Abstract
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.