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Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute
Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute

Journal of Social and Political


ISSN 2615-3718 (Online)

ISSN 2621-5675 (Print)

asia insitute of research, journal of social and political sciences, jsp, aior, journal publication, humanities journal, social journa
asia insitute of research, journal of social and political sciences, jsp, aior, journal publication, humanities journal, social journa
asia insitute of research, journal of social and political sciences, jsp, aior, journal publication, humanities journal, social journa
asia insitute of research, journal of social and political sciences, jsp, aior, journal publication, humanities journal, social journa
open access

Published: 03 September 2020

Constraints to Get Access in Maternal Healthcare: A Review from Lower-middle-Income Countries

Taufiq-E-Ahmed Shovo, Nuzhat Fatema, Asif Ali Jaedi Tamim, Zannatul Ferdaush Keya, Md. Hasan Howlader

University of Newcastle (Australia), Khulna University (Bangladesh)

journal of social and political sciences
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Pages: 822-834

Keywords: Maternal Health Service, Socio-Economic, Determinants, Accessibility


The purpose of this study is to explore the basic constraints to get access to maternal healthcare utilization during the pre- and post-delivery period of women in selected lower-middle-income countries around the world. This paper is a review of the literature of previous articles published from 2000 to 2019 in different database. The findings of the study show that different types of intervening factors including socioeconomic status, health literacy of the women and their husband, education, employment status, decision-making power of the women and religion significantly influence the full and free access to the maternal health care facilities in lower-middle-income countries.


  1. Aarnio, P., Chipeta, E., & Kulmala, T. (2013). Men's perceptions of delivery care in rural Malawi: exploring community level barriers to improving maternal health. Health Care for Women International, 34(6), 419-439. doi:10.1080/07399332.2012.755982

  2. Aboagye, E., & Agyemang, O. S. (2013). Maternal health-seeking behavior: the role of financing and organization of health services in Ghana. Global Journal of Health Science, 5(5), 67. doi:10.5539/gjhs.v5n5p67

  3. Abor, P. A., Abekah-Nkrumah, G., Sakyi, K., Adjasi, C. K. D., & Abor, J. (2011). The socio-economic determinants of maternal health care utilization in Ghana. International Journal of Social Economics, 38(7), 628-648. doi:10.1108/03068291111139258

  4. Adjiwanou, V., & LeGrand, T. (2014). Gender inequality and the use of maternal healthcare services in rural sub-Saharan Africa. Health & Place, 29, 67-78. doi:10.1016/j.healthplace.2014.06.001

  5. Akhter, S., & Dasvarma, G. (2017). Whither MDG 5 in Bangladesh and its regions? Journal of Population Research, 34(3), 279-301. doi:10.1007/s12546-017-9185-4

  6. Ambel, A. A., Andrews, C., Bakilana, A. M., Foster, E. M., Qaiser, K., & Huihui, W. (2017). Examining changes in maternal and child health inequalities in Ethiopia. International Journal for Equity in Health, 16, 1-16. doi:10.1186/s12939-017-0648-1

  7. Anyait, A., Mukanga, D., Oundo, G. B., & Nuwaha, F. (2012). Predictors for health facility delivery in Busia district of Uganda: a cross sectional study. BMC pregnancy and childbirth, 12(1), 132.

  8. Babalola, S., & Fatusi, A. (2009). Determinants of use of maternal health services in Nigeria-looking beyond individual and household factors. BMC pregnancy and childbirth, 9(1), 43.

  9. Banke-Thomas, A., Banke-Thomas, O., Kivuvani, M., & Ameh, C. A. (2017). Maternal health services utilisation by Kenyan adolescent mothers: Analysis of the Demographic Health Survey 2014. Sexual & Reproductive Healthcare, 12, 37-46. doi:10.1016/j.srhc.2017.02.004

  10. Banke-Thomas, O. E., Banke-Thomas, A. O., & Ameh, C. A. (2017). Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review. BMC pregnancy and childbirth, 17(1), 65. doi:10.1186/s12884-017-1246-3

  11. Bellows, B., Warren, C., Vonthanak, S., Chhorvann, C., Sokhom, H., Men, C., . . . Rathavy, T. (2011). Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and status in Cambodia. BMC Public Health, 11(1), 667.

  12. Berhan, Y., & Berhan, A. (2014). Antenatal care as a means of increasing birth in the health facility and reducing maternal mortality: a systematic review. Ethiopian journal of health sciences, 24, 93-104.

  13. Bhat, R., Mavalankar, D. V., Singh, P. V., & Singh, N. (2009). Maternal healthcare financing: Gujarat's Chiranjeevi Scheme and its beneficiaries. Journal of Health, Population, and Nutrition, 27(2), 249.

  14. Blanchet, N. J., Fink, G., & Osei-Akoto, I. (2012). The effect of Ghana’s National Health Insurance Scheme on health care utilisation. Ghana medical journal, 46(2), 76-84. Retrieved from

  15. Bonfrer, I., Breebaart, L., & Van de Poel, E. (2016). The effects of Ghana’s national health insurance scheme on maternal and infant health care utilization. PLoS One, 11(11), e0165623. Retrieved from

  16. Bonita, R., Magnusson, R., Bovet, P., Zhao, D., Malta, D. C., Geneau, R., . . . Hospedales, J. (2013). Country actions to meet UN commitments on non-communicable diseases: a stepwise approach. The Lancet, 381(9866), 575-584.

  17. Browne, J. L., Kayode, G. A., Arhinful, D., Fidder, S. A., Grobbee, D. E., & Klipstein-Grobusch, K. (2016). Health insurance determines antenatal, delivery and postnatal care utilisation: evidence from the Ghana Demographic and Health Surveillance data. BMJ open, 6(3), e008175. Retrieved from

  18. Dalinjong, P. A., Wang, A. Y., & Homer, C. S. (2018). Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in northern Ghana. PLoS One, 13(2), e0184830. Retrieved from

  19. De Groot, A., Van de Munt, L., Boateng, D., Savitri, A. I., Antwi, E., Bolten, N., . . . Browne, J. L. (2019). Equity in maternal health outcomes in a middle-income urban setting: a cohort study. Reproductive health, 16(1), 84. doi:10.1186/s12978-019-0736-3

  20. Desai, S., & Andrist, L. (2010). Gender scripts and age at marriage in India. Demography, 47(3), 667-687.

  21. Devkota, S., & Upadhyay, M. (2015). How do income and education affect health inequality: evidence from four developing countries. Applied Economics, 47(52), 5583-5599. doi:10.1080/00036846.2015.1054069

  22. Dhaher, E., Mikolajczyk, R. T., Maxwell, A. E., & Krämer, A. (2008). Factors associated with lack of postnatal care among Palestinian women: a cross-sectional study of three clinics in the West Bank. BMC pregnancy and childbirth, 8(1), 26.

  23. Dhakal, S., Chapman, G. N., Simkhada, P. P., Van Teijlingen, E. R., Stephens, J., & Raja, A. E. (2007). Utilisation of postnatal care among rural women in Nepal. BMC pregnancy and childbirth, 7(1), 19.

  24. Edu, B. C., Agan, T. U., Monjok, E., & Makowiecka, K. (2017). Effect of free maternal health care program on health-seeking behaviour of women during pregnancy, Intra-partum and Postpartum Periods in Cross River State of Nigeria: A Mixed Method Study. Open access Macedonian journal of medical sciences, 5(3), 370. doi:10.3889/oamjms.2017.075

  25. Elmusharaf, K., Byrne, E., & O'Donovan, D. (2015). Strategies to increase demand for maternal health services in resource-limited settings: Challenges to be addressed. BMC Public Health, 15(1). doi:10.1186/s12889-015-2222-3

  26. Enuameh, Y. A. K., Okawa, S., Asante, K. P., Kikuchi, K., Mahama, E., Ansah, E., . . . Nanishi, K. (2016). Factors influencing health facility delivery in predominantly rural communities across the three ecological zones in Ghana: A cross-sectional study. PLoS One, 11(3), e0152235. Retrieved from

  27. Ezeonwu, M. (2014). Policy strategies to improve maternal health services delivery and outcomes in Anambra State, Nigeria. Health Care for Women International, 35(7-9), 828-844. doi:10.1080/07399332.2014.925454

  28. Faye, A., Diouf, M., Niang, K., Leye, M. M., Ndiaye, S., Ayad, M., & Tal-Dia, A. (2013). Social inequality and antenatal care: Impact of economic welfare on pregnancy monitoring in Senegal. Revue d'Épidémiologie et de Santé Publique, 61(2), 180-185. doi:10.1016/j.respe.2012.08.005

  29. Fenny, A. P., Asuman, D., Crentsil, A. O., & Odame, D. N. A. (2019). Trends and causes of socioeconomic inequalities in maternal healthcare in Ghana, 2003–2014. International Journal of Social Economics, 46(2), 288-308. doi:10.1108/IJSE-03-2018-0148

  30. Gage, A. J. (2007). Barriers to the utilization of maternal health care in rural Mali. Social Science & Medicine, 65(8), 1666-1682. doi:10.1016/j.socscimed.2007.06.001

  31. Gitobu, C., Gichangi, P., & Mwanda, W. (2018). The effect of Kenya’s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities. BMC pregnancy and childbirth, 18(1), 77. doi:10.1186/s12884-018-1708-2

  32. Green, T. L. (2018). Unpacking Racial/Ethnic Disparities in Prenatal Care Use: The Role of Individual-, Household-, and Area-Level Characteristics. Journal of Women's Health (15409996), 27(9), 1124-1134. doi:10.1089/jwh.2017.6807

  33. Gupta, S., Yamada, G., Mpembeni, R., Frumence, G., Callaghan-Koru, J. A., Stevenson, R., . . . Baqui, A. H. (2014). Factors associated with four or more antenatal care visits and its decline among pregnant women in Tanzania between 1999 and 2010. PLoS One, 9(7), e101893. Retrieved from

  34. Haider, M. R., Rahman, M. M., Moinuddin, M., Rahman, A. E., Ahmed, S., & Khan, M. M. (2017). Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh. PLoS One, 12(7), 1-15. doi:10.1371/journal.pone.0181408

  35. Houweling, T. A. J., Ronsmans, C., Campbell, O. M. R., & Kunst, A. E. (2007). Huge poor-rich inequalities in maternity care: an international comparative study of maternity and child care in developing countries. Bulletin of the World Health Organization, 85(10), 745-754. doi:10.2471/BLT.06.038588

  36. Hwang, W. J., & Park, Y. M. (2019). Factors Influencing the Accessibility of Maternal Health Service in Cambodia. International journal of environmental research and public health, 16(16), 2909. Retrieved from

  37. Iacoella, F., & Tirivayi, N. (2019). Determinants of maternal healthcare utilization among married adolescents: Evidence from 13 Sub-Saharan African countries. Public Health, 177, 1-9. doi:10.1016/j.puhe.2019.07.002

  38. Jithesh, V., & Ravindran, T. K. S. (2016). Social and health system factors contributing to maternal deaths in a less developed district of Kerala, India. Journal of Reproductive Health and Medicine, 2(1), 26-32. doi:10.1016/j.jrhm.2015.12.003

  39. Kabeer, N., Piza, C., & Taylor, L. (2012). What are the economic impacts of conditional cash transfer programmes? A systematic review of the evidence. EPPI CENTRE, SOCIAL SCIENCE RESEARCH UNIT, INSTITUTE OF EDUCATION & UNIVERSITY OF LONDON (eds.).

  40. Kanengoni, B., Andajani-Sutjahjo, S., & Holroyd, E. (2019). Women's experiences of disrespectful and abusive maternal health care in a low resource rural setting in eastern Zimbabwe. Midwifery, 76, 125-131. doi:10.1016/j.midw.2019.06.003

  41. Khaki, J. J., & Sithole, L. (2019). Factors associated with the utilization of postnatal care services among Malawian women. Malawi medical journal : the journal of Medical Association of Malawi, 31(1), 2-11. doi:10.4314/mmj.v31i1.2

  42. Khanal, V., Adhikari, M., Karkee, R., & Gavidia, T. (2014). Factors associated with the utilisation of postnatal care services among the mothers of Nepal: analysis of Nepal demographic and health survey 2011. BMC women's health, 14(1), 19.

  43. Kifle, D., Azale, T., Gelaw, Y. A., & Melsew, Y. A. (2017). Maternal health care service seeking behaviors and associated factors among women in rural Haramaya District, Eastern Ethiopia: a triangulated community-based cross-sectional study. Reproductive health, 14(1), 6.

  44. Kitui, J., Lewis, S., & Davey, G. (2013). Factors influencing place of delivery for women in Kenya: an analysis of the Kenya demographic and health survey, 2008/2009. BMC pregnancy and childbirth, 13(1), 40.

  45. Knaul, F. M., González-Pier, E., Gómez-Dantés, O., García-Junco, D., Arreola-Ornelas, H., Barraza-Lloréns, M., . . . Juan, M. (2012). The quest for universal health coverage: achieving social protection for all in Mexico. The Lancet, 380(9849), 1259-1279.

  46. Knaul, F. M., Langer, A., Atun, R., Rodin, D., Frenk, J., & Bonita, R. (2016). Rethinking maternal health. The Lancet Global Health, 4(4), e227-e228.

  47. Koroma, M. M., Kamara, S. S., Bangura, E. A., Kamara, M. A., Lokossou, V., & Keita, N. (2017). The quality of free antenatal and delivery services in Northern Sierra Leone. Health Research Policy and Systems, 15. doi:10.1186/s12961-017-0218-4

  48. Lagarde, M., Haines, A., & Palmer, N. (2007). Conditional cash transfers for improving uptake of health interventions in low-and middle-income countries: a systematic review. JAMA, 298(16), 1900-1910.

  49. Langer, A., Meleis, A., Knaul, F. M., Atun, R., Aran, M., Arreola-Ornelas, H., . . . Caglia, J. M. (2015). Women and health: the key for sustainable development. The Lancet, 386(9999), 1165-1210.

  50. McKinnon, B., Harper, S., & Kaufman, J. (2016). Do Socioeconomic Inequalities in Neonatal Mortality Reflect Inequalities in Coverage of Maternal Health Services? Evidence from 48 Low- and Middle-Income Countries. Maternal & Child Health Journal, 20(2), 434-446. doi:10.1007/s10995-015-1841-8

  51. McNamee, P., Ternent, L., & Hussein, J. (2009). Barriers in accessing maternal healthcare: evidence from low-and middle-income countries. Expert Review of Pharmacoeconomics & Outcomes Research, 9(1), 41-48. doi:10.1586/14737167.9.1.41

  52. Mekonnen, Y., & Mekonnen, A. (2003). Factors influencing the use of maternal healthcare services in Ethiopia. Journal of Health, Population and Nutrition, 21(4), 374-382. Retrieved from

  53. Moindi, R. O., Ngari, M. M., Nyambati, V. C., & Mbakaya, C. (2015). Why mothers still deliver at home: understanding factors associated with home deliveries and cultural practices in rural coastal Kenya, a cross-section study. BMC Public Health, 16(1), 114.

  54. Mumtaz, Z., Salway, S., Bhatti, A., Shanner, L., Zaman, S., Laing, L., & Ellison, G. T. H. (2014). Improving Maternal Health in Pakistan: Toward a Deeper Understanding of the Social Determinants of Poor Women's Access to Maternal Health Services. American Journal of Public Health, 104(S1), S17-S24. doi:10.2105/AJPH.2013.301377

  55. Muzyamba, C., Groot, W., Pavlova, M., & Tomini, S. M. (2019). Factors associated with choice of antenatal, delivery and postnatal services between HIV positive and HIV negative women in Zambia. BMC pregnancy and childbirth, 19(1), 127. doi:10.1186/s12884-019-2272-0

  56. Novignon, J., Ofori, B., Tabiri, K. G., & Pulok, M. H. (2019). Socioeconomic inequalities in maternal health care utilization in Ghana. International Journal for Equity in Health, 18(1), N.PAG-N.PAG. doi:10.1186/s12939-019-1043-x

  57. Ononokpono, D. N., & Azfredrick, E. C. (2014). Intimate Partner Violence and the Utilization of Maternal Health Care Services in Nigeria. Health Care for Women International, 35(7-9), 973-989. doi:10.1080/07399332.2014.924939

  58. Paredes, K. P. P. (2016). Inequality in the use of maternal and child health services in the Philippines: do pro-poor health policies result in more equitable use of services? International Journal for Equity in Health, 15, 1-11. doi:10.1186/s12939-016-0473-y

  59. Pulok, M. H., Uddin, J., Enemark, U., & Hossin, M. Z. (2018). Socioeconomic inequality in maternal healthcare: An analysis of regional variation in Bangladesh. Health & Place, 52, 205-214. doi:10.1016/j.healthplace.2018.06.004

  60. Rahman, A., Nisha, M. K., Begum, T., Ahmed, S., Alam, N., & Anwar, I. (2017). Trends, determinants and inequities of 4+ ANC utilisation in Bangladesh. Journal of Health, Population & Nutrition, 36, 1-8. doi:10.1186/s41043-016-0078-5

  61. Rai, R. K., Singh, P. K., Kumar, C., & Singh, L. (2013). Factors Associated With the Utilization of Maternal Health Care Services Among Adolescent Women in Malawi. Home Health Care Services Quarterly, 32(2), 106-125. doi:10.1080/01621424.2013.779354

  62. Rai, R. K., Singh, P. K., & Singh, L. (2012). Utilization of Maternal Health Care Services among Married Adolescent Women: Insights from the Nigeria Demographic and Health Survey, 2008. Women's Health Issues, 22(4), e407-e414. doi:10.1016/j.whi.2012.05.001

  63. Rana, J., Sen, K. K., Sultana, T., Hossain, M. B., & Islam, R. M. (2019). Prevalence and determinants of menstrual regulation among ever-married women in Bangladesh: evidence from a national survey. Reproductive health, 16(1), N.PAG-N.PAG. doi:10.1186/s12978-019-0785-7

  64. Rosenfield, A., & Maine, D. (1985). Maternal mortality-a neglected tragedy: Where is the M in MCH? The Lancet, 326(8446), 83-85.

  65. Sahoo, J., Singh, S. V., Gupta, V. K., Garg, S., & Kishore, J. (2015). Do socio-demographic factors still predict the choice of place of delivery: A cross-sectional study in rural North India. Journal of Epidemiology and Global Health, 5(4, Supplement 1), S27-S34. doi:10.1016/j.jegh.2015.05.002

  66. Shahjahan, M., Chowdhury, H. A., Akter, J., Afroz, A., Rahman, M. M., & Hafez, M. (2012). Factors associated with use of antenatal care services in a rural area of Bangladesh. South East Asia Journal of Public Health, 2(2), 61-66.

  67. Shahjahan, M., Chowdhury, H. A., Al-Hadhrami, A. Y., & Harun, G. D. (2017). Antenatal and postnatal care practices among mothers in rural Bangladesh: A community based cross-sectional study. Midwifery, 52, 42-48. doi:10.1016/j.midw.2017.05.011

  68. Solanke, B. L. (2018). Factors associated with use of maternal healthcare services during the Boko Haram insurgency in North-East Nigeria. Med Confl Surviv, 34(3), 158-184. doi:10.1080/13623699.2018.1511358

  69. Srivastava, A., Avan, B. I., Rajbangshi, P., & Bhattacharyya, S. (2015). Determinants of women’s satisfaction with maternal health care: a review of literature from developing countries. BMC pregnancy and childbirth, 15(1), 97. doi:10.1186/s12884-015-0525-0

  70. Stephen, A. A., & Joshua, A. O. (2016). Determinants of Maternal Utilization of Health Services and Nutritional Status in a Rural Community in South-West Nigeria. African Journal of Reproductive Health / La Revue Africaine de la Santé Reproductive, 20(2), 72-85. Retrieved from

  71. Tesfahun, F., Worku, W., Mazengiya, F., & Kifle, M. (2014). Knowledge, perception and utilization of postnatal care of mothers in Gondar Zuria District, Ethiopia: a cross-sectional study. Maternal and Child Health Journal, 18(10), 2341-2351. Retrieved from

  72. Walton, L., & Schbley, B. (2013). MATERNAL HEALTHCARE IN BANGLADESH AND GENDER EQUITY: A REVIEW ARTICLE. Online Journal of Health Ethics, 9(1), 1-18. doi:10.18785/ojhe.0901.08

  73. Wang, W., Temsah, G., & Mallick, L. (2017). The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda. Health policy and planning, 32(3), 366-375. Retrieved from

  74. Wang, X. (2017). Health and health care disparities among women in mainland China. Asian Education and Development Studies, 6(2), 166-178. doi:10.1108/AEDS-01-2016-0003

  75. Wehrmeister, F. C., Restrepo-Mendez, M.-C., Franca, G. V. A., Victora, C. G., & Barros, A. J. D. (2016). Summary indices for monitoring universal coverage in maternal and child health care. Bulletin of the World Health Organization, 94(12), 903-912. doi:10.2471/BLT.16.173138

  76. Weitzman, A. (2017). The effects of women's education on maternal health: Evidence from Peru. Social Science & Medicine, 180, 1-9. doi:10.1016/j.socscimed.2017.03.004

  77. WHO. (2013). WHO recommendations on Postnatal care of the mother and newborn. Retrieved from;jsessionid=CDB9C1F7C996E919857E951A06B9B206?sequence=1

  78. Woldemicael, G. (2010). Do Women With Higher Autonomy Seek More Maternal Health Care? Evidence From Eritrea and Ethiopia. Health Care for Women International, 31(7), 599-620. doi:10.1080/07399331003599555

  79. Wong, K. L. M., Restrepo-Méndez, M. C., Barros, A. J. D., & Victora, C. G. (2017). Socioeconomic inequalities in skilled birth attendance and child stunting in selected low and middle income countries: Wealth quintiles or deciles? PLoS One, 12(5), 1-17. doi:10.1371/journal.pone.0174823

  80. Yaya, S., & Ghose, B. (2019). Global Inequality in Maternal Health Care Service Utilization: Implications for Sustainable Development Goals. Health Equity, 3(1), 145-154.

  81. Yaya, S., Ghose, B., & Gunawardena, N. (2019). Socioeconomic factors associated with choice of delivery place among mothers: a population-based cross-sectional study in Guinea-Bissau. BMJ global health, 4(2), e001341-e001341. doi:10.1136/bmjgh-2018-001341

  82. Zere, E., Suehiro, Y., Arifeen, A., Moonesinghe, L., Chanda, S. K., & Kirigia, J. M. (2013). Equity in reproductive and maternal health services in Bangladesh. International Journal for Equity in Health, 12(1), 90-97. doi:10.1186/1475-9276-12-90

  83. Zhang, C., Rahman, M. S., Rahman, M. M., Yawson, A. E., & Shibuya, K. (2019). Trends and projections of universal health coverage indicators in Ghana, 1995-2030: A national and subnational study. PLoS One, 14(5), 1-19. doi:10.1371/journal.pone.0209126

  84. Zhang, R., Li, S., Li, C., Zhao, D., Guo, L., Qu, P., . . . Yan, H. (2018). Socioeconomic inequalities and determinants of maternal health services in Shaanxi Province, Western China. PLoS One, 13(9), 1-13. doi:10.1371/journal.pone.0202129

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