Geographic Access and Maternal Health Services Utilization in Sélingué Health District, Mali.

Moctar Tounkara,Peter J Winch,Hannah C Marker,Lillian Joyce Whiting-Collins,Oumar Sangho,Seydou Doumbia,Rebecca R Goins,Madeleine Beebe

doi:10.1007/s10995-021-03364-4

Abstract

IntroductionMaternal mortality is one of the main causes of death for women of childbearing age in Mali, and improving this outcome is slow, even in regions with relatively good geographic access to care. Disparities in maternal health services utilization can constitute a major obstacle in the reduction of maternal mortality in Mali and indicates a lack of equity in the Malian health system. Literature on maternal health inequity has explored structural and individual factors influencing outcomes but has not examined inequities in health facility distribution within districts with moderate geographic access. The purpose of this article is to examine disparities in education and geographic distance and how they affect utilization of maternal care within the Sélingué health district, a district with moderate geographic access to care, near Bamako, Mali.MethodsWe conducted a cross sectional survey with cluster sampling in the Sélingué health district. Maternal health services characteristics and indicators were described. Association between dependent and independent variables was verified using Kendall’s tau-b correlation, Chi square, logistic regression with odds ratio and 95% confidence interval. Gini index and concentration curve were used to measure inequity.ResultsMost respondents were 20 to 24 years old. Over 31% of our sample had some education, 65% completed at least four ANC visits, and 60.8% delivered at a health facility. Despite this evidence of healthcare access in Sélingué, disparities within the health district contribute to inadequate utilization among approximately 40% of the women in our sample. The concentration index demonstrated the impact of inequity in geographic access,comparing women residing near and far from the referral care facility.ConclusionMaternal health services underutilization, within a district with moderate geographic access, indicates that deliberate attention should be paid to addressing geographic access even in such a district.

Highlights

Maternal mortality is one of the main causes of death for women of childbearing age in Mali, and improving this outcome is slow, even in regions with relatively good geographic access to care
This paper focuses on variations and equity in geographic access, in a district with moderate geographic access, compared to most other districts located farther from the capital
This study examines maternal healthcare utilization within the Sélingué health district, a district with moderate geographic access

Summary

Introduction

Maternal mortality is one of the main causes of death for women of childbearing age in Mali, and improving this outcome is slow, even in regions with relatively good geographic access to care. Over 31% of our sample had some education, 65% completed at least four ANC visits, and 60.8% delivered at a health facility Despite this evidence of healthcare access in Sélingué, disparities within the health district contribute to inadequate utilization among approximately 40% of the women in our sample. After 2000, national-level estimates of the maternal mortality ratio began to decrease in Mali, dropping from 464 to 325 deaths per 100,000 live births between 2000 and 2018 (Cellule de Planification et de Statistique du Ministère de la Santé, 2018; Cellule de Planification et de Statistique Ministère de la Santé, 1996–2002, 2006). Social-systemic factors contributing to the “neglected tragedy” of maternal mortality are inadequate access to care, under-utilization of modern healthcare services, and women’s limited decision-making power, often linked to their education level (Simkhada et al, 2008)

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