Inequities in spatial access to childbirth care in the Grand Conakry conurbation, Guinea

Abstract

In this study, we assessed the geographic accessibility, coverage and wealth-based inequities in childbirth care in the Grand Conakry conurbation, Guinea. We assembled administrative boundaries, locations of health facilities, socio-economic indicators, road networks, land cover features and travel speeds. Using a least-cost path algorithm, we computed travel times to the nearest childbirth care facility by type and ownership (public and private). We measured the percentage of women of childbearing age (WoCBA) living within 15, 30 and 60 minutes of their nearest facility and its variation by socio-economic status. On average, travel speeds ranged from 14 to 28 km h−1. Travel to any facility required an average of 8 minutes, increasing to 22 minutes for public hospitals, with notable variation across communes. While nearly all WoCBA (100%) lived within 30 minutes of any facility, coverage dropped to 82% for public hospitals. Traffic congestion substantially increased travel time and reduced coverage. Our findings reveal disparities favoring wealthier women, particularly in peri-urban communes with longer average travel times. Targeted interventions, such as building new roads and enhancing public transportation, are needed in peri-urban areas to improve access to and equity in childbirth care. Grovogui et al. demonstrate major disparities in Grand Conakry, Guinea, in geographic access to healthcare facilities providing childbirth care, driven by the skewed spatial distribution of health facilities, heavy traffic and socio-economic disadvantage