Academic Journal
Assessing the costs of antenatal care in Eastern Ethiopia: implications for improving the free maternity services policy.
| Title: | Assessing the costs of antenatal care in Eastern Ethiopia: implications for improving the free maternity services policy. |
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| Authors: | Tolossa T; Department of Public Health, Institute of Health Sciences, Wollega University, 395, Nekemte, Ethiopia.; Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong 3220, Australia., Gold L; Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong 3220, Australia., Lau EHY; School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong 3220, Australia.; School of Public Health, University of Hong Kong, Hong Kong., Dheresa M; Departments of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia., Abimanyi-Ochom J; Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong 3220, Australia. |
| Source: | Health policy and planning [Health Policy Plan] 2026 Jan 23; Vol. 41 (1), pp. 13-21. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Oxford University Press in association with the London School of Hygiene and Tropical Medicine Country of Publication: England NLM ID: 8610614 Publication Model: Print Cited Medium: Internet ISSN: 1460-2237 (Electronic) Linking ISSN: 02681080 NLM ISO Abbreviation: Health Policy Plan Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [Oxford] : Oxford University Press in association with the London School of Hygiene and Tropical Medicine, c1986- |
| MeSH Terms: | Prenatal Care*/economics , Prenatal Care*/statistics & numerical data , Health Expenditures*/statistics & numerical data , Maternal Health Services*/economics , Maternal Health Services*/statistics & numerical data , Health Policy*, Humans ; Female ; Ethiopia ; Pregnancy ; Adult ; Adolescent ; Young Adult ; Prospective Studies |
| Abstract: | Most sub-Saharan Africa (SSA) countries are implementing free maternity services starting from the first antenatal care (ANC) visit to postnatal care. However, out of pocket (OOP) health expenditures significantly affect the utilization of maternal services in SSA. Limited evidence exists on the costs incurred for ANC health service utilization in this region. This study aimed to assess the costs of ANC service utilization among adolescent and adult women in Eastern Ethiopia. Data were collected from pregnant women participating in the Kersa Health and Demographic Surveillance Site (KHDSS). The study prospectively followed 394 pregnant women across two rounds, collecting both direct medical and indirect costs of ANC service utilization. Direct medical and non-medical costs were summed up to give OOP health expenditures. Catastrophic health expenditure (CHE) and intensity were assessed using the budget share approach at different thresholds. All costs were converted to 2023/2024 USD and compared between adolescent and adult women. A total of 390 women were included in the final analysis. The total amount of OOP payment due to ANC service utilization was 35.7 USD among adolescents compared to 28.5 USD in adults. Adolescents spent 32.6 USD on direct medical costs compared to 24.9 USD for adult women, and 19.3 USD on direct non-medical costs compared to 19.8 USD in adult women. There was a significant difference in the proportion of women who incurred OOP payments, 85.7% of adolescents versus 66.7% of adults (P-value < .001). CHE incidence among adolescents was 46.8% and 15.6% compared to 28.7% and 9.3% among adult women at 5% and 15% threshold, respectively. Overall, adolescent women faced higher financial hardship than adult women. This highlights the need to expand financial protection beyond direct medical costs and to develop targeted financial protection mechanisms specifically for adolescents in resource-limited settings. Furthermore, strengthening the implementation and ensuring the sustainability of the Free Maternal Services policy could help reduce disparities in service utilization between adolescent and adult women. (© The Author(s) 2025. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.) |
| Competing Interests: | Conflict of interest: None declared. |
| Comments: | Erratum in: Health Policy Plan. 2026 Jun 18;41(6):1043. doi: 10.1093/heapol/czag061.. (PMID: 42118814) |
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| Contributed Indexing: | Keywords: ANC; CHE; Ethiopia; OOP; costs; direct medical costs; non-medical costs |
| Entry Date(s): | Date Created: 20251008 Date Completed: 20260123 Latest Revision: 20260920 |
| Update Code: | 20260920 |
| PubMed Central ID: | PMC12828703 |
| DOI: | 10.1093/heapol/czaf072 |
| PMID: | 41058590 |
| Database: | MEDLINE |
| ISSN: | 1460-2237 |
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| DOI: | 10.1093/heapol/czaf072 |