Out-of-pocket costs and time spent attending antenatal care services: a case study of pregnant women in selected rural communities in Zinder, Niger

Césaire T Ouédraogo,Charles D Arnold,Sonja Y Hess,Stephen A Vosti,M Thierno Faye,K Ryan Wessells

doi:10.1186/s12913-020-06027-2

Césaire T Ouédraogo, Charles D Arnold + Show 4 more

Open Access

https://doi.org/10.1186/s12913-020-06027-2

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Abstract

BackgroundDespite an official policy of exemption from health care costs, pregnant women in Niger still face some out-of-pocket costs (OPC) in addition to time costs when they attend antenatal care (ANC) services. We aimed to: 1) assess the OPC for pregnant woman attending ANC, 2) estimate the time spent to attend ANC and the opportunity cost of that time, and 3) assess how OPC and time spent to attend ANC affected ANC attendance.MethodsData were obtained from a quasi-experimental descriptive study carried out in the region of Zinder, Niger, which compared pre- and post-intervention cohorts of pregnant women (n = 1736 women who reported attending ANC during their current pregnancy). An ANC attendance score was developed to describe the timing of ANC attendance in regard to the WHO recommendation of attending 4 ANC sessions. OPC and time spent were evaluated separately for associations with ANC attendance using Spearman correlations.ResultsThe mean (±SD) age of pregnant women was 25.0 ± 6.4 yr, 19.0% were ≤ 19 yr and 99.7% were in their second or third trimester of gestation at the time of the interview. Among those who were > 13 weeks and > 27 weeks of gestation, 4.0 and 74.4% had attended ANC during their first and second trimesters, respectively. The median (1st quartile (Q1), 3rd quartile (Q3)) ANC score was 0 (− 1, 0), reflecting that the majority of women failed to follow the WHO recommendation. More than half of the women (72.5%) experienced OPC related to ANC. The majority of women (> 80%) reported spending ~ 3 h for an ANC visit, including travel and waiting time. Time spent to attend ANC was not associated with ANC attendance score. Women who experienced OPC, and those who received iron folic acid (IFA) or long-lasting insecticide-treated bednets during an ANC visit, were more likely to have a higher ANC attendance score compared to those who did not.ConclusionOPC and time spent were not identified as barriers to ANC visits, and IFA and long-lasting insecticide-treated bednets distribution could be used to motivate pregnant women to attend ANC.Trial registrationThe NiMaNu project was registered at www.clinicaltrials.gov as NCT01832688. Registered 16 April 2013.

Highlights

Despite an official policy of exemption from health care costs, pregnant women in Niger still face some out-of-pocket costs (OPC) in addition to time costs when they attend antenatal care (ANC) services
Among the 1385 and 922 pregnant women enrolled in the baseline and endline surveys during the main trial respectively, a total of 1736 pregnant women reported having attended any ANC visit during their current pregnancy (Fig. 1). Compared to those who reported not having attended ANC in their current pregnancy, women who reported attending ANC visits were more likely to have been enrolled in the survey during the hot season, were more likely to be in their third trimester of gestation, and were more likely to have attended ANC during their previous pregnancy and delivered in a health facility (Table 2)
More than half were in their third trimester of gestation and 72.5% reported OPC associated with ANC visits (Table 2)

Summary

Introduction

Despite an official policy of exemption from health care costs, pregnant women in Niger still face some out-of-pocket costs (OPC) in addition to time costs when they attend antenatal care (ANC) services. Numerous actions taken by the government of Niger that reduced socioeconomic inequities [2, 3], including an official policy established in 2006 that exempted pregnant women and children under 5 years of age from health care costs, may have contributed to this achievement [4]. The official exemption from health care costs includes free access to family planning, routine antenatal care (ANC), caesarean section, and treatment of gynecologic cancers [4, 5]. Even in the 2012 survey, after the free health care access to ANC had been introduced, only 33% of women reported attending at least four visits and 22% reported early ANC attendance (defined by the DHS survey as before 16 weeks gestation) during their most recent pregnancy [8]

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