Barriers in accessing maternal healthcare: evidence from low-and middle-income countries

Abstract

The goal of improving the health status of people living in developing countries has received increasing priority in recent years. To achieve this goal, evidence is needed regarding methods for optimal allocation of expenditure within particular program areas. Among several competing programs, a commitment has been made to improve maternal health as part of the Millennium Development Goal targets. While there is a growing body of cost–effectiveness evidence relating to maternal healthcare programs, underutilization of services is still pervasive, especially among poorer groups of the population. A major reason for such underutilization lies in underlying adverse socioeconomic factors, or barriers, which impede healthcare use. This article reviews the evidence from studies that have conducted multivariate analyses to quantify the effects of education, economic status and distance barriers on service use. It is concluded that it is not possible to state categorically whether one particular barrier is more important than others and that efforts should continue to consider demand-side barriers more fully, along with supply-side barriers.

Keywords::

• access
• care utilization
• developing country
• economic barrier
• low-income country
• maternal health
• middle-income country
• multivariate analysis
• service use

Acknowledgements

This article benefited greatly from the anonymous comments provided by three referees.

Financial & competing interests disclosure

The Health Economics Research Unit (HERU) is funded by the Chief Scientist Office of the Scottish Government Health Directorates. We are also grateful to the Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK, for funding support. The review was undertaken as part of an international research program – Initiative for Maternal Mortality Programme Assessment (IMMPACT), funded by the Bill and Melinda Gates Foundation, the Department for International Development, the European Commission and United States Agency for International Development (USAID). The funders have no responsibility for the information provided, and the views expressed in the paper are solely those of the authors. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.