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Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International

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Yale Law School




Complications during childbirth and pregnancy are a main source of death and disability among women of reproductive age. Approximately 536,000 women die from pregnancy-related complications each year. Developing countries suffer most profoundly, accounting for 99% of deaths. The world's nations, by endorsing U.N. Millennium Development Goals, recognized that most deaths are preventable; they have pledged to reduce maternal mortality by 75% by 2015. This Article assesses the barriers presented by user fees - formal charges for health services still charged by many countries - to the attainment of MDGs. It shows that user fees hamper healthcare access, particularly in emergency care settings, and fail in meeting their intended purposes of generating funds and improving equity, quality and decentralization of health care. The Article analyzes fees' adverse impact through a human rights lens that privileges each woman with an assessment of her health, unlike the MDGs which assess aggregate improvements and benchmarks. Finally, the Article explores alternatives to user fees, including universal health insurance schemes, tax schemes, and debt forgiveness programs and policies. It offers a guiding framework for assessing health financing systems - a framework that is centered on the needs of the poorest and most marginalized community members and that emphasizes accountability.

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