On The Empirics of User-Fees, Maternal Health-Seeking Behavior and Child Survival in Ghana

Abstract

This study examines the impact of the elimination of health user-fees on a variety of maternal and child health outcomes, under the Free Maternal Healthcare Program in Ghana using data from a nationally-representative sample survey. By employing a battery of linear and binomial logit and probit estimations, we find that the elimination of user fees significantly increases the probability of using the services of a skilled birth attendant (midwife or nurse) at delivery, whilst simultaneously reducing the probability of using a traditional attendant. We also find evidence that the program increases the number of antenatal care visits as well as the probability of going for post-natal baby check-ups. On family planning, even though we do not find a positive impact on the probability that a couple will not use family planning methods or on the ideal number of children a couple wishes to have in our Schultz(1969) family planning model, we find that it significantly increases the probability that a couple will keep an initially unwanted pregnancy. Additionally and perhaps most importantly, we find that the program is more significant in increasing the probability of child survival than any other variable in our Chen and Mosley (1984) child survival model. Our findings remain robust and consistent across specifications and after controlling for regional fixed effects, as well as rural and urban disparities in health facility endowments and non-facility costs.