CoChat
Sign Up
Cited by 1,255Global Maternal and Child HealthMaternal and Perinatal Health InterventionsReproductive Health and Contraception

Still too far to walk: Literature review of the determinants of delivery service use

Open access
Gabrysch, Sabine, Campbell, Oona MR·2009·BMC Pregnancy and Childbirth
DOI 10.1186/1471-2393-9-34PMC PMC2744662
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Skilled attendance at childbirth is crucial for decreasing maternal and neonatal mortality, yet many women in low- and middle-income countries deliver outside of health facilities, without skilled help. The main conceptual framework in this field implicitly looks at home births with complications. We expand this to include "preventive" facility delivery for uncomplicated childbirth, and review the kinds of determinants studied in the literature, their hypothesized mechanisms of action and the typical findings, as well as methodological difficulties encountered. METHODS: We searched PubMed and Ovid databases for reviews and ascertained relevant articles from these and other sources. Twenty determinants identified were grouped under four themes: (1) sociocultural factors, (2) perceived benefit/need of skilled attendance, (3) economic accessibility and (4) physical accessibility. RESULTS: There is ample evidence that higher maternal age, education and household wealth and lower parity increase use, as does urban residence. Facility use in the previous delivery and antenatal care use are also highly predictive of health facility use for the index delivery, though this may be due to confounding by service availability and other factors. Obstetric complications also increase use but are rarely studied. Quality of care is judged to be essential in qualitative studies but is not easily measured in surveys, or without linking facility records with women. Distance to health facilities decreases use, but is also difficult to determine. Challenges in comparing results between studies include differences in methods, context-specificity and the substantial overlap between complex variables. CONCLUSION: Studies of the determinants of skilled attendance concentrate on sociocultural and economic accessibility variables and neglect variables of perceived benefit/need and physical accessibility. To draw valid conclusions, it is important to consider as many influential factors as possible in any analysis of delivery service use. The increasing availability of georeferenced data provides the opportunity to link health facility data with large-scale household data, enabling researchers to explore the influences of distance and service quality.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/1471-2393-9-34

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

No citation lists for this paper

No citation lists for this paper yet — checked again daily.

References 78 · Cited by 1,255

Research works printed but not linked: 65

  1. Lawn JE Cousens S Zupan J 4 million neonatal deaths: when? Where? Why? Lancet 2005 365 891 900 15752534 10.1016/S0140-6736(05)71048-5 · DOI · Paper page
  2. Ronsmans C Graham WJ Maternal mortality: who, when, where, and why Lancet 2006 368 1189 1200 17011946 10.1016/S0140-6736(06)69380-X · DOI
  3. Stanton C Lawn JE Rahman H Wilczynska-Ketende K Hill K Stillbirth rates: delivering estimates in 190 countries Lancet 2006 367 1487 1494 16679161 10.1016/S0140-6736(06)68586-3 · DOI
  4. Campbell OM Graham WJ Strategies for reducing maternal mortality: getting on with what works Lancet 2006 368 1284 1299 17027735 10.1080/09540120050042918 · DOI · Paper page
  5. Fishbein M The role of theory in HIV prevention AIDS Care 2000 12 273 278 10928203 10.1016/j.socscimed.2004.01.006 · DOI
  6. Say L Raine R A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context Bull World Health Organ 2007 85 812 819 18038064 PMC2636485
  7. Burgard S Race and pregnancy-related care in Brazil and South Africa Soc Sci Med 2004 59 1127 1146 15210086 10.1016/S0277-9536(03)00140-0 · DOI
  8. Elo IT Utilization of maternal health-care services in Peru: the role of women's education Health Transit Rev 1992 2 49 69 10148665
  9. Glei DA Goldman N Rodriguez G Utilization of care during pregnancy in rural Guatemala: does obstetrical need matter? Soc Sci Med 2003 57 2447 2463 14572850 10.1363/3200606 · DOI
  10. Navaneetham K Dharmalingam A Utilization of maternal health care services in Southern India Soc Sci Med 2002 55 1849 1869 12383469 10.1016/j.socscimed.2006.11.004 · DOI
  11. Magadi MA Agwanda AO Obare FO A comparative analysis of the use of maternal health services between teenagers and older mothers in sub-Saharan Africa: evidence from Demographic and Health Surveys (DHS) Soc Sci Med 2007 64 1311 1325 17174017 10.1016/j.socscimed.2005.11.034 · DOI
  12. Duong DV Binns CW Lee AH Utilization of delivery services at the primary health care level in rural Vietnam Soc Sci Med 2004 59 2585 2595 15474211 10.1016/j.socscimed.2004.04.007 · DOI · Paper page
  13. Gyimah SO Takyi BK Addai I Challenges to the reproductive-health needs of African women: on religion and maternal health utilization in Ghana Soc Sci Med 2006 62 2930 2944 16406206 10.1177/146642409411400304 · DOI
  14. Mekonnen Y Mekonnen A Factors influencing the use of maternal healthcare services in Ethiopia J Health Popul Nutr 2003 21 374 382 15038593
  15. Nwakoby BN Use of obstetric services in rural Nigeria J R Soc Health 1994 114 132 136 7932482 10.1177/146642409411400304 · DOI
  16. Letamo G Rakgoasi SD Factors associated with non-use of maternal health services in Botswana J Health Popul Nutr 2003 21 40 47 12751673
  17. Onah HE Ikeako LC Iloabachie GC Factors associated with the use of maternity services in Enugu, southeastern Nigeria Soc Sci Med 2006 63 1870 1878 16766107 10.2105/AJPH.2004.057422 · DOI
  18. Stekelenburg J Kyanamina S Mukelabai M Wolffers I van Roosmalen J Waiting too long: low use of maternal health services in Kalabo, Zambia Trop Med Int Health 2004 9 390 398 14996369 10.1111/j.1365-3156.2004.01202.x · DOI
  19. Stephenson R Baschieri A Clements S Hennink M Madise N Contextual influences on the use of health facilities for childbirth in Africa Am J Public Health 2006 96 84 93 16317204 10.2105/AJPH.2004.057422 PMC1470452 · DOI
  20. Mesko N Osrin D Tamang S Shrestha BP Manandhar DS Manandhar M Standing H Costello AM Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components BMC Int Health Hum Rights 2003 3 3 12932300 10.1016/S0968-8080(03)02176-1 PMC194728 · DOI
  21. Mrisho M Schellenberg JA Mushi AK Obrist B Mshinda H Tanner M Schellenberg D Factors affecting home delivery in rural Tanzania Trop Med Int Health 2007 12 862 872 17596254 10.1016/j.socscimed.2004.12.022 · DOI
  22. Kyomuhendo GB Low use of rural maternity services in Uganda: impact of women's status, traditional beliefs and limited resources Reprod Health Matters 2003 11 16 26 12800700 10.1016/S0968-8080(03)02176-1 · DOI
  23. Brentlinger PE Sanchez-Perez HJ Cedeno MA Morales LG Hernan MA Micek MA Ford D Pregnancy outcomes, site of delivery, and community schisms in regions affected by the armed conflict in Chiapas, Mexico Soc Sci Med 2005 61 1001 1014 15955402 10.2307/2061874 · DOI
  24. De Broe S Diversity in the use of pregnancy-related care among ethnic groups in Guatemala J Fam Plann Reprod Health Care 2005 31 199 205 16105283 10.1783/1471189054483889 · DOI
  25. Pebley AR Goldman N Rodriguez G Prenatal and delivery care and childhood immunization in Guatemala: do family and community matter? Demography 1996 33 231 247 8827167 10.2307/2061874 · DOI
  26. Potter JE Utilizacion de los servicios de salud materna en el Mexico rural [Use of maternal health services in rural Mexico] Salud Publica Mex 1988 30 387 402 3187736
  27. Short S Zhang F Use of maternal health services in rural China Popul Stud (Camb) 2004 58 3 19 15204259 10.1136/jech.50.4.451 · DOI
  28. Celik Y Hotchkiss DR The socio-economic determinants of maternal health care utilization in Turkey Soc Sci Med 2000 50 1797 1806 10798333 10.1016/S0277-9536(99)00418-9 · DOI
  29. Toan NV Hoa HT Trong PV Hojer B Persson LA Sundstrom K Utilisation of reproductive health services in rural Vietnam; are there equal opportunities to plan and protect pregnancies? J Epidemiol Community Health 1996 50 451 455 8882231 10.1136/jech.50.4.451 PMC1060318 · DOI
  30. Addai I Determinants of use of maternal-child health services in rural Ghana J Biosoc Sci 2000 32 1 15 10676056
  31. Magadi M Diamond I Rodrigues RN The determinants of delivery care in Kenya Soc Biol 2000 47 164 188 12055693
  32. Yanagisawa S Oum S Wakai S Determinants of skilled birth attendance in rural Cambodia Trop Med Int Health 2006 11 238 251 16451349 10.1080/00324720600895934 · DOI
  33. Stephenson R Tsui AO Contextual influences on reproductive health service use in Uttar Pradesh, India Stud Fam Plann 2002 33 309 320 12561780 10.1111/j.1728-4465.2002.00309.x · DOI
  34. Gage AJ Guirlene Calixte M Effects of the physical accessibility of maternal health services on their use in rural Haiti Popul Stud (Camb) 2006 60 271 288 17060054 10.1002/(SICI)1099-1050(199607)5:4<333::AID-HEC202>3.0.CO;2-K · DOI
  35. Gage AJ Barriers to the utilization of maternal health care in rural Mali Soc Sci Med 2007 65 1666 1682 17643685 10.1363/3201706 · DOI
  36. Hodgkin D Household characteristics affecting where mothers deliver in rural Kenya Health Econ 1996 5 333 340 8880170 10.1002/(SICI)1099-1050(199607)5:4<333::AID-HEC202>3.0.CO;2-K · DOI
  37. Furuta M Salway S Women's position within the household as a determinant of maternal health care use in Nepal Int Fam Plan Perspect 2006 32 17 27 16723298 10.1016/0277-9536(95)00411-4 · DOI
  38. Grosse RN Auffrey C Literacy and health status in developing countries Annu Rev Public Health 1989 10 281 297 2655635 10.1093/ije/31.6.1192 · DOI
  39. Raghupathy S Education and the use of maternal health care in Thailand Soc Sci Med 1996 43 459 471 8844947 10.1111/j.1728-4465.2003.00032.x · DOI
  40. Singh-Manoux A Clarke P Marmot M Multiple measures of socio-economic position and psychosocial health: proximal and distal measures Int J Epidemiol 2002 31 1192 1199 discussion 1199–1200 12540721 10.1353/dem.2001.0001 · DOI
  41. Falkingham J Inequality and changes in women's use of maternal health-care services in Tajikistan Stud Fam Plann 2003 34 32 43 12772444 10.1111/j.1728-4465.2003.00032.x · DOI
  42. Bloom SS Wypij D Das Gupta M Dimensions of women's autonomy and the influence on maternal health care utilization in a north Indian city Demography 2001 38 67 78 11227846 10.1353/dem.2001.0001 · DOI
  43. Bhatia JC Cleland J Determinants of maternal care in a region of South India Health Transition Review 1995 5 127 142
  44. Li J Gender inequality, family planning, and maternal and child care in a rural Chinese county Soc Sci Med 2004 59 695 708 15177828 10.1016/j.socscimed.2003.11.041 · DOI · Paper page
  45. Obermeyer CM Potter JE Maternal health care utilization in Jordan: a study of patterns and determinants Stud Fam Plann 1991 22 177 187 1949100 10.2307/1966644 · DOI
  46. Phoxay C Okumura J Nakamura Y Wakai S Influence of women's knowledge on maternal health care utilization in southern Laos Asia Pac J Public Health 2001 13 13 19 12109254
  47. Amooti-Kaguna B Nuwaha F Factors influencing choice of delivery sites in Rakai district of Uganda Soc Sci Med 2000 50 203 213 10619690 10.1016/S0277-9536(99)00275-0 · DOI
  48. Griffiths P Stephenson R Understanding users' perspectives of barriers to maternal health care use in Maharashtra, India J Biosoc Sci 2001 33 339 359 11446398 10.1017/S002193200100339X · DOI · Paper page
  49. D'Ambruoso L Abbey M Hussein J Please understand when I cry out in pain: women's accounts of maternity services during labour and delivery in Ghana BMC Public Health 2005 5 140 16372911 10.1016/S0277-9536(01)00148-4 PMC1343547 · DOI
  50. Nilses C Knutsson A Förlossningsvård i Addis Abeba, Etiopien: Trots tillgängliga klinker föder de flesta kvinnor hemma [Obstetrics in Addis Abeba, Ethiopia: In spite of access to clinics, most women give birth at home] Lakartidningen 2002 99 3862 3864 12395536
  51. Paul BK Rumsey DJ Utilization of health facilities and trained birth attendants for childbirth in rural Bangladesh: an empirical study Soc Sci Med 2002 54 1755 1765 12113433 10.1016/S0277-9536(01)00148-4 · DOI
  52. MacKeith N Chinganya OJ Ahmed Y Murray SF Zambian women's experiences of urban maternity care: results from a community survey in Lusaka Afr J Reprod Health 2003 7 92 102 12828141 10.2307/3583349 · DOI
  53. Hotchkiss DR Krasovec K El-Idrissi MDZ-E Eckert E Karim AM The Role of User Charges and Structural Attributes of Quality on the Use of Maternal Health Services in Morocco Working Paper WP-03-68 2003 MEASURE Evaluation 10.1002/hpm.802 15991458 · DOI
  54. Mayhew M Hansen PM Peters DH Edward A Singh LP Dwivedi V Mashkoor A Burnham G Determinants of skilled birth attendant utilization in Afghanistan: a cross-sectional study Am J Public Health 2008 98 1849 1856 18703445 10.2105/AJPH.2007.123471 PMC2636465 · DOI
  55. Telfer ML Rowley JT Walraven GE Experiences of mothers with antenatal, delivery and postpartum care in rural Gambia Afr J Reprod Health 2002 6 74 83 12476731 10.2307/3583148 · DOI
  56. Anwar I Sami M Akhtar N Chowdhury ME Salma U Rahman M Koblinsky M Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programmes in Bangladesh Bull World Health Organ 2008 86 252 259 18438513 10.2471/BLT.07.042754 PMC2647426 · DOI
  57. Chowdhury RI Islam MA Gulshan J Chakraborty N Delivery complications and healthcare-seeking behaviour: the Bangladesh Demographic Health Survey, 1999–2000 Health Soc Care Community 2007 15 254 264 17444989
  58. Sharma SK Sawangdee Y Sirirassamee B Access to health: women's status and utilization of maternal health services in Nepal J Biosoc Sci 2007 39 671 692 17359562 10.1017/S0021932007001952 · DOI
  59. Rahman MH Mosley WH Ahmed S Akhter HH Does service accessibility reduce socioeconomic differentials in maternity care seeking? Evidence from rural Bangladesh J Biosoc Sci 2008 40 19 33 17588280 10.1017/S0021932007002258 · DOI
  60. Bolam A Manandhar DS Shrestha P Ellis M Malla K Costello AM Factors affecting home delivery in the Kathmandu Valley, Nepal Health Policy Plan 1998 13 152 158 10180403 10.1093/heapol/13.2.152 · DOI
  61. Mahmud Khan M Hotchkiss DR Berruti AA Hutchinson PL Geographic aspects of poverty and health in Tanzania: does living in a poor area matter? Health Policy Plan 2006 21 110 122 16361350 10.1093/heapol/czj008 · DOI
  62. Montgomery MR Hewett PC Urban poverty and health in developing countries: household and neighborhood effects Demography 2005 42 397 425 16235606 10.1353/dem.2005.0020 · DOI
  63. Anson O Utilization of maternal care in rural HeBei Province, the People's Republic of China: individual and structural characteristics Health Policy 2004 70 197 206 15364149 10.1016/j.healthpol.2004.03.001 · DOI
  64. Chowdhury ME Ronsmans C Killewo J Anwar I Gausia K Das-Gupta S Blum LS Dieltiens G Marshall T Saha S Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh: an observational study Lancet 2006 367 327 332 16443040 10.1016/S0140-6736(06)68070-7 · DOI
  65. Ikeako LC Onah HE Iloabachie GC Influence of formal maternal education on the use of maternity services in Enugu, Nigeria J Obstet Gynaecol 2006 26 30 34 16390706 10.1080/01443610500364004 · DOI

Authors
Gabrysch, S., & Campbell, O. M.
Affiliations
London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Gabrysch, Sabine
ORCID
Venue
BMC Pregnancy and Childbirth
Publisher
Springer Science and Business Media LLC
Published
2009-08-11
Volume
9
Issue
1
Pages
34-34
ISSN
1471-2393 (ISSN-L)
DOI
10.1186/1471-2393-9-34
PMC
PMC2744662
OpenAlex
W2111563482
Cited by
1,255
References
78
Citations by year
2026: 60 · 2025: 40 · 2024: 56 · 2023: 57 · 2022: 89 · 2021: 115 · 2020: 107 · 2019: 110 · 2018: 86 · 2017: 85 · 2016: 86 · 2015: 96 · 2014: 100 · 2013: 59 · 2012: 57
FWCI
31.74
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Pregnancy and Childbirth (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
institutional delivery, skilled birth attendance, home birth, physical accessibility, economic accessibility, sociocultural factors, distance to health facility, quality of care, prenatal care, parity, maternal age, household wealth, low- and middle-income countries
MeSH terms
Age Factors, Developing Countries, Educational Status, Female, Health Facilities, Health Services Accessibility, Humans, Health Knowledge, Attitudes, Practice, Mothers, Parity, Patient Acceptance of Health Care, Pregnancy, Residence Characteristics, Social Class, Health Behavior, Marital Status, Risk Assessment, Delivery, Obstetric

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review