{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T14:18:58Z","timestamp":1765808338852,"version":"3.41.2"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T00:00:00Z","timestamp":1710979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Glob. Womens Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Evidence shows that user fee exemption policies improve the use of maternal, newborn, and child health (MNCH) services. However, addressing the cost of care is only one barrier to accessing MNCH services. Poor geographic accessibility relating to distance is another. Our objective in this study was to assess the effect of a user fee exemption policy in Burkina Faso (Gratuit\u00e9) on antenatal care (ANC) use, considering distance to health facilities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cross-sectional study with sub-analysis by intervention period to compare utilization of ANC services (outcome of interest) in pregnant women who used the service in the context of the Gratuit\u00e9 user fee exemption policy and those who did not, in Manga district, Burkina Faso. Dependent variables included were socio-demographic characteristics, obstetric history, and distance to the lower-level health facility (known as Centre de Sant\u00e9 et Promotion Sociale) in which care was sort. Univariate, bivariate, and multivariate analyses were performed across the entire population, within those who used ANC before the policy and after its inception.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For women who used services before the Gratuit\u00e9 policy was introduced, those living 5\u20139\u2005km were almost twice (OR\u2009=\u20091.94; 95% CI: 1.17\u20133.21) more likely to have their first ANC visit (ANC1) in the first trimester compared to those living &amp;lt;5\u2005km of the nearest health facility. After the policy was introduced, women living 5\u20139\u2005km and &amp;gt;10\u2005km from the nearest facility were almost twice (OR\u2009=\u20091.86; 95% CI: 1.14\u20133.05) and over twice (OR\u2009=\u20092.04; 95% CI: 1.20\u20133.48) more likely respectively to use ANC1 in the first trimester compared to those living within 5\u2005km of the nearest health facility. Also, women living over 10\u2005km from the nearest facility were 1.29 times (OR\u2009=\u20091.29; 95% CI: 1.00\u20131.66) more likely to have 4+ ANC than those living less than 5\u2005km from the nearest health facility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Insofar as the financial barrier to ANC has been lifted and the geographical barrier reduced for the populations that live farther away from services through the Gratuit\u00e9 policy, then the Burkinab\u00e9 government must make efforts to sustain the policy and ensure that benefits of the policy reach the targeted and its gains maximized.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fgwh.2024.1345438","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T04:45:35Z","timestamp":1710996335000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Has the Gratuit\u00e9 policy reduced inequities in geographic access to antenatal care in Burkina Faso? Evidence from facility-based data from 2014 to 2022"],"prefix":"10.3389","volume":"5","author":[{"given":"Marie-Jeanne","family":"Offosse","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Yameogo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9 Lin","family":"Ouedraogo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zanga","family":"Traor\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aduragbemi","family":"Banke-Thomas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"volume-title":"Trends in Maternal Mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population 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