SOCIAL DETERMINANTS OF HEALTH AFFECTING UTILIZATION OF MATERNAL HEALTH SERVICES IN AFRICA: A NARRATIVE REVIEW

Abstract

Despite improvements in maternal health, Sub-Saharan Africa countries still experience high maternal deaths. The provision of quality maternal health services has been adopted as a key strategy to reduce maternal mortality. However, low utilization rates and inequitable access to maternal health services across the region continue to hinder progress. The objective of the study was to synthesize evidence on the social determinants of maternal health services utilization in sub-Saharan Africa. A narrative review of peer-reviewed articles published between 2010 and 2019 was conducted. Peer-reviewed published studies were electronically searched from databases using search terms covering access and use, social determinants, maternal health services and sub-Sharan Africa. Data were qualitatively analyzed, and results summarized using the World Health Organization’s Social Determinants of Health Framework. A total of 36 studies were reviewed. The study identified several social determinants that act as barriers or facilitators to maternal health utilization. Factors identified include socioeconomic status, educational level, women’s autonomy, urban residence, gender norms, geographical proximity, access to media, high social capital, social support, exposure to media and functional health system. Maternal healthcare utilization is still low in sub-Saharan Africa and it reflects disparities according to socioeconomic status and rural/urban residence. Programs and interventions to improve maternal health should target social determinants that create inequalities in society.

Keywords

• Sub-Saharan Africa,maternal health,utilization,social determinants

References

1. [1] WHO, “WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality 2000 to 2017,” 2019.
2. [2] S. M. Umuhoza and J. E. Ataguba, “Inequalities in health and health risk factors in the Southern African Development Community: Evidence from World Health Surveys,” Int. J. Equity Health, 2018.
3. [3] L. Say et al., “Global causes of maternal death: A WHO systematic analysis,” Lancet Glob. Heal., 2014.
4. [4] CSDH, “A Conceptual Framework for Action on the Social Determinants of Health,” 2007.
5. [5] R. B. Khatri and R. Karkee, “Social determinants of health affecting utilisation of routine maternity services in Nepal: a narrative review of the evidence,” Reproductive Health Matters. 2018.
6. [6] Z. T. Dimbuene, J. Amo-Adjei, D. Amugsi, J. Mumah, C. O. Izugbara, and D. Beguy, “Women’s education and utilization of maternal health services in Africa: A multi-country and socioeconomic status analysis,” J. Biosoc. Sci., 2018.
7. [7] G. Rutaremwa, S. O. Wandera, T. Jhamba, E. Akiror, and A. Kiconco, “Determinants of maternal health services utilization in Uganda,” BMC Health Serv. Res., 2015.
8. [8] T. Mekonnen, T. Dune, J. Perz, and F. A. Ogbo, “Trends and Determinants of Antenatal Care Service Use in Ethiopia between 2000 and 2016,” Int. J. Environ. Res. Public Health, 2019.

9. [9] M. M. Kifle, H. F. Kesete, H. T. Gaim, G. S. Angosom, and M. B. Araya, “Health facility or home delivery? Factors influencing the choice of delivery place among mothers living in rural communities of Eritrea,” J. Health. Popul. Nutr., 2018.
10. [10] O. Aremu, S. Lawoko, and K. Dalal, “Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: A multilevel discrete choice analysis,” Int. J. Womens. Health, 2011.
11. [11] C. Muzyamba, W. Groot, M. Pavlova, and S. M. Tomini, “Factors associated with choice of antenatal , delivery and postnatal services between HIV positive and HIV negative women in Zambia,” vol. 0, pp. 1–9, 2019.
12. [12] P. C. Chi, P. Bulage, H. Urdal, and J. Sundby, “A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda,” BMC Pregnancy Childbirth, 2015.
13. [13] D. N. gozi Ononokpono and C. O. bby Odimegwu, “Determinants of Maternal Health Care Utilization in Nigeria: a multilevel approach,” Pan Afr. Med. J., vol. 17, no. Supp 1, p. 2, 2014.
14. [14] K. Shimamoto, “Investigating Pathways Linking Women’s Status and Power to Skilled Birth Attendant Use at Childbirth in Senegal and Tanzania,” 2015.
15. [15] S. T. Adedokun and O. A. Uthman, “Women who have not utilized health Service for Delivery in Nigeria: Who are they and where do they live?,” BMC Pregnancy Childbirth, 2019.
16. [16] F. N. Tiruneh, K. Y. Chuang, and Y. C. Chuang, “Women’s autonomy and maternal healthcare service utilization in Ethiopia,” BMC Health Serv. Res., 2017.
17. [17] F. Okonofua, L. Ntoimo, J. Ogungbangbe, S. Anjorin, W. Imongan, and S. Yaya, “Predictors of women’s utilization of primary health care for skilled pregnancy care in rural Nigeria,” BMC Pregnancy Childbirth, 2018.
18. [18] L. Kumbani, G. Bjune, E. Chirwa, A. Malata, and J. Ø. Odland, “Why some women fail to give birth at health facilities: A qualitative study of women’s perceptions of perinatal care from rural Southern Malawi,” Reprod. Health, 2013.
19. [19] M. Lowe, D. R. Chen, and S. L. Huang, “Social and cultural factors affecting maternal health in rural Gambia: An exploratory qualitative study,” PLoS One, 2016.
20. [20] M. Rashid, D. Antai, and D. Antai, “Socioeconomic position as a determinant of maternal healthcare utilization: A population-based study in Namibia,” J. Res. Health Sci., 2014. [21] S. Yaya, G. Bishwajit, and V. Shah, “Wealth, education and urban–rural inequality and maternal healthcare service usage in Malawi,” BMJ Glob. Heal., 2016.
21. [22] K. Shimamoto and J. D. Gipson, “Investigating pathways linking women’s status and empowerment to skilled attendance at birth in Tanzania: A structural equation modeling approach,” PLoS One, 2019.
22. [23] C. Chol, J. Negin, K. E. Agho, and R. G. Cumming, “Women’s autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: Results from the demographic and health surveys, 2010-2016,” BMJ Open, 2019.
23. [24] K. Machira and M. Palamulen, “Rural–urban differences in the use of postnatal care services in Malawi,” J. Egypt. Public Heal. Assoc., 2018.
24. [25] T. S. Donmozoun, I. Sombie, and N. Meda, “What prevent women for a sustainable use of maternal care in two medical districts of Burkina Faso? A qualitative study,” Pan Afr. Med. J., 2014.
25. [26] K. H. Kim, J. W. Choi, J. Oh, J. Moon, S. You, and Y. K. Woo, “What are the barriers to antenatal care utilization in Rufisque District, Senegal?: A bottleneck analysis,” J. Korean Med. Sci., vol. 34, no. 7, pp. 1–19, 2019.
26. [27] J. K. Ganle, E. Otupiri, M. Parker, and R. Fitzpatrick, “Socio-cultural Barriers to Accessibility and Utilization of Maternal and Newborn Healthcare Services in Ghana after User-fee Aboli- tion,” Int. J. Matern. Child Heal., 2015.
27. [28] K. K. Ganle, M. Parker, R. Fitzpatrick, and E. Otupiri, “A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition,” BMC Pregnancy Childbirth, 2014.
28. [29] M. Tsawe, A. Moto, T. Netshivhera, L. Ralesego, C. Nyathi, and A. S. Susuman, “Factors influencing the use of maternal healthcare services and childhood immunization in Swaziland,” Int. J. Equity Health, 2015.
29. [30] J. K. Ganle, M. Parker, R. Fitzpatrick, and E. Otupiri, “Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: A descriptive study,” Int. J. Equity Health, 2014.
30. [31] J. K. Ganle, E. Otupiri, B. Obeng, A. K. Edusie, A. Ankomah, and R. Adanu, “Challenges women with disability face in accessing and using maternal healthcare services in Ghana: A qualitative study,” PLoS One, 2016.
31. [32] R. N. Ogu, L. F. C. Ntoimo, and F. E. Okonofua, “Perceptions of women on workloads in health facilities and its effect on maternal health care: A multi-site qualitative study in Nigeria,” Midwifery, 2017.
32. [33] E. V. N. Rosário, M. C. Gomes, M. Brito, and D. Costa, “Determinants of maternal health care and birth outcome in the Dande Health and Demographic Surveillance System area, Angola,” PLoS One, 2019.
33. [34] T. Shifraw, Y. Berhane, H. Gulema, T. Kendall, and A. Austin, “A qualitative study on factors that influence women’s choice of delivery in health facilities in Addis Ababa, Ethiopia,” BMC Pregnancy Childbirth, 2016.
34. [35] C. Sialubanje, K. Massar, D. H. Hamer, and R. A. C. Ruiter, “Reasons for home delivery and use of traditional birth attendants in rural Zambia: A qualitative study,” BMC Pregnancy Childbirth, 2015.
35. [36] S. Yaya, G. Bishwajit, M. Ekholuenetale, V. Shah, B. Kadio, and O. Udenigwe, “Factors associated with maternal utilization of health facilities for delivery in Ethiopia,” Int. Health, vol. 10, no. 4, pp. 310–317, Feb. 2018.
36. [37] G. B. Nuamah et al., “Access and utilization of maternal healthcare in a rural district in the forest belt of Ghana,” BMC Pregnancy Childbirth, 2019.
37. [38] S. Yaya, O. A. Uthman, G. Bishwajit, and M. Ekholuenetale, “Maternal health care service utilization in post-war Liberia: Analysis of nationally representative cross-sectional household surveys 11 Medical and Health Sciences 1117 Public Health and Health Services,” BMC Public Health, 2019.
38. [39] T. O. Oyewale and T. R. Mavundla, “Socioeconomic factors contributing to exclusion of women from maternal health benefit in Abuja, Nigeria,” Curationis, 2015.
39. [40] K. Asrese and M. E. Adamek, “Women’s social networks and use of facility delivery services for uncomplicated births in North West Ethiopia: A community-based case-control study,” BMC Pregnancy Childbirth, 2017.
40. [41] J. A. Akowuah, P. Agyei-Baffour, and D. Awunyo-Vitor, “Determinants of antenatal healthcare utilisation by pregnant women in third trimester in peri-urban Ghana,” J. Trop. Med., vol. 2018, no. 2000, 2018.
41. [42] S. McTavish and S. Moore, “On est ensemble: Social capital and maternal health care use in rural Cameroon,” Global. Health, 2015.
42. [43] J. K. Ganle, “Ethnic disparities in utilisation of maternal health care services in Ghana: Evidence from the 2007 Ghana Maternal Health Survey,” Ethn. Heal., 2016.
43. [44] M. Marmot, “Social determinants of health inequalities,” Lancet, 2005.
44. [45] S. Yaya, G. Bishwajit, O. A. Uthman, and A. Amouzou, “Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria,” PLoS One, 2018.