Free maternity care and its impact on gender equality in financial protection in public hospitals in Kinshasa in 2024

Abstract

In 2019, the Democratic Republic of the Congo adopted the National Strategic Plan for Universal Health Coverage 2020–2030, aiming to ensure equitable access to healthcare with financial protection. However, persistent gender disparities limit women’s access to health services, due to structural economic and occupational inequalities. This study analyses the impact of free maternity care on gender-equitable financial protection in public hospitals in Kinshasa.

A comparative study was conducted in four public hospitals in Kinshasa (University Clinics, Ngaliema Clinic, Lemba General Referral Hospital and Ngaba Hospital Centre). Two independent samples were analysed: 2,329 patients in debt in 2021 (before the introduction of free maternity care) and 5,376 in 2024 (after its implementation). The Z-test for proportions was used to compare gender differences in hospital debt.

In 2021, the proportion of women with catastrophic hospital debt was significantly higher than that of men (p < 0.05). In 2024, following the introduction of free maternity care (September 2023), the proportions of debt between men and women had statistically equalised.

These results suggest that free maternity care has reduced gender inequalities relating to financial protection in public hospitals in Kinshasa. The programme thus contributes to one of the key objectives of Universal Health Coverage: equitable access to healthcare for all.

Keywords: Free maternity care, financial protection, gender, equity, Kinshasa, 2024.

Received Date: June 19, 2026

Accepted Date: July 10, 2026

Published Date: August 01, 2026

Available Online at: https://www.ijsrisjournal.com/index.php/ojsfiles/article/view/903