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      Analysis of Out-of-Pocket Expenditure in Utilization of Maternity Care Services in Urban Slums of Rajkot City, Gujarat

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          Abstract

          Background:

          India contributes 20% global maternal deaths every year. An important reason of such maternal mortality is due to cost of maternity services which makes it in accessible to the poor. Knowledge of maternity-related expense and its determinants is useful for health authorities to focus public resources and target financial assistance or exemption guidelines toward the “neediest.”

          Methodology:

          It was a cross-sectional descriptive study conducted amongst 180 women living in urban slums and who had delivered a baby within 1 year of the interview date.

          Results:

          The mean cost of delivery was around Rs. 8880. The average delivery cost of private institutions was significantly higher than that of government hospitals or home delivery. Around 75% of women delivered in private institution had health expenditure of more than 10% of total annual family income – catastrophic expenditure.

          Conclusion:

          In spite of significantly higher maternity care-related costs in private institutes than government hospitals, majority of mothers had utilized services from private clinics and had suffered catastrophic expenditures during utilization of maternity care services. This study highlights the need for birth preparedness counseling as well as effective implementation of maternity benefit schemes to prevent families from pushing downward to the poverty line.

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          Most cited references14

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          Kuppuswamy's socioeconomic scale: updating income ranges for the year 2012.

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            The hidden cost of 'free' maternity care in Dhaka, Bangladesh.

            We studied the cost and affordability of 'free' maternity services at government facilities in Dhaka, Bangladesh, to assess whether economic factors may contribute to low utilization. We conducted a questionnaire survey and in-depth interviews among 220 post-partum mothers and their husbands, selected from four government maternity facilities (three referral hospitals and one Mother and Child Health hospital) in Dhaka. Mothers with serious complications were excluded. Information was collected on the costs of maternity care, household income, the sources of finance used to cover the costs, and the family's willingness to pay for maternity services. The mean cost for normal delivery was 1275 taka (US$31.9) and for caesarean section 4703 taka (US$117.5). Average monthly household income was 4933 taka (US$123). Twenty-one per cent of families were spending 51-100% of monthly income, and 27% of families 2-8 times their monthly income for maternity care. Overall, 51% of the families (and 74% of those having a caesarean delivery) did not have enough money to pay; of these, 79% had to borrow from a money lender or relative. Surprisingly, 72% of the families said they were willing to pay a government-levied user charge, though this was less popular among low-income families (61%). 'Free' maternity care in Bangladesh involves considerable hidden costs which may be a major contributor to low utilization of maternity services, especially among low-income groups. To increase utilization of safer motherhood services, policy-makers might consider introducing fixed user charges with clear exemption guidelines, or greater subsidies for existing services, especially caesarean section.
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              Preventing impoverishment through protection against catastrophic health expenditure.

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                Author and article information

                Journal
                Indian J Community Med
                Indian J Community Med
                IJCM
                Indian Journal of Community Medicine : Official Publication of Indian Association of Preventive & Social Medicine
                Medknow Publications & Media Pvt Ltd (India )
                0970-0218
                1998-3581
                Jul-Sep 2018
                : 43
                : 3
                : 215-219
                Affiliations
                [1 ]Epidemiology, ICMR-National Jalma Institute of Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
                [2 ]Community Medicine Department, GMERS Medical College, Himmatnagar, Gujarat, India
                [3 ]Clinical Epidemiology, ICMR - National Institute of Occupational Health, Ahmedabad, Gujarat, India
                [4 ]Community Medicine Department, GMERS Medical College, Junagadh, Gujarat, India
                Author notes
                Address for correspondence: Dr. Sandeep Sharma, National Jalma Institute of Leprosy and Other Mycobacterial Diseases, MRHRU Ghatampur (ICMR), Jahanabad Road, Ghatampur, Kanpur Nagar, 209 206, Uttar Pradesh, India. E-mail: drsandeepsharma82@ 123456yahoo.in
                Article
                IJCM-43-215
                10.4103/ijcm.IJCM_47_18
                6166517
                30294091
                7d1474fa-cb43-423c-a389-bfd4fb598b64
                Copyright: © 2018 Indian Journal of Community Medicine

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 21 February 2018
                : 24 August 2018
                Categories
                Original Article

                Public health
                catastrophic health events,cost,maternity care,out of pocket expenditure,urban slums
                Public health
                catastrophic health events, cost, maternity care, out of pocket expenditure, urban slums

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