There is now broad consensus among global health stakeholders that essential maternal healthcare should be free of financial barriers
Dar es Salaam. Health experts have raised concern about the cost of healthcare for expectant mothers which remains one of the leading barriers to accessing essential maternal and child health services, particularly in low- and middle-income countries.
Public health research shows that user fees in maternity services significantly contribute to delays—or complete avoidance—of basic care, including antenatal check-ups, safe delivery and postnatal services.
Historically, such fees were justified as a way to sustain health systems and improve service quality, especially in resource-constrained settings.
However, growing scientific evidence and global experience indicate that the intended benefits are outweighed by the financial burden placed on expectant mothers, a group already exposed to heightened health and social risks.
There is now broad consensus among global health stakeholders, including the World Health Organization, United Nations agencies and development partners, that essential maternal healthcare should be free of financial barriers.
This position aligns with the principle of Universal Health Coverage (UHC), which emphasises access to quality, safe and timely healthcare services without causing financial hardship to individuals or families.
The health experts warn that out-of-pocket costs directly undermine access to critical services, particularly for expectant mothers and newborns.
They say such charges often prevent low-income women from seeking timely care, increasing the risk of complications, maternal deaths and neonatal mortality—many of which are preventable with early and adequate medical attention.
A nursing and midwifery specialist, Ms Martha Rimoy, said there is a need to ensure free maternal healthcare while exploring mechanisms for those who can afford to contribute, without disadvantaging vulnerable groups.
She noted that requiring expectant mothers to raise funds for treatment can have psychological effects and discourage them from seeking care.
“Financial barriers limit women’s ability to attend clinics, follow immunisation schedules and access essential health screenings.”
According to Ms Rimoy, women in low-income settings are often forced to delay or forgo care due to cost constraints, increasing the likelihood of preventable complications such as severe bleeding, hypertension during pregnancy and infections.
“These conditions significantly contribute to maternal and neonatal deaths.”
The Resident Director of Regional Psychosocial Support Initiative, Mr Edwick Mapalala, said ensuring free access to healthcare for expectant mothers is critical to safeguarding the lives of both mother and child.
“When policymakers proposed free maternal care, the intention was to protect lives. Any nation that safeguards the wellbeing of its people is also protecting its economy,” he said.
Mr Mapalala added that pregnancy is a vulnerable period and complications affecting a mother’s health could also result in long-term consequences for the child, including disability.
Medical practitioner Daud Emanuel said pregnancy and the postnatal period are critical stages, with outcomes closely linked to the quality of care received.
“Access to quality healthcare increases the likelihood of a healthy pregnancy and safe delivery,” he said.
Dr Emanuel noted that various conditions can arise during pregnancy or childbirth, requiring timely medical intervention, diagnostic tests and specialist care—all of which come at a cost.
“Ensuring guaranteed access to treatment encourages expectant mothers to seek care early. If services are free, more women will attend clinics on time.”
Dr Emanuel added that essential supplements provided during pregnancy help prevent complications such as anaemia and protect the unborn child from disease. However, limited financial capacity can prevent women from accessing such services.
He warned that delays in seeking care due to financial constraints can lead to life-threatening complications for both mother and child.
“Lack of funds can prevent mothers from attending clinics for necessary tests, which are critical in determining the safest delivery method, including the need for surgical intervention.”
Dr Emanuel called for the removal of financial barriers to ensure mothers receive appropriate care and reduce the risk of mortality.
Budget constraints
Socio-economic analyst Oscar Mkude said while the 2007 Health Policy provides for free medical services for vulnerable groups, implementation remains incomplete due to budget limitations.
“Policies often outline long-term goals, but their implementation depends on the availability of adequate resources. In many cases, competing fiscal demands constrain effective execution,” he said.
He cited the Tanzania Demographic and Health Survey 2022, which shows a fertility rate of 3.2 children per woman, underscoring the need for substantial investment in maternal and child health services.
“This implies that the budget required to serve this group must be significant,” he said.
Mr Mkude stressed that removing user fees is essential not only for improving health outcomes but also for reducing poverty and enhancing access to services.
“You may build many health facilities, but if people cannot afford to use them, access remains limited. That is why this policy direction remains relevant—whether through universal health insurance or other financing mechanisms,” he said.
He added that, from a public health perspective, waiving user fees is widely recognised globally as an effective strategy for reducing maternal deaths, particularly among low-income households.
