Geospatial and Socioeconomic Inequities in the Continuum of Maternal and Child Preventive Care Utilization Among Women of Childbearing Age in Low- And Middle-Income Countries: A Systematic Review of Multilevel Analysis Studies.

Abstract

One of the biggest public health challenges in Resource limited settings is maternal and child mortality, which is highly concentrated among certain populations living in low- and middle-income countries (LMICs). Even if the continuum of care (CoC) continues to be differentiated in how it is applied, and that remains one of the main barriers, the CoC claims itself as to be perceived as "the most fundamental approach that has or will strongly affect survival". This systematic review summarises evidence on the multilevel analytic studies of socioeconomic and geographic inequalities in the utilisation of maternal and child preventive care which are found in women of reproductive age. Methods We conducted a search of the literature published between 2020 and 2026 on PubMed, Scopus, Web of Science and WHO Global Index Medicus. Inclusion criteria: Studies with the observational design (cross-sectional or longitudinal) and multilevel/hierarchical modelling of individual and community-level predictors of MCH. A preselection of the study followed PRISMA 2020 guidelines. Using the Newcastle-Ottawa Scale, quality was assessed (without interaction with other research domains), prioritising data from clustered research. Only 43 studies fulfilling the qualifying criteria included approximately 1.9 million people in 34 countries. There were consistent social gradients across the evidence, with mother education and household wealth showing strong correlations with service uptake. However, the community-level variables- proximity of the facility to community and area-level poverty density-were independent risk factors that explained up to 35% of the variation in care completion. The distance-decay patterns were more pronounced with the transitions between birth and the postnatal period especially when geospatial disparities were quite evident. Results show that community environment and completion of the continuum of care were connected. As improvement across the core of community infrastructure leads to increased service use as measured, trends favour urban residents and high-literacy groups. Interventions should speak to geospatial distance as an unambiguous proxy for personal socio-economic status. The public health content should focus on the structural and community level barriers to participation in strengthening the regional health system.