Abstract
BackgroundGeographic 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.MethodsMultiple 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.FindingsIn 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.InterpretationGeographic 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.
Highlights
Geographic access to obstetric care facilities has a significant influence on women’s uptake of institutional delivery care
Geographic access measured in either physical distance and/or travel time was significantly associated with women’s use of facility delivery
The main findings of this meta-analysis and systematic review were that geographic access to obstetric care facilities, measured in either physical distance and/or travel time, had an impact on institutional delivery use
Summary
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. Multiple combinations of search terms or keywords, such as delivery or obstetric care, childbirth, geographic/physical access or proximity, observational studies, low and middle-income countries, and Boolean operators were used (see S1 Table). Two authors independently screened the titles and abstracts to determine if the returned electronic search articles were related to the study. The respective lists of articles of both authors were combined and full-text articles were reviewed against the inclusion and exclusion criteria.
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