title: The free delivery and caesarean policy in Morocco: how much do households still pay?
abstract: BACKGROUND
  The Free Deliveries and Caesarean Policy (FDCP) entitles all women in Morocco to deliver free of charge within public hospitals. This study assesses the policy's effectiveness by analysing household expenditures related to childbirth, by delivery type and quintile.
  
  
  METHODS
  Structured exit survey of 973 women in six provinces at five provincial hospitals, two regional hospitals, two university hospitals and three primary health centres with maternity units.
  
  
  RESULTS
  Households reported spending a median of US$ 59 in total for costs inside and outside of hospitals. Women requiring caesareans payed more than women with uncomplicated deliveries (P < 0.0001). The median cost was US$45 for a uncomplicated delivery, US$50 for a complicated delivery and US$65 for a caesarean section. The prescription given upon exiting the hospital comprised 62% of the total costs. Eighty-eight per cent of women from the poorest quintiles faced catastrophic expenditures. The women's perception of their hospital stay and the FDCP policy was overwhelmingly positive, but differences were noted at the various sites.
  
  
  CONCLUSIONS
  The policy has been largely but not fully effective in removing financial barriers for delivery care in Morocco. More progress should also be made on increasing awareness of the policy and on easing the financial burden, which is still borne by households with lower incomes.
authors.affiliation: Ecole Nationale de Santé Publique, Rabat, Morocco.
authors.forename: C
authors.initials: C
authors.lastname: Boukhalfa
authors.affiliation: Ecole Nationale de Santé Publique, Rabat, Morocco.|Université Libre de Bruxelles, Bruxelles, Belgium.|Institut of Tropical Medecine, Antwerp, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Abouchadi
authors.affiliation: University of Aberdeen, Aberdeen, UK.
authors.forename: N
authors.initials: N
authors.lastname: Cunden
authors.affiliation: University of Aberdeen, Aberdeen, UK.
authors.forename: S
authors.initials: S
authors.lastname: Witter
mesh_terms: D002585:Cesarean Section / Q000191:economics; D036861:Delivery, Obstetric / Q000191:economics*; D005191:Family Characteristics; D005249:Fees and Charges; D005260:Female; D005382:Financing, Personal; D005102:Health Expenditures; D006297:Health Services Accessibility; D006779:Hospitals, Public; D006801:Humans; D007182:Income; D009018:Morocco; D017060:Patient Satisfaction; D057766:Policy; D011203:Poverty; D011247:Pregnancy
keywords: Maroc; Marruecos; Morocco; accouchements; caesarean section; cesárea; césarienne; deliveries; dépenses des ménages; excepción de tarifas; exonération des frais; fee exemptions; gastos del hogar; household expenditures; maternal mortality; partos