High resolution mapping of maternal health access inequities
Despite substantial in nearly halving maternal deaths worldwide, pregnancy remains risky for many of the world’s most vulnerable women, and inequalities persist across the socioeconomic spectrum. Geographic accessibility to health facilities represents a fundamental barrier to utilisation of maternal and newborn health (MNH) services, driving these historically hidden spatial pockets of regionalized inequalities. To examine utilisation of MNH care in East Africa as an emergent property of accessibility, we visualise geographic accessibility to the nearest health facility using a dataset of nearly 10,000 georeferenced health facilities, and utilise statistical models to predict the probability of: 1) skilled birth attendance, 2) receiving 4+ antenatal care visits at time of delivery, and 3) receiving a postnatal health check-up within 48 hours of delivery. We apply results from our statistical models to the accessibility surface to visualise the probabilities of obtaining MNH care, highlighting high-resolution spatial heterogeneity and subnational inequities in receiving care before, during, and after pregnancy. These applications demonstrate how spatial approaches can inform policy efforts and promote evidence-based decision-making, and are particularly pertinent to the East African policy makers to accelerate progress in women’s, children’s and adolescent’s health and equity within the framework of the Sustainable Development Goals.
Fig. 1. Mapping accessibility to the nearest health facility. A) Impedance surface representing the difficulty in traversing a given 300 x 300 m cell. B) Health facility locations used as destinations. C) Accessibility surface generated via least-cumulative cost distance analysis using inputs A) and B).
Fig. 2. Modelled probability surfaces representing the spatial effect of accessibility at 300 x 300 m. a) Delivery with skilled birth attendant present, b) Four or more antenatal care visits at time of delivery, and c) Postnatal care received within 48 hours of delivery.
Andy Tatem, Cori Ruktanonchai WorldPop, Geography and Environment University of Southampton
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Open Health Initiative of the East African Community, NORAD
Ruktanonchai et al (2016) Equality in Maternal and Newborn Health: Modelling Geographic Disparities in Utilisation of Care in Five East African Countries, PLoS ONE
Tatem et al (2014) Mapping for maternal and newborn health: the distributions of women of childbearing age, pregnancies and births, IJHG