee exemption policies focused on caesarean sections (C-sections) in2005 and 2009, respectively. These policies had a positive impact on access to C-sections and facility based deliveriesamong all women, but the impact on socioeconomic inequality is still highly uncertain. The objective of this study wasto observe whether there was an increase or a decrease in urban/rural and socioeconomic inequalities in access toC-sections and facility based deliveries after the free C-section policy was introduced.Methods: We used data from three consecutive Demographic and Health Surveys (DHS): 2001, 2006 and 2011–2012 inBenin and 2001, 2006 and 2012–13 in Mali. We evaluated trends in inequality in terms of two outcomes: C-sections andfacility based deliveries. Adjusted odds ratios were used to estimate whether the distributions of C-sections and facilitybased deliveries favoured the least advantaged categories (rural, non-educated and poorest women) or the mostadvantaged categories (urban, educated and richest women). Concentration curves were used to observe the degreeof wealth-related inequality in access to C-sections and facility based deliveries.Results: We analysed 47,302 childbirths (23,266 in Benin and 24,036 in Mali). In Benin, we found no significantdifference in access to C-sections between urban and rural women or between educated and non-educated women.However, the richest women had greater access to C-sections than the poorest women. There was no significantchange in these inequalities in terms of access to C-sections and facility based deliveries after introduction of the freeC-section policy.In Mali, we found a reduction in education-related inequalities in access to C-sections after implementation of thepolicy (p-value = 0.043). Inequalities between urban and rural areas had already decreased prior to implementation ofthe policy, but wealth-related inequalities were still present.Conclusions: Urban/rural and socioeconomic inequalities in C-section access did not change substantially after thecountries implemented free C-section policies. User fee exemption is not enough. We recommend switching tomechanisms that combine both a universal approach and targeted action for vulnerable populations to address thisissue and ensure equal health care access for all individuals. |
| Doi : |
DOI : 10.1186/s12939-018-0789-x 
|
| Axe de recherche : | Trajectoires de développement durable |
| En ligne : | https://hal.archives-ouvertes.fr/hal-01811304 |
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