An analysis of the out-of-pocket expenditure on post-abortion care in eight public-sector health care facilities in Dakar, Senegal

by Colin Baynes, Mohamed Diadhiou, Grace Lusiola, Kate O’Connell, Thierno Dieng

Global Public Health 14 Sept 2021  (Not open access)  DOI: 10.1080/17441692.2021.1977972

Abstract
Timely access to treatment is essential for women when they experience abortion complications. Out-of-pocket (OOP) expenditure is a known barrier to health care access. In 2018, we assessed the financial burden of accessing post-abortion care (PAC) borne by women in Dakar, Senegal, where studies estimate that half of poor women with complications obtain PAC. We interviewed 729 women following discharge from PAC. Women reported expenditures on transportation, admission, treatment, family planning, hospitalisation, complementary tests, prescriptions, other medicines and materials. We compare women’s OOP on PAC by expenditure category, type of treatment and facility type, and use multiple generalised linear regression analysis to explain variation in overall OOP and forecast it under alternate scenarios. The average OOP was USD $93.84. At health centres it was $65.47 and at hospitals it was $120.47. The average cost of PAC using dilation and curettage was $112.37, manual vacuum aspiration was $99.84, and misoprostol $61.80. Overall OOP on PAC amounts, on average, to 15% of the average monthly salary for women living in Dakar. Strategies that emphasise timely access to misoprostol for treating complications in primary care settings will address the contribution of OOP costs to Senegal’s appreciable unmet need for PAC among the poor.

[Editor’s note: In the absence of details from the full paper, this abstract implies that cost is the most important reason to choose primary care settings and misoprostol for treatment of PAC complications. While acces to care is highly likely to be better at primary care settings, which are closer to women’s homes than hospitals, and it is obviously important given many women’s very limited income, another important factor is the type and severity of complications, and that use of misoprostol may be too slow in an emergency to save the woman’s life, making MVA the method of choice even if it costs more. See: Health and Human Rights, 2019 Dec; 21(2): 145-55]

INFOGRAPHIC: Guttmacher Institute, 2016