Determinants of utilisation of maternal care services after the reduction of user fees: A case study from rural Burkina Faso
Abstract
Objective To identify determinants of utilisation for antenatal care (ANC) and skilled attendance at birth after a substantial reduction in user fees.Methods The study was conducted in the Nouna Health District in north-western Burkina Faso in early 2009. Data was collected by means of a representative survey on a sample of 435 women who reported a pregnancy in the prior 12 months. Two independent logit models were used to assess the determinants of (a) ANC utilisation (defined as having attended at least 3 visits) and (b) skilled assistance at birth (defined as having delivered in a health facility).Results 76% of women had attended at least 3 ANC visits and 72% had delivered in a facility. Living within 5 km from a facility was positively associated, while animist religion, some ethnicities, and household wealth were negatively associated with ANC utilisation. Some ethnicities, living within 5 km from a health facility, and having attended at least 3 ANC visits were positively associated with delivering in a facility.Conclusions User fee alleviation secured equitable access to care across socio-economic groups, but alone did not ensure that all women benefited from ANC and from skilled attendance at birth. Investments in policies to address barriers beyond financial ones are urgently needed.
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In rural Burkina Faso, obstacles to maternal care access remain numerous, including social, geographical and economic barriers, shortages of skilled health staff, lack of information on sexual and reproductive health, cost of medical treatment, and negative perceptions of quality of care.
“In rural areas, obstacles to maternal care access remain numerous, and include social, geographical and economic barriers, shortages of skilled health staff, lack of information on sexual and reproductive health, the cost of medical treatment, and negative perceptions of quality of care [48–52].”
From Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso (2017) · cites this paper as [51]
Healthcare-seeking behaviours in rural Burkina Faso are influenced by many factors.
“Healthcare-seeking behaviours in rural Burkina Faso are obviously no exception [51, 75, 76].”
From Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso (2017) · cites this paper as [51]
Distance to health facility is a major determinant of maternal care utilisation, including likeliness to seek ANC and to deliver in a health facility, in rural Burkina Faso.
“Additionally, many studies have shown how distance to health facility is a major determinant of maternal care utilisation, including likeliness to seek ANC and to deliver in a health facility, in rural Burkina Faso [51, 78, 79].”
From Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso (2017) · cites this paper as [51]
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Self-citation
- Authors
- De Allegri, M., Ridde, V., Louis, V. R., Sarker, M., Tiendrebéogo, J., Yé, M., Müller, O., & Jahn, A.
- Affiliations
- Centre Hospitalier de l’Université de Montréal (CA)
- Heidelberg University (DE)
- Centre de Recherche en Santé de Nouna (BF)
- Venue
- Health Policy
- Publisher
- Elsevier BV
- Published
- 2011-03
- Volume
- 99
- Issue
- 3
- Pages
- 210-218
- ISSN
- 0168-8510 (ISSN-L)
- OpenAlex
- W2074059565
- Cited by
- 215
- References
- 72
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 7 · 2023: 7 · 2022: 12 · 2021: 17 · 2020: 28 · 2019: 14 · 2018: 13 · 2017: 15 · 2016: 16 · 2015: 21 · 2014: 21 · 2013: 21 · 2012: 14
- FWCI
- 10.73
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Policy (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Collaborative Research
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- antenatal care utilization, skilled birth attendance, institutional delivery, obstetric care, health care access, distance to health facility, animism, ethnicity, household wealth, rural Burkina Faso
- MeSH terms
- Adult, Burkina Faso, Fees and Charges, Female, Financing, Government, Financing, Personal, Health Services Accessibility, Humans, Maternal Health Services, Pregnancy, Prenatal Care, Logistic Models, Rural Health Services, Organizational Case Studies, Delivery, Obstetric
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