Multilevel modified Poisson regression analysis of barriers to healthcare access among pregnant women in high and very high maternal mortality sub-Saharan African countries: insights from demographic and health surveys data

BACKGROUND: Sub-Saharan Africa has the highest maternal death rate worldwide. Access to quality healthcare for pregnant women can significantly reduce the number of maternal deaths. There is limited evidence on barriers to healthcare access, particularly among pregnant women in countries with a high burden of maternal mortality. Therefore, this study intended to examine the magnitude of barriers to healthcare access among pregnant women in high and very high maternal mortality countries in sub-Saharan Africa. METHODS: This study employed a population-based cross-sectional study design. Data was gathered from the latest Demographic and Health Surveys data of the top 15 high and very high maternal mortality sub-Saharan African countries. A total weighted sample of 21,079 pregnant women were participated. A multilevel modified poison regression analysis model was fitted. Adjusted Prevalence Ratio (APR) with a 95% confidence interval and a P-value of less than 0.05 was used to declare statistical significance. RESULTS: This study revealed that 65.08% (95% CI: 64.43-65.72) of pregnant women in high and very high maternal mortality sub-Saharan African countries have barriers to healthcare access. In this study, age 15-24 (adjusted prevalence ratio [APR] = 1.12, 95%CI: 1.06-1.18), no education (APR = 1.53, 95%CI: 1.37-1.73), primary education (APR = 1.35, 95%CI: 1.49-1.82), secondary educational (APR = 1.48, 95%CI: 1.36-1.62), poor wealth quantile (APR = 1.76, 95%CI: 1.65-1.88), middle wealth quantile (APR = 1.30, 95%CI: 1.23-1.41), partner's no education (APR = 1.18, 95%CI: 1.06-1.30), partner's primary education (APR = 1.16, 95%CI: 1.04-1.34), unmarried (APR = 1.13, 95%CI: 1.08-1.21), no health insurance (APR = 1.59, 95%CI: 1.24-1.94), not autonomous in household decision making (APR = 2.12, 95%CI: 1.32-2.88), unwanted pregnancy (APR = 1.20, 95%CI: 1.06-1.40), rural resident (APR = 1.25, 95%CI: 1.17-1.33), community level of women's education (APR = 1.31, 95%CI: 1.16-1.51), low poverty status (APR = 1.86, 95%CI:1.20-2.52) were significantly associated with barriers to healthcare access. CONCLUSIONS: Our findings concluded that two-thirds of women in high and very high maternal mortality sub-Saharan African countries have barriers to healthcare access. Women's barrier to healthcare access was affected by individual and community-level factors. Our findings recommend that empowering women by enhancing their education and reducing poverty can help mitigate women's barriers to healthcare access. Moreover, healthcare policymakers and stakeholders should improve healthcare infrastructure and the availability of healthcare services in rural areas.