Telehealth and maternal referral services: A systematic review and meta-analysis

BackgroundHigh-quality healthcare during pregnancy, childbirth, and the postnatal period can reduce maternal and child mortality, which remain alarmingly high in LMICs. Telehealth has emerged as a transformative solution in healthcare delivery, leveraging telecommunications technology to deliver a variety of health-related services. This review synthesizes peer-reviewed evidence on the role of telehealth in maternal referral service delivery globally.ObjectivesAssess the role of telehealth in maternal referral service delivery globally.DesignSystematic review and meta-analysis.Data Sources and MethodsWe searched four databases, namely CINAHL, Web of Science, PubMed, and Scopus, for eligible studies published up to August 2025. The thematic analysis approach was conducted iteratively. The quality of the included studies was evaluated using the Mixed Methods Appraisal Tool (MMAT). Estimates of studies having comparable methodology were pooled in a meta-analysis using the random intercept logistic regression model. Summary prevalence estimates and their 95% confidence intervals (95% CIs) were calculated.ResultsA total of 12,984 articles were screened for eligibility, out of which 15 were included in this review. These telehealth interventions enhanced referral communication, monitoring and supported referral processes. The evidence also pointed to a generally positive reception of telehealth adoption among users, with a pooled user acceptance of 89.5% (95%CI: 67.2 to 97.3%), even though the results showed a high degree of heterogeneity (I²=92%, p<0.01). Some notable barriers/facilitators were reported, including extent of telehealth access for rural and less educated women, internet reliability and ownership of smartphones.ConclusionTelehealth has the potential to enhance maternal referral processes by improving access to care, facilitating timelier interventions, and supporting communication among healthcare providers. However, given the substantial heterogeneity observed in the pooled studies, these findings should be interpreted with caution as the acceptance and impact of telehealth may vary across settings and populations.