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Abstract
This paper looks at the implications of user fees for women's utilization of health care services, based on
selected studies in Africa. Lack of access to resources and inequitable decision-making power mean that when poor
women face out-of-pocket costs such as user fees when seeking health care, the cost of care may become out of
reach. Even though many poor women may be exempt from fees, there is little incentive for providers to apply exemptions,
as they too are constrained by restrictive economic and health service conditions. If user fees and other
out-of-pocket costs are to be retained in resource-poor settings, there is a need to demonstrate how they can be successfully
and equitably implemented. The lack of hard evidence on the impact of user fees on women.s health outcomes
and reproductive health service utilization reminds us of the urgent need to examine how women cope with
health care costs and what trade-offs they make in order to pay for health care. Such studies need to collect genderdisaggregated
data in relation to women.s health service utilization and in relation to the range of reproductive health
services, taking into account not only out-of-pocket fees charged by public health providers but also by private and
traditional providers.© Reproductive Health Matters. Published by Elsevier Science Ltd. All rights reserved.
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