USAID Maternal Health Technical Series: The Effects of Removing User Fees on Caesareans in Mali

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You are invited to the USAID Maternal Health Technical Series:


The effects of removing user fees on access to life-saving maternal health services: The case of caesareans in Mali


Marianne El-Khoury, MPA, MA, Associate/Economist, USAID/Health Systems 20/20 Project
Laurel Hatt, MPH, PhD, Senior Associate/Health Economist, USAID/Health Systems 20/20 Project


Wednesday, April 27 2011
12:30-1:30 PM
Ronald Reagan Building R. 2.09 d/e


Despite more than a decade of health sector reforms, Mali’s maternal mortality ratio remains high, with 464 maternal deaths per 100,000 live births. In an effort to increase access to skilled birth attendance and emergency obstetric care, the government of Mali in 2005 removed user fees for caesareans in all public sector facilities. This study examines the effects of the policy on access to caesareans, assesses equity of utilization of caesarean services across socioeconomic groups, and identifies important remaining access barriers.

The authors find that while caesarean rates have increased since 2005, about 24% of women receiving caesareans belong to the poorest third of the population while as high as 49% belong to the wealthiest third, suggesting that barriers to access remain among the most economically disadvantaged population. Transportation barriers and drug costs are among the most significant remaining obstacles.

The paper is available here.


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