Geospatial disparities in maternal and newborn health indicators across 62 conurbations in 33 sub-Saharan African countries

Abstract Background : Maternal and perinatal mortality remains high in sub-Saharan Africa, where population growth in cities is outpacing healthcare services expansion. Urban maternal and newborn care is usually monitored through national urban-area averages, which may hide differences between cities. We examined variation in maternal and newborn healthcare across 62 conurbations (core cities and surrounding peri-urban areas). Methods : We used Demographic and Health Survey data on 20,104 livebirths from surveys conducted after 2010 in 33 sub-Saharan African countries. We assessed six indicators of utilisation, content and continuity of care: at least one and at least four antenatal care visits, facility-based childbirth, caesarean section, postnatal check within 48 hours, and newborn weighing. We estimated indicators at conurbation and national urban levels, assessed continuity as the relative loss between successive stages of care, and summarised the patterns in a seven-category typology. Results : Coverage varies widely between conurbations, including within countries: in 51 of 62 conurbations, the national urban average falls outside the conurbation confidence interval for at least one indicator. A first antenatal visit is near universal, but coverage falls between the first and fourth visits and between facility-based childbirth and postnatal check. Caesarean section rates range from 1% to 32%, and newborn weighing varies most. The typology classes 20 conurbations as high or highest coverage, five as consistently low and 37 as inconsistent. Conclusions : Measuring maternal and newborn care at conurbation level and summarising it in a typology shows where urban care falls short. Targeting the specific gaps in each conurbation can guide health system action.