An Economic Evaluation of a Delivery-Fee Exemption Policy on Maternal and Child Health Indicators in Ghana

Karen A. Grepin, Harvard University

User fees are believed to represent important barriers to access to essential health services, and eliminating user fees for maternity services has been advocated to improve maternal and child health. Few studies, however, have evaluated the impact of these fees on the utilization of maternity services in developing countries. In late 2003, Ghana introduced a delivery-fee exemption policy, initially rolling the policy out to 4 of its 10 regions, creating a natural experiment to evaluate the effect of user fees on the utilization of maternity services. Using nationally representative household survey data and routine administrative data on reproductive health services, I evaluate the effectiveness of this policy using a difference-in-difference study design comparing early-intervention regions with the other regions in the country. My findings suggest that this policy was effective at increasing the proportion of births supervised by trained medical personnel and other maternal and child health outcomes.