Exploring barriers to hospital delivery in Sub-Saharan Africa: a review of the literature

Background: The maternal mortality ratio (MMR) in sub-Saharan Africa is more than 60 times that in the UK. Both the Millennium Development Goals and the Sustainable Development Goals set out by the United Nations include a focus on reducing worldwide MMR. One way in which to achieve this is to encourage mothers in the developing world to deliver their babies in healthcare facilities. This review aims to identify the barriers to hospital delivery in sub-Saharan Africa. Methods: Two databases were searched for relevant studies published within the last five years. All articles included in the review were critically appraised using CASP checklists and the STROBE statement to assess for bias. Barriers to hospital delivery were identified in each study and organised into categories according to the three delays model. Results: Thirteen barriers to facility delivery were identified. Fear of maltreatment by healthcare staff; perceived low quality of care; distance and lack of transport to facilities; and cost of delivery were identified as the barriers for which there was the highest level of evidence. Discussion: Successful interventions to tackle lack of transport and cost of delivery have been identified, though it appears more difficult to find a solution to the barriers created by societal norms, as it would be culturally insensitive to impose Western beliefs on those with different traditional and religious views. This review provides suggestions for future research and potential interventions to reduce maternal mortality in sub-Saharan Africa