Being insured improves safe delivery practices in Rwanda.

Rwanda still faces major hurdles in its effort to achieve universal access to health care for all. Even though there is an improvement in overall population health status and community-based funding of insurance coverage, a large percentage of women still deliver their babies at home assisted by unskilled birth attendants or unassisted. This paper examines the relationship between being insured and delivery at home and delivery by an unskilled attendant/unassisted. It is evident that uninsured women are significantly more likely to deliver their babies at home by an unskilled birth attendant/unassisted. Moreover, taking other factors into consideration, women who delivered at home are more likely to have no formal education, reside in a rural area, work in the agricultural sector, and are in the poorest household quintile. Findings from this study suggest that being insured may lift financial barriers and encourage women to deliver their babies in a health facility by a skilled birth attendant. Nonetheless, when health insurance status is controlled in multivariate models, certain socioeconomic inequalities do exist for women giving birth in a health facility and by a skilled birth attendant. These inequalities should decline when the insured population increases.