Maternal Healthcare Gaps Persist Across Developing Countries Despite Higher Prenatal Care Access
A major international review led by Ririt Yuliarti Taha from STIKES Pelita Ibu reveals that millions of women in low- and middle-income countries still lack complete maternal healthcare services, despite improvements in initial prenatal care access. Published in 2026 in the International Journal of Contemporary Sciences (IJCS), the study analyzed data from 145 studies covering 89 countries and more than 2.8 million women.
The findings highlight a major global health challenge. While many pregnant women attend at least one antenatal care visit, far fewer complete the recommended number of checkups, receive skilled delivery assistance, or access postnatal care after childbirth. Researchers warn that these gaps continue to contribute to preventable maternal deaths, especially in poorer and rural regions.
Maternal Mortality Remains a Global Health Crisis
According to the study, maternal mortality remains one of the world’s most urgent health problems. Around 287,000 women die each year from pregnancy-related complications worldwide, with 95% of these deaths occurring in low- and middle-income countries.
Sub-Saharan Africa carries the heaviest burden, accounting for nearly two-thirds of global maternal deaths. Despite international commitments under Sustainable Development Goal (SDG) 3.1 to reduce maternal mortality below 70 deaths per 100,000 live births by 2030, progress remains uneven across many regions.
The research argues that improving maternal health is no longer only a medical issue. It is also closely tied to poverty reduction, education, transportation access, healthcare financing, and gender equality.
Researchers Reviewed Data From 89 Countries
The study used a systematic review and meta-analysis approach following PRISMA 2020 international standards.
Researchers searched major global health databases, including PubMed, Scopus, Web of Science, CINAHL, and the Cochrane Library, examining studies published between 2015 and 2024.
The final analysis included:
- 145 studies
- 89 low- and middle-income countries
- More than 2.8 million women
- Data from Africa, South Asia, Southeast Asia, Latin America, and the Middle East
Most studies used nationally representative health surveys such as Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS).
The researchers evaluated several indicators of maternal healthcare, including antenatal care visits, skilled birth attendance, institutional delivery, and postnatal care.
Major Gaps Found in Maternal Healthcare Continuum
One of the study’s most important findings is the dramatic decline in healthcare utilization throughout pregnancy and childbirth.
The meta-analysis found:
- 85% of pregnant women attended at least one antenatal care visit
- Only 50.8% completed four antenatal visits
- Just 18.3% reached the WHO-recommended eight antenatal contacts
- Skilled birth attendance reached 65.6%
- Institutional delivery reached 66.9%
- Postnatal care remained lowest at 48.9%
The study describes this pattern as a “continuity of care failure,” where women enter the healthcare system during pregnancy but do not consistently receive comprehensive services through childbirth and the postpartum period.
Researchers noted that the postpartum period is particularly neglected, even though many maternal and newborn deaths occur within the first 48 hours after delivery.
Rural and Poor Women Face the Greatest Barriers
The research found severe inequalities in maternal healthcare access based on income, education, and geographic location.
Women with secondary or higher education were:
- 3.42 times more likely to complete four antenatal visits
- 4.18 times more likely to receive skilled birth attendance
- 4.31 times more likely to deliver in healthcare facilities
Wealth disparities were even larger. Women from the wealthiest households had up to six times greater odds of accessing maternal healthcare services compared to women in the poorest households.
Geographic inequality also played a major role.
Urban women had:
- 2.87 times higher odds of completing four antenatal visits
- 3.54 times higher odds of institutional delivery compared to rural women
Distance to healthcare facilities was another major barrier. Women living more than five kilometers from healthcare centers were 59% less likely to deliver in medical facilities.
Health Insurance and Service Quality Improve Outcomes
The study identified several factors that significantly improved maternal healthcare utilization.
Health insurance nearly tripled the likelihood of institutional delivery, while positive perceptions of healthcare quality increased maternal healthcare use by three to four times.
Community health workers also played a critical role. Pregnant women who received support from community health workers were more than twice as likely to complete recommended antenatal visits.
According to Ririt Yuliarti Taha, the findings show that financial support alone is insufficient. Women also need respectful care, reliable healthcare systems, and accessible community-based services.
The study emphasizes that healthcare quality strongly influences whether women continue seeking maternal care throughout pregnancy and after childbirth.
Progress Exists, But Remains Uneven
The review found gradual improvements in some maternal healthcare indicators over time.
Coverage for four antenatal visits increased by approximately 1.8% annually, while skilled birth attendance increased by 2.1% per year and institutional delivery by 2.3% annually.
However, postnatal care showed little meaningful progress.
Researchers believe many healthcare systems still prioritize childbirth itself while neglecting the critical recovery period after delivery.
The study also found major regional differences. Sub-Saharan Africa consistently showed the lowest maternal healthcare utilization rates, while Latin America and the Caribbean reported the highest institutional delivery and skilled birth attendance coverage.
Why the Findings Matter
The research has important implications for governments, healthcare providers, and international development agencies.
The study recommends:
- Expanding universal health coverage
- Increasing transportation support for rural women
- Strengthening community health worker programs
- Improving respectful maternity care
- Expanding mobile health clinics
- Building stronger postnatal care systems
Researchers argue that reducing maternal mortality requires more than increasing healthcare access. Countries also need equitable healthcare systems that address poverty, education gaps, transportation barriers, and healthcare quality.
The study concludes that achieving global maternal health targets will require “comprehensive, equity-focused approaches” that ensure all women receive quality maternal healthcare regardless of socioeconomic status or geographic location.
Author Profile
Ririt Yuliarti Taha is a health researcher affiliated with STIKES Pelita Ibu. Her academic expertise focuses on maternal health, public health systems, healthcare access inequalities, maternal mortality prevention, and healthcare policy in low- and middle-income countries.
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