Pay for a free service, access to cesarean section in the slums of Dakar

In sub-Saharan Africa, equitable access to cesarean section remains a major challenge for reducing maternal and neonatal mortality, particularly among disadvantaged populations. This situation is further exacerbated in slums, where women face significant financial barriers to accessing expensive healthcare services, such as cesarean. Within this context, this paper aims to study access to emergency cesarean services among women living in the slums of Dakar, considering the free cesarean policy implemented in Senegal since 2005. Quantitative data were collected using a cross-sectional retrospective approach, from 18 health facility managers and 260 women living in slums in Dakar who had undergone cesarean delivery between July and December 2022. The surveys aimed to collect socio-demographic data on women and the costs they paid to have a cesarean section, as well as on the application of the policy of free caesarean sections by public health facilities. The data were processed using Stata. The results indicated that poor women residing in Dakar slums do have access to emergency cesarean section services in public health facilities. However, a significant portion of these women come from impoverished households and lack higher education, making them more vulnerable to financial constraints when seeking a C-section. Despite cesarean sections being performed primarily based on medical necessity, regardless of the woman's economic status, ethnicity, or educational background, women often find themselves having to pay substantial amounts to undergo the procedure. This is particularly concerning, as cesarean sections are intended to be entirely free in public health facilities in Senegal. Health facility managers attribute this financial burden to the State, which recurrently delays reimbursements for cesarean sections, forcing them to charge women higher prices for the procedure. A more rigorous enforcement of the policy for free cesarean section could greatly enhance access to this obstetric practice for women living in the slums of Dakar.