Impact of maternal and child health private expenditure on poverty and inequity: review of the literature on the extent and mechanisms by which maternal, newborn and child healthcare expenditures exacerbate poverty with focus on evidence from Asia and the Pacific

Expenditures on healthcare in Asian and Pacific countries (APCs) are widely seen as financially burdensome to household budgets and contributing to impoverishment. This review examines the evidence on maternal, neonatal, and child health (MNCH) care expenditures in APCs and looks into how and to what extent these expenditures exacerbate poverty.

The paper finds that:

• although free MNCH services are widely offered in the region, maternal care is still very expensive in many APCs, and cost remains a major barrier to safe motherhood in these countries
• these financial costs appear to be major barriers to improving access to and use of MNCH services in many APCs, and contribute significantly to observed inequalities in access and MNCH outcomes
• as a result, MNCH care expenditures do heighten poverty, not only through paying MNCH costs but also through the coping strategies that households may adopt (e.g. loans)
• in the final analysis, it seems that many households choose to forgo MNCH care to avoid the financial costs
• on the other hand, there is limited evidence that community insurance schemes are successful in protecting the poor from the detrimental effects of MNCH expenditures

Conclusions are as follows:

• there is an urgent need across the Asia and Pacific region to increase public financing for MNCH care services in order to substantially expand access to services and to lessen the catastrophic impact of health expenditures
• further research to develop more sensitive and accurate measures of opportunity costs would increase understanding of the overall cost of MNCH care to households