Continuum of maternal healthcare services utilization in low-and middle-income countries: A multi-level analysis

While predictors of individual maternal healthcare service (MHS) indicators are studied, there is a knowledge gap in low and middle-income countries (LMICs) regarding the continuum of MHS utilization.

The continuum of maternal healthcare services (MHS) utilization refers to a systematic approach that ensures integrated and effective service(s) delivery across pregnancy, childbirth, and the postpartum periods. Continuity in maternal healthcare from antepartum to postpartum stages can reduce the combined risk of neonatal, perinatal, and maternal mortality by up to 15 %, essential for reducing maternal mortality and ensuring overall health during pregnancy and childbirth.

Estimate MHS continuum prevalence and country differences, and investigate its determinants in LMICs.

This study used multilevel models to analyze data from 246,272 women aged 15-49 with recent live births across 35 LMICs from Demographic and Health Surveys.

Although 55.8 % of women received at least four antenatal care visits by skilled providers (ANC4₊SP), only 47.0 % had skilled birth attendance (SBA) at delivery, and just 36.7 % received ANC4₊SP, SBA, and postnatal care (PNC), with country-wise variation. Women with ANC4₊SP had 2.8 times higher odds of SBA use. Those with both ANC4₊SP and SBA had 1.6 and 19.2 times higher odds of PNC use, respectively. The continuum of MHS utilization was linked to education, wealth, place of residence, distance to the health facilities, employment, decision-making power, and media exposure.

Utilization of maternal health services decreases from antepartum to postpartum stages. Improving antenatal care quality and targeting interventions for less-educated, unemployed, and rural women, while increasing health provider density and adopting successful intervention practices, are crucial to enhance MHS accessibility and completion rates, aiming to meet SDGs by 2030.