User fees are in place in most Sub-Saharan African countries since the 80’s and have been extended to maternal healthcare services. However, the effects of these type out-of-pocket payments in contexts where poverty deeply affects women’s purchasing power are not yet clear. This book asks for the purpose of user fees for maternal care in low resource settings and is based on a literature review. Conclusions: User fees can be harmful in a context were women are very poor and where healthcare services, like maternal care, have suboptimal levels of consumption. Therefore, when asking for what are the alternatives to out-of-pocket expenses, demand side approaches must be considered (like voucher schemes, community insurance, cash transfers and loan funds), as well as supply side approaches (like reimbursement schemes, cost-effectiveness analysis, etc.) and as other set of interrelated tools. Still, all these tools may fail if context is not taken into account. It is necessary to understand the cause for the lack of demand for maternal healthcare and keep in mind that the reasons for the arousal of the problem may be different from community to community.