Maternal and neonatal health service access and utilisation in sub-Saharan Africa (2015–2023): a systematic review and meta-analysis

Despite maternal and neonatal health being crucial health indicators, in sub-Saharan Africa (SSA), access and utilisation remain low, leading to high maternal and neonatal death rates. Current epidemiological data is vital to inform policy planners to improve these health outcomes; however, relevant evidence from SSA is limited. This review assessed maternal (antenatal, delivery, and postnatal care) and neonatal health service use, access status, and associated factors in SSA. It aimed to raise awareness about the challenges mothers and newborns face in the region to support the development of sustainable solutions. Following Joanna Briggs Institute (JBI) guidelines, specific inclusion and exclusion criteria were established using the PECOS framework (Population, Exposure, Comparator, Outcome, and Study area). Medline, Embase, Web of Science, Emcare, CINAHL, Scopus, and Maternity and Infant Care databases were searched, and titles, abstracts, and full texts were reviewed to determine eligibility. Independent quality assessments were performed using JBI checklists. Data were extracted, and descriptive synthesis was performed. Random effects meta-analysis was used to estimate the proportion of deliveries occurring in a health facility and within SSA regions. A total of 64 studies were included. Six studies focused exclusively on antenatal care (ANC), twenty on delivery care, eleven on maternal and neonatal postnatal care, and thirteen on mixed components of maternal health services. The proportion of mothers receiving at least one antenatal care (ANC) visit ranged from 22% in Chad to 99% in Ghana. The median prevalence of receiving four or more ANC visits across all SSA countries was 52.5%. Most women did not receive the World Health Organization’s recommended four or more ANC visits. Maternal delivery service utilisation varied widely across SSA countries due to financial constraints, transportation limitations, and low awareness of the importance of ANC services. The pooled proportion of deliveries conducted in a health facility was 63% (95% CI: 0.55, 0.72). In most countries, the utilisation of postnatal care services within the recommended 2–7 days was critically low. The practice of essential newborn care services, such as immediate breastfeeding initiation and skin-to-skin contact, were influenced by factors including caesarean section birth, ANC attendance, place and mode of delivery, maternal education, and awareness of neonatal danger signs. In SSA, maternal and neonatal health service access and utilisation rates remain low and need more attention. Prioritisation of this issue by policymakers and healthcare providers, including the development of targeted interventions, is crucial to enhance maternal and neonatal healthcare access and utilisation.