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The free delivery and caesarean policy in Morocco: how much do households still pay?
Author(s) -
Boukhalfa C.,
Abouchadi S.,
Cunden N.,
Witter S.
Publication year - 2016
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12638
Subject(s) - childbirth , caesarean section , medicine , medical prescription , user fee , business , socioeconomics , pregnancy , nursing , economics , political science , genetics , biology , law
Background The Free Deliveries and Caesarean Policy ( FDCP ) entitles all women in Morocco to deliver free of charge within public hospitals. This study assesses the policy's effectiveness by analysing household expenditures related to childbirth, by delivery type and quintile. Methods Structured exit survey of 973 women in six provinces at five provincial hospitals, two regional hospitals, two university hospitals and three primary health centres with maternity units. Results Households reported spending a median of US $ 59 in total for costs inside and outside of hospitals. Women requiring caesareans payed more than women with uncomplicated deliveries ( P < 0.0001). The median cost was US $45 for a uncomplicated delivery, US $50 for a complicated delivery and US $65 for a caesarean section. The prescription given upon exiting the hospital comprised 62% of the total costs. Eighty‐eight per cent of women from the poorest quintiles faced catastrophic expenditures. The women's perception of their hospital stay and the FDCP policy was overwhelmingly positive, but differences were noted at the various sites. Conclusion The policy has been largely but not fully effective in removing financial barriers for delivery care in Morocco. More progress should also be made on increasing awareness of the policy and on easing the financial burden, which is still borne by households with lower incomes.