Accessibility of cesarean deliveries in Benin

Introduction: To be used effectively, emergency obstetric and neonatal care must be available and accessible. This study sought to measure the accessibility of cesarean deliveries in Benin. Method: Cross-sectional study of randomly selected women in each of the 12 obstetrics departments in Benin. Geographical accessibility was measured by estimating the distance between the parturientes residence and the hospital. Financial accessibility was the average direct cost of the cesarean delivery —the sum of medical and nonmedical costs. The functionality of the referral system was assessed according to the conditions of referral of women referred for cesareans. Results: The mean distance between women’s homes and the hospital was 20.2 ± 22.3 kilometers. Of the 579 women, 63.0% were referred from a peripheral health center to a hospital; the referral conditions were completed in the obstetric record for only half of them. The data sheet for the referral was completed for only 34.4%; venous access had been placed in 28.5%, and the patient was accompanied by medical personnel in only 1.7% of cases. The average direct cost of the cesarean to families was 36,782 ± 30,859 FCFA. Conclusion: Cesarean deliveries are now more accessible financially due to the policy of free access, but they remains geographically inaccessible, because of the long distances to be covered and the poor organization of referrals to ensure continuity of care.