Fact Sheet: Focus on Burkina Faso

1. OCTOBER 2015
The maternal mortality ratio in Burkina Faso is 400
deaths per 100,000 live births, according to the most
recent data available.1
This figure has declined 49
percent since 1990, but is well short of the target set for
all countries in the Millennium Development Goals: to
reduce maternal mortality by 75 percent by 2015.2
Like the majority of sub-Saharan African countries,
Burkina Faso’s maternal mortality ratio is far higher than
the global average of 126 deaths per 100,000 live births
in 2013. Most maternal deaths are caused by severe
obstetric complications that could have been prevented
by adequate treatment and care. Some pregnancy-
related crises end in a “near miss,” a situation in which
a woman survives a crisis but would have died without
urgent medical intervention and may have an unresolved
illness or injury.3
Poverty limits access to emergency obstetric care that
can help avert maternal or infant death. In Burkina
Faso, nearly half of residents live below the poverty line
and over 80 percent live on less than US$2 per day;
user fees make health care unaffordable for many.4
Pregnancy-related outcomes can be dire if health care
is unavailable, inaccessible, or unaffordable.
Findings From the Research
Women and their households may experience adverse
effects for years following a pregnancy-related crisis.
Maternal illness or injury may interfere with the social,
emotional, physical, and financial well-being of women
and their families. Maternal illness also contributes to
lost work productivity and expenditures that disrupt
household economics. Even a small expenditure
on health care may force an already impoverished
household to reduce food consumption, drain
savings, borrow money, or sell assets—all potential
contributions to further impoverishment.5
A maternal
death can have an even greater impact due to the loss
of a caregiver and/or income earner. Thus, maternal
health is central to the well-being of women, families,
and communities.
MATERNAL ILLNESS OR INJURY AFFECTS
WOMEN’S WELL-BEING
Pregnancy-related illnesses influence Burkinabe
women’s lives in various ways: Their physical and
mental health, social standing, economic productivity,
and financial security can all change as a result of a
pregnancy-related crisis.
• Near-miss events are associated with depression,
isolation, abandonment, and diminished social status
as a result of lingering health issues, such as urinary
incontinence or obstetric fistula in affected women.6
Infertility resulting from a crisis may also adversely
affect a woman’s well-being. A woman who does not
bear children is at risk of abandonment by her partner,
a likely source of financial security.7
• Women who survive a pregnancy-related crisis may
have a reduced capacity to perform work they did
before the crisis. Diminished physical productivity can
result in reduced social standing, reduced earnings,
and an increased risk of abuse or abandonment when
illness delays or prevents a woman’s return to regular
household and income-generating activities.8
• Women who experience a near-miss event, and
their children, are significantly more likely to die
within four years than women with uncomplicated
deliveries.9
Social vulnerability, lack of access to care,
or insufficient care provided by a weak health care
system may contribute to this ongoing risk of death.
• Seventeen percent of women who have a near
miss are not fully recovered when they are
discharged from the hospital. Some leave the
hospital prematurely because they can no longer
afford to pay for care or remain absent from their
regular activities, possibly contributing to further
health complications and death.10
THE ECONOMIC IMPACT OF ADVERSE
MATERNAL HEALTH OUTCOMES
Fact Sheet
Focus on
Burkina Faso
About the Population and
Poverty Research Initiative
The William and Flora Hewlett Foundation’s
Population and Poverty (PopPov) Research
Initiative, in partnership with other funders,
has supported a global group of researchers
looking at how population dynamics affect
economic outcomes. Research funded
through the PopPov Initiative sheds light
on pathways through which fertility, health,
and population growth affect economic
growth, providing insights and an evidence
base relevant to achieving the Sustainable
Development Goals (SDGs). Findings show
that investing in women’s health, education,
and empowerment improves economic
well-being for individuals and households,
and contributes to economic growth.

2. PRB is the Secretariat of the PopPov Research Network. For additional information, please visit www.poppov.org.
MATERNAL OUTCOMES INFLUENCE CHILDREN’S
HEALTH AND HUMAN CAPITAL
The detrimental economic consequences following a near-miss event
directly affect the well-being of the children in that household. Research
from Burkina Faso shows that the effects of a crisis can last for years.11
• Even four to five years after such complications, households spent
significantly less money per school-age child than those who had
uncomplicated deliveries.
• Households where women experienced a near miss were
significantly less likely to eat relatively expensive foods such as
rice, an essential component of the diet in Burkina Faso.
• When researchers looked at child height—an indicator of child
development—they found that the children of women who
experienced a near miss were shorter than those of women with
uncomplicated deliveries.
ECONOMIC EFFECTS OF A PREGNANCY-RELATED
CRISIS LINGER
Maternal deaths and near-miss events can be catastrophic in the life
of an individual or family, particularly for those who are already living
in poverty.
• Women who experience a near-miss event pay more than double
what their counterparts with uncomplicated deliveries are charged
for medical care, leaving the near-miss households significantly
worse off financially (see Table).12
• After a maternal death, surviving infants may be sent to live with
another family member. Similarly, women who experience illness
or injury—and subsequently experience lost productivity, social
stigma, or abandonment—may return to their parental household.13
Thus, financial responsibility shifts from one household to another
and affects larger networks of families and communities.
TABLE
Near-Miss Events Place Financial Burdens on Households
Cost of Delivery by Type, 2004/2005 (in West African CFA Francs)
TRANSPORT
COST
DELIVERY
COST
TOTAL
COST
Uncomplicated Delivery 1,000 17,000 18,000
Near Miss With Early
Pregnancy Loss
1,500 34,000 35,500
Near Miss With Perinatal Death 2,500 49,000 51,500
Near Miss With Live Birth 2,500 51,000 53,500
Source: Patrick G. C. Ilboudo, Steve Russell, and Ben D’Exelle, “The Long-Term Economic
Impact of Severe Obstetric Complications for Women and Their Children in Burkina Faso,”
PLoS One 8, no. 11 (2013); DOI:10.1371/journal.pone.0080010.
Policy Implications
In 2006, the government of Burkina Faso began subsidizing 80
percent of the cost of deliveries and emergency obstetric care, and
fully exempted the poorest women from paying for care. In 2010, the
president of Burkina Faso announced there would be no charges
for emergency obstetric care. The policy does not cover costs
for ongoing or follow-up care—something that can be critical for
women’s recovery. The subsidy policy is scheduled to end in 2015.
Action by the government of Burkina Faso could increase health care
access, improving the health and economic well-being of women,
families, and communities.
• Extending the delivery and emergency obstetric care subsidy
would help impoverished women access care and avoid financial
shocks. Reduced costs for delivery and follow-up health care for
the most vulnerable women could help households avoid further
impoverishment.
• Strengthening the health system to increase access to follow-up
care, essential medicines, and family planning services is critical for
women to maintain and improve their health.
• Increasing access to voluntary family planning services is important
because contraception empowers women to decide when to
become pregnant. Women can avoid potentially life-threatening
pregnancies, space births to allow for physical recovery between
deliveries, and delay pregnancy until their households are financially
equipped to better address health care costs or financial shocks.
References
1 Toshiko Kaneda and Kristin Bietsch, 2015 World Population Data Sheet
(Washington, DC: Population Reference Bureau, 2015); World Health
Organization (WHO), Trends in Maternal Mortality: 1990 to 2013, Estimates by
WHO, UNICEF, UNFPA, The World Bank, and the United Nations Population
Division (Geneva: WHO, 2014).
2 WHO, Trends in Maternal Mortality,“Data Files and Programmes,”
accessed at http://www.who.int/reproductivehealth/publications/
monitoring/maternal-mortality-2013/en/ on Oct. 8, 2015.
3 Katerini T. Storeng et al., “Beyond Body Counts: A Qualitative Study of
Lives and Loss in Burkina Faso After ‘Near-Miss’ Obstetric Complications,”
Social Science & Medicine 71, no. 10 (2010): 1749-56.
4 Patrick G. C. Ilboudo, Steve Russell, and Ben D’Exelle, “The Long Term
Economic Impact of Severe Obstetric Complications for Women and Their
Children in Burkina Faso,” PLoS One 8, no. 11 (2013); DOI: 10.1371/journal.
pone.0080010; and Katerini T. Storeng et al., “Mortality After Near-Miss
Obstetric Complications in Burkina Faso: Medical, Social, and Health-Care
Factors,” Bulletin of the World Health Organization 90, no. 6 (2012): 401-76.
5 Patrick G. C. Ilboudo et al., “Costs and Consequences of Abortions to
Women and Their Households: A Cross-Sectional Study in Ouagadougou,
Burkina Faso,” Health Policy and Planning 30, no. 4 (2015); DOI: 10.1093/
heapol/czu025.
6 Ilboudo, Russell, and D’Exelle, “The Long Term Economic Impact of Severe
Obstetric Complications for Women and Their Children in Burkina Faso.”
7 Susan F. Murray, Mélanie Akoum, and Katerini T. Storeng, “Capitals
Diminished, Denied, Mustered, and Deployed: A Qualitative Longitudinal
Study of Women’s Four-Year Trajectories After Acute Health Crisis,
Burkina Faso,” Social Science & Medicine 75, no. 12 (2012): 2455-62.
8 Katerini T. Storeng, Melanie Akoum, and Susan F. Murray, “‘This Year I
Will Not Put Her to Work’: The Production/Reproduction Nexus in
Burkina Faso,” Anthropology & Medicine 20, no. 1 (2013): 85-97;
and Murray, Akoum, and Storeng, “Capitals Diminished, Denied,
Mustered, and Deployed.”
9 Storeng et al., “Mortality After Near-Miss Obstetric Complications
in Burkina Faso.”
10 Storeng et al., “Mortality After Near-Miss Obstetric Complications
in Burkina Faso.”
11 Ilboudo, Russell, and D’Exelle, “The Long Term Economic Impact of Severe
Obstetric Complications for Women and Their Children in Burkina Faso.”
12 Ilboudo, Russell, and D’Exelle, “The Long Term Economic Impact of Severe
Obstetric Complications for Women and Their Children in Burkina Faso.”
13 Murray, Akoum, and Storeng, “Capitals Diminished, Denied, Mustered,
and Deployed.”