Summary (English)

The report describes and analyzes the maternity protection arrangements in Ghana, Kenya, Rwanda, and Tanzania. It finds that all four countries under consideration introduced exemptions and fee waivers for common maternal care (i.e., ante- and postnatal care, and simple delivery), but that inconsistencies, ambiguities and poor knowledge about the exemption policies frequently result in payment of official and unofficial fees often also resulting in catastrophic maternal payments. The report concludes that Maternal mortality is inextricably linked to the health care system and cannot be improved in isolation from the context of health care. National health insurance schemes, by making maternal health care economically accessible and reducing catastrophic payments for delivery complications, can help to reduce maternal mortality, but insurance schemes alone, without the supporting health infrastructure including emergency transport and geographically accessible health facilities staffed by qualified personnel, is unable to reduce maternal mortality for those who need it most—poor rural women.

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