The effect of the cost of obstetric care on antenatal and postnatal healthcare utilization: Evidence from Armenia

The high cost of obstetric care is a common reason for late or no detection of preventable preterm labor, serious complications, long-term disabilities, and neonatal and maternal death. To resolve the debate of whether affordable, high-quality healthcare can be used as a policy tool to incentivize timely and more frequent checkups during and after pregnancy, we examine the causal effect of the Obstetric Care State Certificate (OSCS) program, which fully covered the costs of all antenatal services, consultations, medical exams, delivery and postnatal care in Armenia after 2008, on utilization of prenatal and postnatal care in the country. Evidence suggests that the reform had a significant, positive effect on care utilization during and after pregnancy, with the largest effects being elicited in the subsamples of women at high risk pregnancies, and mothers who have had a miscarriage or an abortion.