Removing user fees for facility-based delivery services: a difference-in-differences evaluation from ten sub-Saharan...

Area of Science:

• Public Health
• Health Economics
• Maternal and Child Health

Background:

• Sub-Saharan African nations are implementing policies to eliminate user fees for facility-based childbirth.
• Limited evidence exists on the impact of these fee-removal policies on service utilization and neonatal mortality rates.

Purpose of the Study:

• To estimate the causal effect of removing user fees on facility-based delivery rates.
• To assess the impact of these policies on Caesarean section rates and neonatal mortality rates (NMR).

Main Methods:

• Utilized Demographic and Health Surveys from 10 African countries (1997-2012).
• Employed a difference-in-differences (DD) regression analysis comparing countries with and without user fee removal policies.
• Controlled for secular trends and time-invariant country-specific differences.

Main Results:

• A 5% increase in facility-based deliveries was observed following policy implementation.
• An estimated 9% reduction in neonatal mortality rates (NMR) was associated with the policy change.
• No significant increase in Caesarean deliveries was detected; facility deliveries showed sustained increases post-policy.

Conclusions:

• Removing user fees for facility-based delivery services appears to boost service utilization.
• These policies may contribute to a reduction in neonatal mortality rates.
• Findings offer valuable evidence for governments considering the benefits of eliminating user fees for childbirth.