title: The economic burden of maternal mortality on households: evidence from three sub-counties in rural western Kenya.
abstract: BACKGROUND
  This study explores the consequences of a maternal death to households in rural Western Kenya focusing particularly on the immediate financial and economic impacts.
  
  
  METHODS
  Between September 2011 and March 2013 all households in the study area with a maternal death were surveyed. Data were collected on the demographic characteristics of the deceased woman; household socio-economic status; a history of the pregnancy and health care access and utilization; and disruption to household functioning due to the maternal death. These data were supplemented by in-depth and focus group discussions.
  
  
  RESULTS
  The health service utilization costs associated with maternal deaths were significantly higher, due to more frequent service utilization as well as due to the higher cost of each visit suggesting more involved treatments and interventions were sought with these women. The already high costs incurred by cases during pregnancy were further increased during delivery and postpartum mainly a result of higher facility-based fees and expenses. Households who experienced a maternal death spent about one-third of their annual per capita consumption expenditure on healthcare access and use as opposed to at most 12% among households who had a health pregnancy and delivery. Funeral costs were often higher than the healthcare costs and altogether forced households to dis-save, liquidate assets and borrow money. What is more, the surviving members of the households had significant redistribution of labor and responsibilities to make up for the lost contributions of the deceased women.
  
  
  CONCLUSIONS
  Kenya is in the process of instituting free maternity services in all public facilities. Effectively implemented, this policy can lift a major economic burden experienced by a very large number of household who seek maternal health services which can be catastrophic in complicated cases that result in maternal death. There needs to be further emphasis on insurance schemes that can support households through catastrophic health spending.
authors.forename: Aslihan
authors.initials: A
authors.lastname: Kes
authors.forename: Sheila
authors.initials: S
authors.lastname: Ogwang
authors.forename: Rohini
authors.initials: R
authors.lastname: Pande
authors.forename: Zayid
authors.initials: Z
authors.lastname: Douglas
authors.forename: Robinson
authors.initials: R
authors.lastname: Karuga
authors.forename: Frank O
authors.initials: FO
authors.lastname: Odhiambo
authors.forename: Kayla
authors.initials: K
authors.lastname: Laserson
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schaffer
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003906:Developing Countries; D005260:Female; D017144:Focus Groups; D017048:Health Care Costs / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D063130:Maternal Death / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics* / Q000453:epidemiology; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data; D036301:Qualitative Research; D012423:Rural Health / Q000191:economics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult