title: User charges for antenatal care and ultrasound--an unwillingness to pay.
abstract: OBJECTIVE
  The aim of this study was to evaluate attitudes towards user charges in specialized antenatal care, as well as if ultrasound for dating and antenatal care provided by a midwife or family doctor had been charged.
  
  
  METHODS
  Participants included all women delivering and registered for antenatal care at the Umeå University Hospital from September 15th-December 20th, 1995. Questionnaires, used to measure attitudes towards specialist fees, and the influence these user charges have on the utilization of services, were mailed two weeks post partum.
  
  
  RESULTS
  Few mothers, 4%, actually hesitated or refrained from charged care, while 19%-50% would have hesitated or refrained from care if being charged. Bad economy was the significant risk factor for unwillingness to pay for care by midwife OR 2.7 (95% CI 1.4-5.6) and family doctor OR 2.5 (95% CI 1.3-5.0), referral charged for specialist care OR 4.2 (95% CI 0.5-38) and if charged early ultrasound OR 4.6 (95% CI 2.4-9.2). When adjusted for economy neither young maternal age, father's unemployment or low birth weight were significantly associated to a unwillingness to pay.
  
  
  CONCLUSIONS
  The attitudes expressed implied that user charges could lower attendance of pregnancy ultrasound and antenatal care. This could add a substantial negative impact on perinatal outcome to an already affected group of infants with an increased risk of a low birth weight and preterm delivery, and interfere with the benefits of early dating by ultrasound.
mesh_terms: D000328:Adult; D001290:Attitude; D005249:Fees and Charges; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016216:Ultrasonography, Prenatal / Q000191:economics* / Q000523:psychology / Q000706:statistics & numerical data*