Abstract
Maternal health remains a major global public health challenge, particularly in low- and middle-income countries, especially in sub-Saharan Africa, where financial barriers constitute a significant obstacle to accessing healthcare services. In this context, the present study evaluates the impact of free maternity care implemented under the Multisectoral Nutrition and Health Program (PMNS) in the rural SIA Health Zone, Kwilu Province, Democratic Republic of the Congo. Using a mixed-methods analytical and comparative approach combining quantitative and qualitative data, the study was conducted among 118 women of reproductive age. The results demonstrate a significant improvement in the utilization of maternal health services following the introduction of free maternity care. In particular, the use of health facilities for childbirth increased substantially, while home deliveries almost completely disappeared. Similarly, antenatal care, postnatal care, and outpatient consultations increased markedly, indicating a positive effect of eliminating direct costs on access to healthcare. Furthermore, this dynamic was accompanied by an improvement in beneficiaries’ perceptions, both regarding service utilization and the quality of care. However, despite these advances, several structural constraints persist. These include drug stock-outs, service overcrowding, prolonged waiting times, and the continued occurrence of informal payments, all of which limit the overall effectiveness of the policy. These findings therefore suggest that, although free maternity care constitutes an essential lever for improving financial access to healthcare, its impact remains closely dependent on implementation conditions. Consequently, strengthening the health system, particularly in terms of supply management, human resources, and service organization, is essential to ensure sustainable effects. This study thus contributes to informing public policies aimed at achieving equitable and effective improvements in maternal health in rural settings.
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