Determinants of utilisation of maternal care services after the reduction of user fees: a case study from rural Burkina Faso

Health Policy. 2011 Mar;99(3):210-8. doi: 10.1016/j.healthpol.2010.10.010. Epub 2010 Nov 5.


Objective: To identify determinants of utilisation for antenatal care (ANC) and skilled attendance at birth after a substantial reduction in user fees.

Methods: The study was conducted in the Nouna Health District in north-western Burkina Faso in early 2009. Data was collected by means of a representative survey on a sample of 435 women who reported a pregnancy in the prior 12 months. Two independent logit models were used to assess the determinants of (a) ANC utilisation (defined as having attended at least 3 visits) and (b) skilled assistance at birth (defined as having delivered in a health facility).

Results: 76% of women had attended at least 3 ANC visits and 72% had delivered in a facility. Living within 5 km from a facility was positively associated, while animist religion, some ethnicities, and household wealth were negatively associated with ANC utilisation. Some ethnicities, living within 5 km from a health facility, and having attended at least 3 ANC visits were positively associated with delivering in a facility.

Conclusions: User fee alleviation secured equitable access to care across socio-economic groups, but alone did not ensure that all women benefited from ANC and from skilled attendance at birth. Investments in policies to address barriers beyond financial ones are urgently needed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Burkina Faso
  • Delivery, Obstetric / economics
  • Delivery, Obstetric / statistics & numerical data
  • Fees and Charges*
  • Female
  • Financing, Government*
  • Financing, Personal
  • Health Services Accessibility*
  • Humans
  • Logistic Models
  • Maternal Health Services / economics*
  • Maternal Health Services / statistics & numerical data*
  • Organizational Case Studies
  • Pregnancy
  • Prenatal Care / economics
  • Prenatal Care / statistics & numerical data
  • Rural Health Services / economics
  • Rural Health Services / statistics & numerical data