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APHA Scientific Session and Event Listing

Reducing financial barriers to skilled birth attendance: Does it really matter?

Slavea Chankova, MPA and Tania Dmytraczenko, PhD. International Health Division, Abt Associates, 4800 Montgomery Lane, Suite 600, Bethesda, MD 20814, 301-347-5625, slavea_chankova@abtassoc.com


There is overwhelming evidence that skilled care at childbirth is critical for preventing maternal death and disability and for saving newborn lives. The Millennium Development Declaration identifies the proportion of births attended by skilled personnel as an indicator for attaining the Millennium Development Goal to reduce maternal mortality by 75 percent between 1990 and 2015. However, nearly half of women in the developing world currently give birth without the help of a skilled attendant. It is well established that inability to pay is a strong barrier to accessing health care. Therefore, it is widely assumed that reducing financial barriers to accessing skilled birth care will lead to higher utilization rates. We present a systematic review of evidence on whether removing financial barriers leads to increases in skilled attendance at birth, particularly among the poorest.


We did a comprehensive literature search for studies on whether removing or placing financial barriers to accessing maternal care had an effect on utilization rates. We searched for published articles using major journal article databases such as Medline, Global Health, Econlit, Scopus, and PubMed, and also searched the websites of major international and donor organizations for grey literature.


The evidence on the impact of removing financial barriers on utilization of maternal care is mixed. Most programs and policies focusing on improving maternal health use a combination of interventions (such as improvements in availability and quality of maternal care services, IEC campaigns, and other). In most cases, studies that evaluate the impact of such programs or policies on utilization of care do not separate out the effect of improving financial access from that of the other interventions. Therefore, existing evidence is not sufficient to assist policy makers in prioritizing between financial and other interventions.

Learning Objectives:

Presenting author's disclosure statement:

Any relevant financial relationships? No

Maternal Mortality: Do Women have the Right to Safe Childbirth?

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA