How costly is the first prenatal clinic visit? Analysis of out-of-pocket expenditure in rural Sri Lanka - a country with free maternal health care

• Published in: BMC health services research Vol. 21; no. 1; p. 974
• Main Authors: Gunarathne, Sajaan Praveena, Wickramasinghe, Nuwan Darshana, Agampodi, Thilini Chanchala, Prasanna, Indika Ruwan, Agampodi, Suneth Buddhika
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16-09-2021; BioMed Central; BMC
• Subjects: Ambulatory Care; Analysis; Clinics; COVID-19; Cross-Sectional Studies; Families & family life; Female; First prenatal clinic visit; Free health; GDP; Global health; Gross Domestic Product; Health aspects; Health care expenditures; Health Expenditures; Health services; Households; Humans; Laboratories; Maternal & child health; Maternal Health; Maternal Health Services; Maternal mortality; Measurement; Medical care, Cost of; Out-of-pocket expenditure; Out-of-pocket expenses; Population; Pregnancy; Prenatal care; Prices and rates; Public health; Rajarata pregnancy cohort; Rural areas; Sri Lanka; Women; Womens health; Sri Lanka; Free health; Pregnancy; Rajarata pregnancy cohort; Out-of-pocket expenditure; First prenatal clinic visit
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-021-07005-y

This study aimed to determine the magnitude of and factors associated with out-of-pocket expenditure (OOPE) during the first prenatal clinic visit among pregnant women in Anuradhapura district, Sri Lanka, which provides free maternal healthcare.
The study design was a cross-sectional study, and the study setting was 22 Medical Officers of Health (MOOH) areas in Anuradhapura District, Sri Lanka. Data of 1389 pregnant women were analyzed using descriptive statistics and non-parametric tests.
The mean OOPE of the first prenatal clinic visit was USD 8.12, which accounted for 2.9 and 4.5% of the household income and expenditure, respectively. Pregnant women who used only government-free health services (which are free of charge at the point of service delivery) had an OOPE of USD 3.49. A significant correlation was recorded between household expenditure (r
 = 0.095, p = 0.002) and the number of pregnancies (r
 = - 0.155, p < 0.001) with OOPE. Education level less than primary education is positively contributed to OOPE (p < 0.05), and utilizing government-free maternal health services lead to a decrease in the OOPE for the first prenatal clinic visit (p < 0.05).
Despite having free maternal services, the OOPE of the first prenatal clinic visit is high in rural Sri Lanka. One-fifth of pregnant women utilize private health services, and pregnant women who used only government-free maternal health services also spend a direct medical cost for medicines/micronutrient supplements.