title: How Has the Free Obstetric Care Policy Impacted Unmet Obstetric Need in a Rural Health District in Guinea?
abstract: BACKGROUND
  In 2010, the Ministry of Health (MoH) of Guinea introduced a free emergency obstetric care policy in all the public health facilities of the country. This included antenatal checks, normal delivery and Caesarean section.
  
  
  OBJECTIVE
  This study aims at assessing the changes in coverage of obstetric care according to the Unmet Obstetric Need concept before (2008) and after (2012) the implementation of the free emergency obstetric care policy in a rural health district in Guinea.
  
  
  METHODS
  We carried out a descriptive cross-sectional study involving the retrospective review of routine programme data during the period April to June 2014.
  
  
  RESULTS
  No statistical difference was observed in women's sociodemographic characteristics and indications (absolute maternal indications versus non-absolute maternal indications) before and after the implementation of the policy. Compared to referrals from health centers of patients, direct admissions at hospital significantly increased from 49% to 66% between 2008 and 2012 (p = 0.001). In rural areas, this increase concerned all maternal complications regardless of their severity, while in urban areas it mainly affected very severe complications. Compared to 2008, there were significantly more Major Obstetric Interventions for Maternal Absolute Indications in 2012 (p < 0.001). Maternal deaths decreased between 2008 and 2012 from 1.5% to 1.1% while neonatal death increased from 12% in 2008 to 15% in 2012.
  
  
  CONCLUSIONS
  The implementation of the free obstetric care policy led to a significant decrease in unmet obstetric need between 2008 and 2012 in the health district of Kissidougou. However, more research is needed to allow comparisons with other health districts in the country and to analyse the trends.
authors.affiliation: Centre national de formation et de recherche en santé rurale de Maferinyah, Forécariah, Guinea; Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgium; Women and Child Health Research Center, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Delamou
authors.affiliation: Observatoire Wallon de la Santé, Namur, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Dubourg
authors.affiliation: Centre national de formation et de recherche en santé rurale de Maferinyah, Forécariah, Guinea.
authors.forename: Abdoul Habib
authors.initials: AH
authors.lastname: Beavogui
authors.affiliation: Women and Child Health Research Center, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Thérèse
authors.initials: T
authors.lastname: Delvaux
authors.affiliation: Hopital Prefectoral de Kissidougou, Kissidougou, Guinea.
authors.forename: Jacques Seraphin
authors.initials: JS
authors.lastname: Kolié
authors.affiliation: Hopital Prefectoral de Kissidougou, Kissidougou, Guinea.
authors.forename: Thierno Hamidou
authors.initials: TH
authors.lastname: Barry
authors.affiliation: Centre national de formation et de recherche en santé rurale de Maferinyah, Forécariah, Guinea.
authors.forename: Bienvenu Salim
authors.initials: BS
authors.lastname: Camara
authors.affiliation: The International Union Against Tuberculosis and Lung Disease, Paris, France; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Mary
authors.initials: M
authors.lastname: Edginton
authors.affiliation: University of Bergen, Bergen, Norway.
authors.forename: Sven
authors.initials: S
authors.lastname: Hinderaker
authors.affiliation: Women and Child Health Research Center, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: De Brouwere
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D016701:Guinea; D006291:Health Policy; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D066087:Perinatal Death; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012423:Rural Health / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data*; D055815:Young Adult