Kaiser Jeanette L, McGlasson Kathleen L, Rockers Peter C, Fong Rachel M, Ngoma Thandiwe, Hamer Davidson H, Vian Taryn, Biemba Godfrey, Lori Jody R, Scott Nancy A
Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
Department of Research, Right to Care Zambia, Lusaka, Zambia.
Int J Womens Health. 2019 Aug 1;11:411-430. doi: 10.2147/IJWH.S214081. eCollection 2019.
Out-of-pocket expenses associated with facility-based deliveries are a well-known barrier to health care access. However, there is extremely limited contemporary information on delivery-related household out-of-pocket expenditure in sub-Saharan Africa. We assess the financial burden of delivery for the most remote Zambian women and compare differences between delivery locations (primary health center, hospital, or home).
We conducted household surveys and in-depth interviews among randomly selected remote Zambian women who delivered a baby within the last 13 months. Women reported expenditures for their most-recent delivery for delivery supplies, transportation, and baby clothes, among others. Expenditures were converted to US dollars for analysis.
Of 2280 women sampled, 2223 (97.5%) reported spending money on their delivery. Nearly all respondents in the sample (95.9%) spent money on baby clothes/blanket, while over 80% purchased delivery supplies such as disinfectant or cord clamps, and a third spent on transportation. Women reported spending a mean of USD28.76 on their delivery, with baby clothes/blanket (USD21.46) being the main expenditure and delivery supplies (USD3.81) making up much of the remainder. Compared to women who delivered at home, women who delivered at a primary health center spent nearly USD4 (p<0.001) more for their delivery, while women who delivered at a level 1 or level 2 hospital spent over USD7.50 (p<0.001) more for delivery.
These expenses account for approximately one third of the monthly household income of the poorest Zambian households. While the abolition of user fees has reduced the direct costs of delivering at a health facility for the poorest members of society, remote Zambian women still face high out-of-pocket expenses in the form of delivery supplies that facilities should provide as well as unofficial policies/norms requiring women to bring new baby clothes/blanket to a facility-based delivery. Future programs that target these expenses may increase access to facility-based delivery.
与设施分娩相关的自付费用是众所周知的医疗保健获取障碍。然而，关于撒哈拉以南非洲地区与分娩相关的家庭自付支出的当代信息极为有限。我们评估了赞比亚最偏远地区妇女的分娩经济负担，并比较了不同分娩地点（初级卫生中心、医院或家中）之间的差异。
我们对在过去13个月内分娩的随机选取的赞比亚偏远地区妇女进行了家庭调查和深入访谈。妇女报告了她们最近一次分娩在分娩用品、交通和婴儿服装等方面的支出。支出换算成美元进行分析。
在抽样的2280名妇女中，2223名（97.5%）报告在分娩上花钱。样本中几乎所有受访者（95.9%）都在婴儿服装/毛毯上花钱，超过80%购买了消毒剂或脐带夹等分娩用品，三分之一的人在交通上花钱。妇女报告她们分娩平均花费28.76美元，其中婴儿服装/毛毯（21.46美元）是主要支出，分娩用品（3.81美元）占其余大部分。与在家分娩的妇女相比，在初级卫生中心分娩的妇女分娩花费多近4美元（p<0.001），而在一级或二级医院分娩的妇女分娩花费多超过7.50美元（p<0.001）。
这些费用约占赞比亚最贫困家庭月家庭收入的三分之一。虽然取消使用费降低了社会最贫困成员在医疗机构分娩的直接成本，但赞比亚偏远地区的妇女仍然面临高额自付费用，形式包括医疗机构应提供的分娩用品以及要求妇女在设施分娩时携带新婴儿服装/毛毯的非官方政策/规范。针对这些费用的未来项目可能会增加设施分娩的可及性。
