Global dropout from the maternity continuum of care and associated factors: a systematic review and meta-analysis

Abstract Background The maternity continuum of care is a comprehensive maternal health service during pregnancy, birth, and postpartum periods. Dropout from the maternity continuum of care was the failure to complete one or more of the recommended components of the maternity continuum of care, including fewer than four ANC visits during pregnancy, delivery without skilled birth attendance, or failure to receive at least one postnatal care visit within six weeks of childbirth. This study aimed to determine the global pooled prevalence and associated factors for dropout from the maternity continuum of care. Methods Systematic searching was done using predefined criteria for article selection through PubMed, Cochrane Library, Google Scholar, HINARI, DOAJ, Web of Science, and ProQuest databases that were published and grey literature available from 1 January 2000 to 30 July 2024. Covidence software was used for article screening and data extraction. Stata software version 14 was used for data analysis. Study quality appraisal was done using the Joanna Briggs Institute checklist, while publication bias was assessed using the LFK index, funnel plot, and Egger’s test. Heterogeneity was assessed using Cochran’s Q test and I 2 statistics, in which I 2 of 25%, 50%, and 75% are considered benchmarks of low, moderate, and high heterogeneity, respectively. A fixed-effect model was used when I 2 ≤ 50%, whereas a random-effect model was used when I 2 > 50%. The results of meta-analyses were presented in forest plot and tables. Results The pooled prevalence of dropout from the maternity continuum of care was 76%. The key factors associated with dropout from the maternity continuum of care included educational level below secondary school (OR = 1.21, 95% CI: 1.04–1.41), limited exposure to media (OR = 1.20, 95% CI: 1.07–1.35), unintended pregnancy (OR = 1.13, 95% CI: 1.01–1.26), antenatal care initiation after sixteen weeks (OR = 1.49, 95% CI: 1.23–1.80), lack of husband support (OR = 1.41, 95% CI: 1.20–1.66), perceived distance to health facility as a big problem (OR = 1.18, 95% CI: 1.08–1.28), not informed about the danger signs of pregnancy (OR = 1.21, 95% CI: 1.10–1.32), and rural residence (OR = 1.24, 95% CI: 1.14–1.35). Conclusion There was a high global prevalence of dropout from the maternity continuum of care. Multiple factors associated with this high dropout were identified, which call for policymakers and stakeholders to implement targeted and comprehensive intervention strategies through increasing community awareness, empowering women’s decision-making, and improving accessibility of health facilities to reduce dropout from the maternity continuum of care. The PROSPERO registry number was ID CRD42024575258.