Beyond the operation room: Exploring inequalities in out-of-pocket and catastrophic health expenditures for caesarean surgical care in Cameroon, a decomposition analysis.

In this study, we examined inequalities in out-of-pocket payments (OOP) and catastrophic health expenditures (CHE) for Cesarean Section care in Cameroon. We collected data from 436 women across 13 hospitals and used decomposition analysis of the concentration index to identify key drivers of inequality. We found that OOP costs were more concentrated among wealthier households, whereas CHE burdened the poorest, exposing sharp socioeconomic inequalities. Wealth status and educational attainment emerged as the most significant contributors to these inequalities. Although we focused on Cameroon, our findings hold relevance for other low- and middle-income countries with similar health financing systems. Through this research, we contribute a methodological approach to global maternal health literature by demonstrating how financial inequalities in surgical care can be quantified and understood across settings.