Demand-side barriers to access and utilization of skilled birth care in low and lower-middle-income countries: A scoping review of evidence

Abstract

A myriad of demand-side factors hamper childbearing women from utilizing needed skilled birth care in low and lower-middle income countries. The objective of this scoping review is to explore the extent of evidence available on the subject matter and identify knowledge gaps in the reviewed literature. We used the Arksey and O’Malley scoping review framework as a guide for this review and conducted searches on four electronic databases: PubMed, Embase, PsycInfo and Google Scholar. Eligible studies were those published in English and French languages between 2013 and 2022 that discussed demand-side barriers to access and utilization of skilled birth care in low and lower-middle-income countries. Five themes emerged as major types of barriers influencing the utilization of skilled birth care in low and lower-middle-income countries. These were socio-economic and sociodemographic status of women; lack of access to healthcare facilities; cost of healthcare services; ineffective healthcare systems and socio-cultural/religious factors. The identified gap in the literature was the lack of studies on the influence of women’s behaviour and psychological traits as barriers to the use of skilled birth care among reviewed publications. To design effective interventions, it is important to consider all influential factors that determine the utilization of skilled birth care by women in low-resource settings.