title: Effect of delivery care user fee exemption policy on institutional maternal deaths in the central and volta regions of ghana.
abstract: BACKGROUND
  To improve access to skilled attendance at delivery and thereby reduce maternal mortality, the Government of Ghana introduced a policy exempting all women attending health facilities from paying delivery care fees.
  
  
  OBJECTIVE
  To examine the effect of the exemption policy on delivery-related maternal mortality.
  
  
  METHODS
  Maternal deaths in 9 and 12 hospitals in the Central Region (CR) and the Volta Region (VR) respectively were analysed. The study covered a period of 11 and 12 months before and after the introduction of the policy between 2004 and 2006. Maternal deaths were identified by screening registers and clinical notes of all deaths in women aged 15-49 years in all units of the hospitals. These deaths were further screened for those related to delivery. The total births in the study period were also obtained in order to calculate maternal mortality ratios (MMR).
  
  
  RESULTS
  A total of 1220 (78.8%) clinical notes of 1549 registered female deaths were retrieved. A total of 334 (21.6%) maternal deaths were identified. The delivery-related MMR decreased from 445 to 381 per 100,000 total births in the CR and from 648 to 391 per 100,000 total births in the VR following the implementation of the policy. The changes in the 2 regions were not statistically significant (p=0.458) and (p=0.052) respectively. No significant changes in mean age of delivery-related deaths, duration of admission and causes of deaths before and after the policy in both regions.
  
  
  CONCLUSIONS
  The delivery-related institutional maternal mortality did not appear to have been significantly affected after about one year of implementation of the policy.
authors.affiliation: Immpact, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon.
authors.forename: Wk
authors.initials: W
authors.lastname: Bosu
authors.forename: Jacqueline S
authors.initials: JS
authors.lastname: Bell
authors.forename: Margaret
authors.initials: M
authors.lastname: Armar-Klemesu
authors.forename: Janet Ansong
authors.initials: JA
authors.lastname: Tornui