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A look back on how far to walk: Systematic review and meta-analysis of physical access to skilled care for childbirth in Sub-Saharan Africa

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  • Kerry L M Wong
  • Lenka Benova
  • Oona M R Campbell

Abstract

Objectives: To (i) summarize the methods undertaken to measure physical accessibility as the spatial separation between women and health services, and (ii) establish the extent to which distance to skilled care for childbirth affects utilization in Sub-Saharan Africa. Method: We defined spatial separation as the distance/travel time between women and skilled care services. The use of skilled care at birth referred to either the location or attendant of childbirth. The main criterion for inclusion was any quantification of the relationship between spatial separation and use of skilled care at birth. The approaches undertaken to measure distance/travel time were summarized in a narrative format. We obtained pooled adjusted odds ratios (aOR) from studies that controlled for financial means, education and (perceived) need of care in a meta-analysis. Results: 57 articles were included (40 studied distance and 25 travel time), in which distance/travel time were found predominately self-reported or estimated in a geographic information system based on geographic coordinates. Approaches of distance/travel time measurement were generally poorly detailed, especially for self-reported data. Crucial features such as start point of origin and the mode of transportation for travel time were most often unspecified. Meta-analysis showed that increased distance to maternity care had an inverse association with utilization (n = 10, pooled aOR = 0.90/1km, 95%CI = 0.85–0.94). Distance from a hospital for rural women showed an even more pronounced effect on utilization (n = 2, pooled aOR = 0.58/1km increase, 95%CI = 0.31,1.09). The effect of spatial separation appears to level off beyond critical point when utilization was generally low. Conclusion: Although the reporting and measurements of spatial separation in low-resource settings needs further development, we found evidence that a lack of geographic access impedes use. Utilization is conditioned on access, researchers and policy makers should therefore prioritize quality data for the evidence-base to ensure that women everywhere have the potential to access obstetric care.

Suggested Citation

  • Kerry L M Wong & Lenka Benova & Oona M R Campbell, 2017. "A look back on how far to walk: Systematic review and meta-analysis of physical access to skilled care for childbirth in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-20, September.
    • Handle: RePEc:plo:pone00:0184432
    DOI: 10.1371/journal.pone.0184432
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    References listed on IDEAS

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    1. Jerome K Kabakyenga & Per-Olof Östergren & Eleanor Turyakira & Karen Odberg Pettersson, 2012. "Influence of Birth Preparedness, Decision-Making on Location of Birth and Assistance by Skilled Birth Attendants among Women in South-Western Uganda," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-8, April.
    2. Masters, Samuel H. & Burstein, Roy & Amofah, George & Abaogye, Patrick & Kumar, Santosh & Hanlon, Michael, 2013. "Travel time to maternity care and its effect on utilization in rural Ghana: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 93(C), pages 147-154.
    3. Diez Roux, A.V., 2001. "Investigating neighborhood and area effects on health," American Journal of Public Health, American Public Health Association, vol. 91(11), pages 1783-1789.
    4. Spangler, Sydney A. & Bloom, Shelah S., 2010. "Use of biomedical obstetric care in rural Tanzania: The role of social and material inequalities," Social Science & Medicine, Elsevier, vol. 71(4), pages 760-768, August.
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    2. Sochas, Laura, 2021. "Challenging categorical thinking: A mixed methods approach to explaining health inequalities," Social Science & Medicine, Elsevier, vol. 283(C).
    3. Noah Kaiser & Christina K. Barstow, 2022. "Rural Transportation Infrastructure in Low- and Middle-Income Countries: A Review of Impacts, Implications, and Interventions," Sustainability, MDPI, vol. 14(4), pages 1-48, February.
    4. Kian, Ramez & Erdoğan, Güneş & de Leeuw, Sander & Sibel Salman, F. & Sabet, Ehsan & Kara, Bahar Y. & Demir, Muhittin H., 2022. "Logistics planning of cash transfer to Syrian refugees in Turkey," European Journal of Operational Research, Elsevier, vol. 296(3), pages 1007-1024.

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