User charges for antenatal care and ultrasound - an unwillingness to pay

Objective. The aim of this study was to evaluate altitudes towards user cha rges in specialized antenatal care, as well as if ultrasound for dating and antenatal care provided by a midwife or family doctor had been charged. Subjects and methods. Participants included all women delivering and regist ered for antenatal care at the Umea University Hospital from September 15(t h)-December 20(th), 1995. Questionnaires, used to measure attitudes towards specialist fees, and the influence these user charges have on the utilizat ion of services, were mailed two weeks post partum. Results. Few mothers, 4%, actually hesitated or refrained from charged care , while 19%-50% would have hesitated or refrained from care if being charge d. Bad economy was the significant risk factor for unwillingness to pay for care by midwife OR 2.7 (95% CI 1.4-5.6) and family doctor OR 2.5 (95% CI 1 .3-5.0), referral charged for specialist care OR 4.2 (95% CI 0.5-38) and if charged early ultrasound OR 4.6 (95% CI 2.4-9.2). When adjusted for econom y neither young maternal age, father's unemployment or low birth weight wer e significantly associated to a unwillingness to pay. Conclusions. The attitudes expressed implied that user charges could lower attendance of pregnancy ultrasound and antenatal care. This could add a sub stantial negative impact on perinatal outcome to an already affected group of infants with an increased risk of a low birth weight and preterm deliver y, and interfere with the benefits of early dating by ultrasound.