Effects of Out-of-Pocket Payments on Access to Maternal Health Services in Almaty, Kazakhstan: A Qualitative Study

The current study addresses health care reform in transitional countries and explores the impact of out-of-pocket payments on access to maternal health services drawing on Kazakhstan's case. Data on out-of-pocket payments and access to maternity care were generated through qualitative in-depth interviews conducted in Almaty during the period 2009-2010. The results indicate that while health sector reform was designed to improve the quality of care and equity, the introduction of official user charges accompanied by a rapid growth of informal payments created financial barriers that prevented women from accessing maternal services leading to reduction in utilisation of maternity care.