Evaluation of Caesarean Expenditures of Households in Benin

Abstract

After years of effort, sub-Saharan Africa has seen little improvement in maternal and neonatal health indicators. Providing all women with access to emergency obstetric care is an accepted effective strategy to reduce maternal and neonatal mortality. In many African countries such as Benin, the cost of health care is a major obstacle to access obstetric care. The aim of this study was to evaluate the caesarean section expenditures of households in Benin and to determine the strategies for obtaining the necessary resources to meet the caesarean section expenditures of the households. Three hospitals and 505 households in the Littoral region were sampled, and data were collected by applying a questionnaire to the people accompanying the woman to the hospital. The socioeconomic status of the households was evaluated using a wealth index created by principal component analysis. Factors significantly associated with expenditure were determined using multivariate linear regression analysis. Despite the free caesarean section policy in effect, households spend a median of US$180.60 (IQR: 148.13–222.35) for a caesarean section, of which 76.0% are direct costs, 17.0% are indirect costs, and 7.0% are opportunity costs. Expenditures vary considerably depending on the residence area of the household, the presence of complications, the presence of health insurance, the socioeconomic class of the households, the education level, and working status of the woman. Finally, households use 11 strategies to obtain funds to pay for the caesarean costs. While poor households resort to foreign aid, asset sales, and/or current spending cuts, the rich use their income and/or savings to cover their caesarean section expenses. The results favour the adoption of a mechanism for direct exemption of the costs of caesarean sections payable by the poorest households, in addition to the current free caesarean policy.