Social and Economic Consequences of the Cost of Obstetric and Neonatal Care in Lubumbashi, in the Democratic Republic of Congo: Mixed Study

Background: The aim of this study was to explore and measure the social and economic consequences of the cost of obstetric and neonatal care in Lubumbashi, the Democratic Republic of Congo.Methods: We conducted a mixed qualitative and quantitative study in the maternity departments of health facilities in Lubumbashi. The qualitative results were based on a case study conducted in 2018 that included 14 respondents (8 parturients, 2 accompanying family members and 4 health care providers). A quantitative cross-sectional analytical study was carried out in 2019 with 411 women who gave birth at 10 referral hospitals. Data were collected for one month at each hospital, and selected parturients were included in the study only if they paid out-of-pocket and at the point of care for costs related to obstetric and neonatal care.Results: Costs for obstetric and neonatal care averaged US $77, US $207 and US $338 for simple, complicated vaginal and cesarean deliveries, respectively. These health expenditures were greater than or equal to 40% of the ability to pay for 58.4% of households. At the time of delivery, 14.1% of women in childbirth did not have enough money to pay for care. Of those who did, 76.5% spent their savings. When households did not pay for care, mothers and their babies were held for a long time at the place of care. This resulted in prolonged absence of the mother from the household, reduced household income, family conflicts, and the abandonment of the home by the spouse. At the health facility level, the length of stay increased without generating any additional financial benefits. Disrespectful care and the deterioration of the relationships between caregivers and parturients were also recorded.Conclusion: To reduce the social and economic consequences of care, the government of the DRC should implement a mechanism for subsidizing care and should associate it with a cost-sharing system. This would result in achieving universal health coverage and improving the physical, mental and social health of mothers, their babies and their households.