Ravindran BMC Public Health 2012, 12(Suppl 1):S4 http://www.biomedcentral.com/1471-2458/12/S1/S4 the employer and in some countries, by the government. The Schemes cover employees and at times, their dependents. A significant proportion of women globally do not participate in waged employment and those who do work mostly in the informal sector [7]. Social Insur- ance Schemes are therefore likely to exclude a vast majority of women except those who are covered as dependents of formal sector employees [8]. In many countries Micro-insurance Schemes, also known as Community-based Health Insurance (CBHI) mark the first stage in the transition to universal cover- age, with the intention of consolidating the various funds after a certain stage. They are characterised by low pre- miums and low coverage that is typically provided to individuals that cannot afford/qualify for other insurance plans [9]. They are usually the route to cover those in the informal sector of the economy, and are also considered as an effective means of covering women for health care [10]. However, the poorest and those without access to cash –including the elderly and women from non-poor households- may be excluded from coverage even when the premium involved is small, both for reasons of non- affordability and of lack of information. Social Protection Health Schemes are targeted interven- tions catering to vulnerable populations with a view to removing financial barriers to health care access. Fees and payments at the point of service delivery may be waived in specific health facilities, or vouchers and cash benefits may be provided to the targeted households. Social Protection Health Schemes are most common in Latin American and Caribbean countries, but are increas- ingly found in other parts of the world as well. A large number of these are focused on maternal and child health services. Studies carried out in countries where they have a long track record indicate that they are effec- tive in removing financial barriers to health service access for low-income women [11-13]. While Social Protection Health Schemes expand coverage to poor women, women from non-poor households who may face finan- cial constraints to seeking care still fall between the cracks. Conditional Cash-Transfers are social protection schemes through demand-side financing. These typically consist of making cash payment to households or indivi- duals from groups identified as under-served, conditional on their adopting desirable health behaviours, such as attendance for preventive health services by children and pregnant women. A review of six conditional cash transfer programmes in Latin America found that they consistently increased use of health services [14]. In the Muthulakshmi Reddy Maternity Benefit Scheme in Tamil Nadu, India, a substantial cash incentive is provided to low-income women conditional on institutional delivery, for the first two deliveries. The Scheme has increased rates of Page 3 of 7 institutional delivery especially among the poorest women [15]. At the same time, women from the poorest and most socially marginalised households were disproportionately represented among those excluded from the Scheme. Reasons included pregnancy of higher than second order – thus not satisfying the eligibility criterion, but more impor- tantly, of not being able to produce documentary proof of poverty status and of residence because of lack of informa- tion, time and resources [16]. Adolescent girls and older women are among sub- groups of women often excluded from coverage. This is because of the almost exclusive focus on maternal health needs in services covered by prepayment schemes and Essential Service Packages (discussed in the next section). Coverage of health services essential for most women “Essential Services Package” (ESP) consists of publicly funded services available at no cost or subsidised cost to those with ‘coverage’. An assessment of publicly financed Essential Services packages in about 152 coun- tries during 1993-99, found that only 20 of 152 coun- tries included within their ESPs all of the following: family planning, prenatal and delivery care, clean/safe delivery by trained attendants, post partum care and essential emergency obstetric care. Delivery care and emergency obstetric care were missing in a large num- ber of Essential Services packages. Only 44 of the 152 included prevention of HIV/AIDS through condom pro- motion [17]. Safe abortion services are rarely part of the Essential Services Packages, although abortion is legal in almost all countries in specific circumstances, e.g. when the preg- nancy is the result of rape or endangers the mother’s life. ESPs also rarely include services for reproductive health needs of men, older women and young women and men, and treatment for chronic diseases which affect a large proportion of women (and men). Micro-insurance schemes are too small to achieve effective risk pooling and cross-subsidising to cover rou- tine sexual and reproductive health services. They are “uninsurable” as stand-alone benefits because they are non-random and/or high probability events. Many micro-insurance schemes in South Asia and Latin America have been found to either not cover pregnancy; exclude coverage for the first pregnancy which has a higher risk of complications, or require a mandatory waiting period of 9 months before enrolling in the Scheme to prevent women from joining when they are pregnant [18]. Financial protection The extent of financial protection is linked to who is covered or excluded and for what services. In many