In many countries families bear the brunt of health care costs, with out of pocket payments making up over half of health care payments in many parts of Asia and Sub-Saharan Africa. This is a major barrier to poor women seeking care – the cost of treatment can plunge families into debt for many years. Women are sometimes kept prisoner, or forced to work as cleaners in the hospital, until their fees are paid off.
So does a family risk the cost of medical care – or keep a woman at home and pray that she will survive?
The good news is that there is growing momentum to remove hospital fees for women in labour and their babies particularly in Sub-Saharan Africa. Where this has happened we are often seeing greater numbers of women starting to use services, particularly the poorest.
However these user fees are often a crucial source of funds to bolster public services, so alternative funding sources must be found to ensure free care can continue without sacrificing quality. Some countries are looking at other possible funding approaches such as cash transfers and voucher systems that can be given to particularly poor groups – but it's not altogether clear yet if these schemes really work.