Impact de la politique de gratuité des accouchements et des césariennes au Sénégal : une évaluation basée sur l’approche de la double-différence
DOI:
https://doi.org/10.64707/revstss.v49i1.1855Keywords:
User fee removal, maternal health care, childbirth, caesarean section, difference-in-difference, SénégalAbstract
Background: In Sub-Saharan Africa, maternal mortality is linked to the access to care during childbirth including caesarean section (CS). Among the determinants of this access, the household's ability to finance the cost of care plays a key role. With the goal to improve access to maternal health services, Senegal set up a system of free deliveries and CS in 2005 in priority regions, which was gradually extended to the entire territory until 2011. The aim of this study was to assess the impact of this policy on the use of maternity services during childbirth including CS.
Methods: Our study design corresponded to a historical cohort of 45,168 women who gave birth between 2000 and 2018 in Senegal, included from the women interviewed during the eight Demographic and Health Surveys, carried out between 2005 and 2018. The evaluation of the impact was carried out using a quasi-experimental approach, using a difference-in-difference regression model.
Results: The results show that free health care exposure did not have a significant effect on the use of maternity services during childbirth, after adjusting on area of residence (OR=1.15; 95%CI=0.95-1.40). Exposure to free health care also had no significant impact on CS use (OR=1.10; 95%CI=0.81-1.51).
Conclusions: Our findings indicated that the removal of user fees in Senegal did not significantly increase institutional deliveries or CS rates. The increase in these indicators over the period was more likely attributable to underlying secular trends or to other contextual determinants unrelated to the fee exemption policy.
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