Abstract
Since 2001, several sub-Saharan African countries have eliminated user fees for childbirth. Although intended to improve maternal and infant health outcomes, service quality also fell as facilities became overburdened. In this paper I combine DHS surveys on births from countries eliminating user fees. I identify the effect of user fee elimination using (i) a maternal fixed effect and (ii) an event study within a small geographic area. I find that user fees increase the likelihood of delivery at public sector facilities by 2-7 percentage points. I also find that user fee elimination reduces maternal mortality but may increase neonatal mortality.
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