Expectant mothers in Mali risk financial ruin; systems problems impede universal health coverage

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A Malian refugee mother with her child wait to receive relief items in Gaoudel, Ayorou district, northern Niger. Photo: UNHCR/H. Caux

Families in Mali risk financial ruin when expectant mothers need a Caesarean section to guarantee safe delivery, despite recent measures to make this life-saving procedure accessible and free at point-of-care, according to a study published this month in the Bulletin of the World Health Organization.

Mali's experience is relevant to the many countries that are drawing up plans to make essential health services, including Caesareans, more widely available to their people as part of broader efforts to achieve universal coverage.

According to the Bulletin, Mali has traditionally had one of the world's highest rates of death among women due to pregnancy and childbirth. But to address this, a national system was set up in 2002 under which expectant women in need are referred to the nearest hospital for a Caesarean or other emergency obstetric care.

Within a couple of years, the number of women receiving emergency obstetric care had doubled.

But Mali's success in reducing the risk of maternal death has been marred by the fact that, despite abolition of point-of-care fees for Caesareans in 2005, families who seek them still risk financial ruin. The study, which was published this month, was based on data collected between 2008 and 2011.

Co-author of the study, Pierre Fournier, director of the Global Health Center at the University of Montreal in Canada said "We found that 44.6% of the families who incurred these high costs were, as a result, forced to reduce their food consumption, while 23.2% of them were still in debt 10 months to two and a half years after the birth".

Donn Bobb, United Nations.

Duration: 1’28″

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