Out-of-pocket expenses for maternity care in Bangladesh: A public- private comparison

Service cost is one of the important factors keeping women from receiving maternity care services in Bangladesh. This paper examined out-of-pocket expenses incurred by women for availing maternal health care services at public and private health facilities. This presentation used data from a baseline household survey evaluating the impact of demand side finance (DSF) vouchers on utilization and service delivery. The survey was conducted in 2010 where 3300 women, who had given birth in the previous 12 months during data collection period, were interviewed. Information on costs incurred to receive antenatal, delivery and postnatal care services were collected. Findings reveal that the majority of women reported paying out-of-pocket expenses for availing maternal health services both at public and private health facilities. Out-of-pocket expenses include registration, consultation, laboratory examination, medicine, equipments, transportation and other associated costs incurred for receiving maternal health care services. On average women paid US$3.60 out-of-pocket when receiving ANC care at public health facilities and US$10.70 at private health facilities. Similarly, women expensed 1.7 times more for normal delivery (US$71) and 1.3 times more for cesarean delivery (US$235) at private health facilities compared to public health facilities. On the other hand, costs for postnatal care services did not vary significantly between private and public health facility (US$12.50). Utilization of maternal health care services can be improved if women can minimize out-of-pocket expenses. At the same time effective demand generation strategies are necessary to encourage women to utilize health facilities.