Bridging gaps in maternity care for women with disabilities: a scoping review of access and utilisation in sub-Saharan Africa adopting the WHO health systems framework.

Background: Women with disabilities face higher risks of maternal morbidity and mortality, particularly in low- and middle-income countries like sub-Saharan Africa (SSA). Barriers such as socio-cultural stigma, health facility inaccessibility, and lack of supportive healthcare contribute to their limited access to maternity services, exacerbating their vulnerability. Despite significant research on maternal health in SSA, studies focusing on women with disabilities remain scarce, and current healthcare services often fail to accommodate their needs. This scoping review explores barriers to maternity care accessibility among women with disabilities in SSA, highlighting gaps in research necessary for developing interventions that align with global health goals, such as reducing maternal mortality by 2030.

Methods: This current scoping review was informed by the methodological framework proposed by Arksey and O'Malley. Exploratory searches were conducted in JSTOR, PubMed, PsycINFO, African Journals Online, and Web of Science, etc., to identify studies conducted in SSA that focused on access, utilisation, and barriers to maternity services such as antenatal care (ANC) visits, facility delivery, and postnatal care visits among women with disabilities in SSA since the introduction of the sustainable development goals (SDGs). Twenty-two studies were included, spanning from June 1st 2016 to 30th May 2024.

Results: Of the 22 eligible studies out of 416 identified studies published between 2016 and 2024, 20 were conducted across eight countries in SSA. Eight studies employed quantitative methods, 12 used qualitative approaches, and two used mixed-methods analysis. These studies focused on all or either of the maternal health services measured in this study, which include antenatal care (ANC), facility delivery, and postnatal care (PNC) among women with disabilities. Findings indicate that, despite a strong desire for ANC, physical impairments, mobility issues, and unsupportive infrastructure hinder access. Although facility deliveries were high, support gaps and negative provider attitudes were common. The WHO health system framework categorisation shows that more barriers are within the service delivery and health workforce domains.

Conclusion: The review found limited studies on access to and utilisation of ANC, facility delivery, and PNC for women with disabilities in SSA. This gap restricts understanding of the issue and hampers interventions, increasing risks to maternal and child health. Urgent research and interventions are needed to address equity challenges in these services for disabled women in SSA.