Outcome of Increment in User Fees on Utilization of Maternal Health Services in an Urban Comprehensive Health Centre, South-West, Nigeria

Nigeria records one of the highest annual maternal deaths globally, contributing significantly to the high regional burden of maternal mortality in Sub-Saharan Africa. This study determined the outcome of increment in user fees on trends of utilization of maternal health services (MHS) among pregnant women in an Urban Comprehensive Health Centre in South-West Nigeria. Health facility records of pregnant women were reviewed to describe trends of MHS over four-year period from May 2012-April 2016. A before and after analytic design was used to determine the outcome of increment in user fees for MHS by over 230% at the beginning of the third year. A total of 1,038 and 162 pregnant women registered for antenatal care (ANC) services and delivered at the health facility respectively. There was decreasing trend of utilization of MHS, 47.1% and 50.6% of the pregnant women registered for ANC and had deliveries respectively in the first year and13.6% and 18% respectively during the fourth year. There was statistically significant reduction in utilization of MHS- ANC registration, HIV testing services and skilled birth attendance- after increment in user fees. However, the reduction in utilization of family planning where there was no increment in user fee was not statistically significant. There was decreasing trend in utilization of MHS during the period with the increment in user fees being a critical factor. The user fees should be replaced with a robust social health insurance scheme for pregnant women receiving care at the health facility.