Naomi Lince-Deroche1, Deborah Constant2, Jane Harries2, Kelly Blanchard3, Edina Sinanovic4, Daniel Grossman5. 1. Ibis Reproductive Health, Johannesburg, South Africa; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: naomi.lince.deroche@gmail.com. 2. Women's Health Research Unit, School of Public Health, University of Cape Town, Cape Town, South Africa. 3. Ibis Reproductive Health, Cambridge, MA, USA. 4. Health Economics Unit, School of Public Health, University of Cape Town, Cape Town, South Africa. 5. Ibis Reproductive Health, San Francisco, CA, USA.
Abstract
OBJECTIVES: To assess women's costs of accessing second-trimester labor induction and dilation and evacuation (D&E) services at four public hospitals in Western Cape Province, South Africa. STUDY DESIGN: From April to August 2010, in interviews immediately after completion of their abortion, we asked women about specific direct and indirect costs incurred. We collected information on recurring costs (i.e., per visit) and one-time expenditures and calculated total costs. RESULTS: In total, 194 patients participated (136 D&E; 58 induction). Their median age was 26; 37.6% reported being employed or doing paid work. Most (73.2%) women visited two different facilities, including the study facility, while seeking the procedure. Induction women reported a median of three required visits [interquartile range (IQR) 2.0-3.0] to the study facility, while D&E women reported two required visits [IQR 1.0-2.0]. Twenty-seven percent of women missed work due to the procedure, and few (4.6%) paid for childcare. At each visit, almost all women (180, 92.8%) paid for transportation costs and reported additional one-time costs (177, 91.2%) such as sanitary supplies or doctor's fees. The total median cost incurred per woman was $21.23 [IQR 11.94-44.68]. Roughly half (49.0%) received help with these costs. CONCLUSIONS: Although technically offered freely or low cost in the public sector, women accessing second-trimester abortion lost income and incurred costs for transport, fees, supplies and childcare. Their total costs could be reduced by minimizing the number of required visits to facilities and freely offering supplies such as sanitary pads and pregnancy tests. IMPLICATIONS: Limited access to second-trimester, safe abortion services in South Africa may result in some women incurring unnecessary costs. Women make multiple visits in attempting to obtain an abortion, often because of facility or health systems requirements, and incur costs for lost income, child care, transport, fees and supplies.
OBJECTIVES: To assess women's costs of accessing second-trimester labor induction and dilation and evacuation (D&E) services at four public hospitals in Western Cape Province, South Africa. STUDY DESIGN: From April to August 2010, in interviews immediately after completion of their abortion, we asked women about specific direct and indirect costs incurred. We collected information on recurring costs (i.e., per visit) and one-time expenditures and calculated total costs. RESULTS: In total, 194 patients participated (136 D&E; 58 induction). Their median age was 26; 37.6% reported being employed or doing paid work. Most (73.2%) women visited two different facilities, including the study facility, while seeking the procedure. Induction women reported a median of three required visits [interquartile range (IQR) 2.0-3.0] to the study facility, while D&E women reported two required visits [IQR 1.0-2.0]. Twenty-seven percent of women missed work due to the procedure, and few (4.6%) paid for childcare. At each visit, almost all women (180, 92.8%) paid for transportation costs and reported additional one-time costs (177, 91.2%) such as sanitary supplies or doctor's fees. The total median cost incurred per woman was $21.23 [IQR 11.94-44.68]. Roughly half (49.0%) received help with these costs. CONCLUSIONS: Although technically offered freely or low cost in the public sector, women accessing second-trimester abortion lost income and incurred costs for transport, fees, supplies and childcare. Their total costs could be reduced by minimizing the number of required visits to facilities and freely offering supplies such as sanitary pads and pregnancy tests. IMPLICATIONS: Limited access to second-trimester, safe abortion services in South Africa may result in some women incurring unnecessary costs. Women make multiple visits in attempting to obtain an abortion, often because of facility or health systems requirements, and incur costs for lost income, child care, transport, fees and supplies.
Authors: Marie E Sullivan; Abigail Harrison; Jane Harries; Namhla Sicwebu; Rochelle K Rosen; Omar Galárraga Journal: Health Care Women Int Date: 2017-12-15
Authors: Naomi Lince-Deroche; Deborah Constant; Jane Harries; Judith Kluge; Kelly Blanchard; Edina Sinanovic; Daniel Grossman Journal: PLoS One Date: 2018-06-28 Impact factor: 3.240
Authors: Samantha R Lattof; Ernestina Coast; Yana van der Meulen Rodgers; Brittany Moore; Cheri Poss Journal: PLoS One Date: 2020-11-04 Impact factor: 3.240