Childbirth can be a costly process for households in countries where financing arrangements are fragmented and fail to provide universal coverage. Seeking obstetric care results in immediate financial outlays as well as longer term economic and social consequences in terms of debt repayment and potential ongoing complications. This chapter reviews the evidence on the obstetric care costs faced by households and seeks to demonstrate both to what extent these costs affect access to facility-based care for certain groups, and the impact of resulting expenditures on the household economy for those who do reach the facility. The chapter further highlights the consequences of these expenditures for a woman’s health, as well as the economic and social consequences for the household. Obstetric care costs in hospitals are shown to be significant. The official user charges interact with unofficial costs, transport costs and time costs resulting in catastrophic expenditures and debt, particularly in the event of complications. Finding a source of financial protection for poor women is essential as they suffer the greatest impact of payments, and are more likely to be deterred from seeking care. Women’s work and everyday poverty must be addressed alongside clinical factors in public health efforts, either by helping them plan for their delivery, providing free or less costly delivery or emergency obstetric care, or by targeting poor women through exemptions or cash transfers around the time of delivery. Greater government participation in the financing of obstetric care would contribute towards reducing the economic impact on households and is hence likely to increase rates of skilled attendance at delivery.
Chapter 1, pp. 23-46, in iReducing financial barriers to obstetric care in low income countriesi (2009), edited by F. Richard, S. Witter and V. De Brouwere (iStudies in Health Services Organisation & Policyi series no. 24, published by Instituut voor Tropische Geneeskunde, Antwerp, Belgium; ISBN ISBN 978-90-76070-00-1). [Also available in French].