Abstract
BackgroundIn 2016, the national user fee exemption policy for women and children under five was introduced in Burkina Faso. It covers most reproductive healthcare services for women including prenatal care, delivery, and postnatal care. In subsequent years, the policy was gradually extended to include family planning. While studies have shown that user fee abolition policies increase visits to health centers and improve access to reproductive healthcare and family planning, there are also indications that other barriers remain, notably women’s lack of decision-making power. The objective of the study is to investigate women’s decision-making power regarding access to reproductive health and family planning in a context of free healthcare in rural Burkina Faso.MethodsA descriptive qualitative study was carried out in rural areas of the Cascades and Center-West regions. Qualitative data were collected using individual semi-structured interviews (n = 20 participants) and focus groups (n = 15 participants) with Burkinabe women of childbearing age, their husbands, and key informants in the community. Data was analyzed using thematic analysis.ResultsA conceptual framework describing women’s participation in the decision-making process was built from the analysis. Results show that the user fee exemption policy contributes to improving access to reproductive care and family planning by facilitating the negotiation processes between women and their families within households. However, social norms and gender inequalities still limit women’s decision-making power.ConclusionIn light of these results, courses of action that go beyond the user fee exemption policy should be considered to improve women’s decision-making power in matters of health, particularly with regard to family planning. Interventions that involve men and community members may be necessary to challenge the social norms, which act as determinants of women’s health and empowerment.
Highlights
In 2016, the national user fee exemption policy for women and children under five was introduced in Burkina Faso
World Health Organization (WHO) recommends facilitating access to reproductive healthcare and family planning, which is in line with the improvement of Universal Health Coverage, the main strategy to achieve the Sustainable Development Goals
The aim of this study is to describe women’s decisionmaking power regarding access to reproductive healthcare and family planning in rural Burkina Faso
Summary
In 2016, the national user fee exemption policy for women and children under five was introduced in Burkina Faso. It covers most reproductive healthcare services for women including prenatal care, delivery, and postnatal care. In order to improve access to reproductive care, the government of Burkina Faso implemented a national user fee exemption policy for women and children under five years of age in June 2016 [4]. The policy provides free screening for breast and cervical cancer, prenatal and postnatal care, deliveries and caesarean sections, universal healthcare for children under five [5], as well as fuel for in-country medical evacuations, including emergency obstetric care [6]. This extended exemption covers the cost for family planning consultations and counseling, for contraceptives (mainly injectable, implants, copper intrauterine devices, emergency contraceptive pills and condoms) and consumables, and for all related medical procedures, tests and examinations
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