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APHA Scientific Session and Event Listing

Rebecca Kohler, MPH, Project NOVA, IntraHealth International, 7 Aygedzor St., Yerevan, Armenia, 374-1-274-125, rkohler@intrahealth.org

The government of Armenia considers maternal health a priority, and through its laws and policies guarantees women the right to free pregnancy care. In practice, however, women who need these services often encounter an ingrained system of required informal payments, thus limiting accessibility and quality of care. In preparation for implementing advocacy interventions designed to help women exercise their right to free care, USAID's Project NOVA conducted research to gauge the impact of informal payments on women's care and assess the degree to which the basic right to pregnancy care is achievable. The study focused on revealing the actual cost of pregnancy care, women's knowledge of what services are free, the inherent vulnerabilities in the government-sponsored benefit package and recommendations to increase equitable access to pregnancy care. The study used qualitative and quantitative methods (literature review, key informant interview and client survey). More than 80% of women reported paying for pregnancy care. Of those, women paid on average $8 for antenatal care, $73 for delivery and $22 for postpartum care (average monthly income is $45). Only 30% of interviewees were aware they could receive free services. The study also revealed inadequate government funding, insufficient financial controls and disincentives for providers to offer quality care. Based on the study results, the project is implementing advocacy/policy actions designed to improve accountability of the government for free pregnancy care. Actions include an educational campaign on right to free services, a pregnancy care costing study and promotion of a Code of Ethics among providers.

Learning Objectives:

• • Recognize the factors impacting women's financial access to pregnancy care
• • Describe how a system of informal payments adversely impacts women's access to quality pregnancy care
• • Discuss advocacy interventions to pressure governments to address issues of informal payments and inequitable access to care

Keywords: Maternal Health, Health Care Reform

Presenting author's disclosure statement:

Not Answered