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The impact of geographic access on institutional delivery care use in low and middle-income countries: Systematic review and meta-analysis

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  • Teketo Kassaw Tegegne
  • Catherine Chojenta
  • Deborah Loxton
  • Roger Smith
  • Kelemu Tilahun Kibret

Abstract

Background: Geographic access to obstetric care facilities has a significant influence on women’s uptake of institutional delivery care. However, this effect was not consistent across studies. Some studies reported that geographic access to obstetric care facilities had no influence on the use of facility delivery. Therefore, this systematic review and meta-analysis synthesized and pooled the influence of geographic access on institutional delivery service uptake in low and middle-income countries. Methods: Multiple combinations of search terms were used to search articles from six databases and a hand search of reference lists performed. We included observational studies conducted in low and middle-income countries which reported the influence of geographic access on delivery care use. The pooled effects of geographic access on institutional delivery care use were calculated using a random-effects model with a 95% confidence interval. Findings: In this study a total of 31 studies were included. Among these studies, 15 met criteria for inclusion in the meta-analyses, while the remaining 16 were summarized using qualitative synthesis. Studies included in the analysis where women had to walk 60 minutes or less to access a health facility delivery were significantly heterogeneous. Having access to obstetric care facilities within five kilometres was significantly associated with institutional deliveries (pooled OR = 2.27; 95% CI = 1.82, 2.82). Similarly, a travelling time of 60 minutes or less was significantly associated with higher odds of health facility delivery (pooled OR = 3.30; 95% CI = 1.97, 5.53). Every one-hour and one-kilometre increase in travel time and distance, respectively, was negatively associated with institutional delivery care use. Interpretation: Geographic access measured in either physical distance and/or travel time was significantly associated with women’s use of facility delivery. The greater the distance and/or travel time to obstetric care facilities, the greater the barrier and the lesser the service uptake.

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  • Teketo Kassaw Tegegne & Catherine Chojenta & Deborah Loxton & Roger Smith & Kelemu Tilahun Kibret, 2018. "The impact of geographic access on institutional delivery care use in low and middle-income countries: Systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-16, August.
    • Handle: RePEc:plo:pone00:0203130
    DOI: 10.1371/journal.pone.0203130
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    1. Wong, Kerry L.M. & Brady, Oliver J. & Campbell, Oona M.R. & Banke-Thomas, Aduragbemi & Benova, Lenka, 2020. "Too poor or too far? Partitioning the variability of hospital-based childbirth by poverty and travel time in Kenya, Malawi, Nigeria and Tanzania," LSE Research Online Documents on Economics 103300, London School of Economics and Political Science, LSE Library.
    2. 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.
    3. Finn McGuire & Noemi Kreif & Peter C. Smith, 2021. "The effect of distance on maternal institutional delivery choice: Evidence from Malawi," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2144-2167, September.
    4. Milena Dalton & Emily Holzman & Erica Erwin & Sophia Michelen & Anne F Rositch & Somesh Kumar & Verna Vanderpuye & Karen Yeates & Erica J Liebermann & Ophira Ginsburg, 2019. "Patient navigation services for cancer care in low-and middle-income countries: A scoping review," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-14, October.
    5. Md Nuruzzaman Khan & Melissa L. Harris & Desalegn Markos Shifti & Alexander Suuk Laar & Deborah Loxton, 2019. "Effects of unintended pregnancy on maternal healthcare services utilization in low- and lower-middle-income countries: systematic review and meta-analysis," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(5), pages 743-754, June.
    6. Teketo Kassaw Tegegne & Catherine Chojenta & Theodros Getachew & Roger Smith & Deborah Loxton, 2019. "Service environment link and false discovery rate correction: Methodological considerations in population and health facility surveys," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-17, July.
    7. Abhishek Dureja & Digvijay S. Negi, 2024. "Birth Order Effects in Maternal Health-Seeking Behavior: Evidence from India," Working Papers 118, Ashoka University, Department of Economics.

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