Health Policy and Planning, Vol 13, 417-422, Copyright © 1998 by Oxford University Press
S Nahar and A Costello
We studied the cost and affordability of 'free' maternity services at
government facilities in Dhaka, Bangladesh, to assess whether economic
factors may contribute to low utilization. We conducted a questionnaire
survey and in-depth interviews among 220 post-partum mothers and their
husbands, selected from four government maternity facilities (three
referral hospitals and one Mother and Child Health hospital) in Dhaka.
Mothers with serious complications were excluded. Information was collected
on the costs of maternity care, household income, the sources of finance
used to cover the costs, and the family's willingness to pay for maternity
services.The mean cost for normal delivery was 1275 taka (US$31.9) and for
caesarean section 4703 taka (US$117.5). Average monthly household income
was 4933 taka (US$123). Twenty-one per cent of families were spending
51-100% of monthly income, and 27% of families 2-8 times their monthly
income for maternity care. Overall, 51% of the families (and 74% of those
having a caesarean delivery) did not have enough money to pay; of these,
79% had to borrow from a money lender or relative. Surprisingly, 72% of the
families said they were willing to pay a government levied user charge,
though this was less popular among low-income families (61%).'Free'
maternity care in Bangladesh involves considerable hidden costs which may
be a major contributor to low utilization of maternity services, especially
among low-income groups. To increase utilization of safer motherhood
services, policy-makers might consider introducing fixed user charges with
clear exemption guidelines, or greater subsidies for existing services,
especially caesarean section.
ARTICLES
Research report. The hidden cost of 'free' maternity care in Dhaka, Bangladesh
National Institute of Preventive and Social Medicine, Dhaka, Bangladesh; Centre for International Child Health, Institute of Child Health, London, UK
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