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Gender Dimensions of User Fees: Implications for Women's Utilization of Health Care

Priya Nanda

Senior Program Associate, Center for Health and Gender Equity, Takoma Park, MD, USA.

This article was first published in the journal Reproductive Health Matters. It is posted with their permission and with that of Centre for Health and Gender Equity (CHANGE). CHANGE's website can be accessed at:
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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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