Factors Influencing Women's access to Healthcare Services in Low- and Middle-Income Countries: A Systematic Review

Women's access to Healthcare in LMICs

Authors

  • Sachi Saxena Sammamish High School, Bellevue, Washington, United States of America
  • Aatik Arsh Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar, Pakistan
  • Syed Ashraf Mount Sinai Health System, New York, United States of America
  • Noopur Gupta Department of Head and Neck Surgery, Dr Ram Manohar Lohia Hospital, New Delhi, India

DOI:

https://doi.org/10.54393/nrs.v3i02.47

Keywords:

Accessibility, Disparity, Health, Women

Abstract

Gender inequalities in accessing healthcare services, particularly in low- and middle-income countries (LMICs) are consistently reported in the literature. Financial constraints and greater distance from healthcare facilities are the most reported barriers to the limited accessibility of women to healthcare services in these countries. However, these two barriers are not specific to women as men living in these countries also face these barriers, then why do gender disparities exist in accessing healthcare services? Objective: To explore this question, we conducted this study to identify factors influencing women’s access to healthcare services in LMICs. Methods: A review article was conducted in September 2023. PubMed, CINHAL, EMBASE and HMIC databases were searched. Additional searching was performed in Google Scholar. Qualitative studies published from the earliest record to August 2023 which reported barriers to women’s access to healthcare services in LMICs were included. Results: Results showed that individual-level factors that influence women’s access to healthcare services in LMICs include economic status and knowledge and beliefs, inter-personal level factors include social norms and support from family and friends, community-level factors include support from community members and transportation facilities while system-level factors that influence women’s access to healthcare services include the availability of healthcare services and providers, the role of the medical fraternity, health insurance coverage, availability and implementation of effective policies and evidence-based practice and research. Conclusion: The review identified a wide range of individual, interpersonal, community and system-level barriers that hinder women residing in LMICs from accessing appropriate healthcare services. There is a need to develop cost-effective, culturally appropriate approaches, guidelines, and policies to improve women’s access to healthcare services in LMICs. 

References

Zhang Y. Access to Healthcare Facilities and Women's Healthcare Requirements in Urban Areas: A Case Study of Beijing. International Journal of Environmental Research and Public Health. 2022 Mar; 19(6): 3709. doi: 10.3390/ijerph19063709. DOI: https://doi.org/10.3390/ijerph19063709

Moroz N, Moroz I, D'Angelo MS. Mental health services in Canada: Barriers and cost-effective solutions to increase access. Healthcare Management Forum. 2020 Nov; 33(6): 282-7. doi: 10.1177/0840470420933911. DOI: https://doi.org/10.1177/0840470420933911

George MS, Davey R, Mohanty I, Upton P. "Everything is provided free, but they are still hesitant to access healthcare services": why does the indigenous community in Attapadi, Kerala continue to experience poor access to healthcare? International Journal for Equity in Health. 2020 Dec; 19(1): 105. doi: 10.1186/s12939-020-01216-1. DOI: https://doi.org/10.1186/s12939-020-01216-1

Zegeye B, El-Khatib Z, Ameyaw EK, Seidu AA, Ahinkorah BO, Keetile M, et al. Breaking Barriers to Healthcare Access: A Multilevel Analysis of Individual- and Community-Level Factors Affecting Women's Access to Healthcare Services in Benin. International Journal of Environmental Research and Public Health. 2021 Jan; 18(2): 750. doi: 10.3390/ijerph18020750. DOI: https://doi.org/10.3390/ijerph18020750

Shiner B, Gottlieb D, Rice K, Forehand JA, Snitkin M, Watts BV. Evaluating policies to improve access to mental health services in rural areas. The Journal of Rural Health. 2022 Sep; 38(4): 805-16. doi: 10.1111/jrh.12674. DOI: https://doi.org/10.1111/jrh.12674

Mohd Rosnu NS, Singh DKA, Mat Ludin AF, Ishak WS, Abd Rahman MH, Shahar S. Enablers and Barriers of Accessing Health Care Services among Older Adults in South-East Asia: A Scoping Review. International Journal of Environmental Research and Public Health. 2022 Jun; 19(12): 7351. doi: 10.3390/ijerph19127351. DOI: https://doi.org/10.3390/ijerph19127351

Griffin G, Ali M, Nau SZ, Riggs E, Dantas JAR. Accessing and navigating healthcare: A scoping review of the experiences of women of refugee background from Myanmar. Health & Social Care in the Community. 2022 Nov; 30(6): e3459-e76. doi: 10.1111/hsc.13955. DOI: https://doi.org/10.1111/hsc.13955

Mondal D, Karmakar S, Banerjee A. Women's autonomy and utilization of maternal healthcare in India: Evidence from a recent national survey. PLoS One. 2020 Dec; 15(12): e0243553. doi: 10.1371/journal.pone.0243553. DOI: https://doi.org/10.1371/journal.pone.0243553

The World Bank. World Bank Country and Lending Groups. 2022. [Last cited: 15th Nov 2023]. Available at: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.

Arsh A, Afaq S, Carswell C, Coales K, Siddiqi N. Barriers & facilitators to physical activity in people with depression and type 2 diabetes mellitus in Pakistan: A qualitative study to explore perspectives of patient participants, carers and healthcare staff. Mental Health and Physical Activity. 2023 Oct; 25: 100542. doi: 10.1016/j.mhpa.2023.100542. DOI: https://doi.org/10.1016/j.mhpa.2023.100542

Devkota HR, Murray E, Kett M, Groce N. Are maternal healthcare services accessible to vulnerable group? A study among women with disabilities in rural Nepal. PLoS One. 2018 Jul; 13(7): e0200370. doi: 10.1371/journal.pone.0200370. DOI: https://doi.org/10.1371/journal.pone.0200370

Dey A, Hay K, Afroz B, Chandurkar D, Singh K, Dehingia N, et al. Understanding intersections of social determinants of maternal healthcare utilization in Uttar Pradesh, India. PLoS One. 2018 Oct; 13(10): e0204810. doi: 10.1371/journal.pone.0204810. DOI: https://doi.org/10.1371/journal.pone.0204810

Gill R and Stewart DE. Relevance of gender-sensitive policies and general health indicators to compare the status of South Asian women’s health. Women's Health Issues. 2011 Jan; 21(1): 12-8. doi: 10.1016/j.whi.2010.10.003. DOI: https://doi.org/10.1016/j.whi.2010.10.003

Habib SS, Jamal WZ, Zaidi SMA, Siddiqui JU, Khan HM, Creswell J, et al. Barriers to Access of Healthcare Services for Rural Women-Applying Gender Lens on TB in a Rural District of Sindh, Pakistan. International Journal of Environmental Research and Public Health. 2021 Sep; 18(19): 10102. doi: 10.3390/ijerph181910102. DOI: https://doi.org/10.3390/ijerph181910102

Hamiduzzaman M, De Bellis A, Abigail W, Kalaitsidis E. Health Services Utilization Barriers for Rural Elderly Women in Bangladesh: Narratives of Clinicians, Pharmacists and Public Health Assistants. Journal of Cross-Cultural Gerontology. 2022 Dec; 37(4): 407-26. doi: 10.1007/s10823-022-09465-z. DOI: https://doi.org/10.1007/s10823-022-09465-z

Kaphle S, Vaughan G, Subedi M. Respectful Maternity Care in South Asia: What Does the Evidence Say? Experiences of Care and Neglect, Associated Vulnerabilities and Social Complexities. International Journal of Women's Health. 2022 Jul; 14: 847-79. doi: 10.2147/ijwh.S341907. DOI: https://doi.org/10.2147/IJWH.S341907

Kim C, Saeed KM, Salehi AS, Zeng W. An equity analysis of utilization of health services in Afghanistan using a national household survey. BMC Public Health. 2016 Dec; 16(1): 1226. doi: 10.1186/s12889-016-3894-z. DOI: https://doi.org/10.1186/s12889-016-3894-z

Kingdon C, Downe S, Betran AP. Women's and communities' views of targeted educational interventions to reduce unnecessary caesarean section: a qualitative evidence synthesis. Reproductive Health. 2018 Dec; 15(1): 130. doi: 10.1186/s12978-018-0570-z. DOI: https://doi.org/10.1186/s12978-018-0570-z

Mishra BK, Kanungo S, Panda S, Patel K, Swain S, Dwivedy S, et al. Access to Maternal and Child Health Services during the COVID-19 Pandemic: An Explorative Qualitative Study in Odisha, India. Indian Journal of Community Medicine. 2023 May; 48(3): 459-64. doi: 10.4103/ijcm.ijcm_285_22. DOI: https://doi.org/10.4103/ijcm.ijcm_285_22

Mukerji R and Turan JM. Challenges in accessing and utilising health services for women accessing DOTS TB services in Kolkata, India. Global Public Health. 2020 Nov; 15(11): 1718-29. doi: 10.1080/17441692.2020.1751235. DOI: https://doi.org/10.1080/17441692.2020.1751235

Panday S, Bissell P, Teijlingen EV, Simkhada P. Perceived barriers to accessing Female Community Health Volunteers' (FCHV) services among ethnic minority women in Nepal: A qualitative study. PLoS One. 2019 Jun; 14(6): e0217070. doi: 10.1371/journal.pone.0217070. DOI: https://doi.org/10.1371/journal.pone.0217070

Parkhurst JO, Rahman SA, Ssengooba F. Overcoming access barriers for facility-based delivery in low-income settings: insights from Bangladesh and Uganda. Journal of Health, Population, and Nutrition. 2006 Dec; 24(4): 438-45.

Senarath U and Gunawardena NS. Women's autonomy in decision making for health care in South Asia. Asia Pacific Journal of Public Health. 2009 Apr; 21(2): 137-43. doi: 10.1177/1010539509331590. DOI: https://doi.org/10.1177/1010539509331590

Tey NP and Lai SL. Correlates of and barriers to the utilization of health services for delivery in South Asia and Sub-Saharan Africa. The Scientific World Journal. 2013 Oct; 2013: 423403. doi: 10.1155/2013/423403. DOI: https://doi.org/10.1155/2013/423403

Thomas MA and Narayan P. Reproductive tract infections: Attitude and barriers among marginalized fisher women in Kerala, South India. Health Care for Women International. 2017 Apr; 38(4): 361-78. doi: 10.1080/07399332.2017.1279616. DOI: https://doi.org/10.1080/07399332.2017.1279616

Gajbhiye RK, Sawant MS, Kuppusamy P, Surve S, Pasi A, Prusty RK, et al. Differential impact of COVID-19 in pregnant women from high-income countries and low- to middle-income countries: A systematic review and meta-analysis. International Journal of Gynecology & Obstetrics. 2021 Oct; 155(1): 48-56. doi: 10.1002/ijgo.13793. DOI: https://doi.org/10.1002/ijgo.13793

Montgomery HE, Haines A, Marlow N, Pearson G, Mythen MG, Grocott MPW, et al. The future of UK healthcare: problems and potential solutions to a system in crisis. Annals of Oncology. 2017 Aug; 28(8): 1751-5. doi: 10.1093/annonc/mdx136. DOI: https://doi.org/10.1093/annonc/mdx136

Davis A, Lembo T, Laurie E, Mutua E, Loosli K, Nthambi M, et al. How public health crises expose systemic, day-to-day health inequalities in low- and-middle income countries: an example from East Africa. Antimicrobial Resistance & Infection Control. 2022 Feb; 11(1): 34. doi: 10.1186/s13756-022-01071-5. DOI: https://doi.org/10.1186/s13756-022-01071-5

Escañuela Sánchez T, Linehan L, O'Donoghue K, Byrne M, Meaney S. Facilitators and barriers to seeking and engaging with antenatal care in high-income countries: A meta-synthesis of qualitative research. Health & Social Care in the Community. 2022 Nov; 30(6): e3810-e28. doi:10.1111/hsc.14072. DOI: https://doi.org/10.1111/hsc.14072

Turkmani S, Homer CSE, Dawson A. Maternity care experiences and health needs of migrant women from female genital mutilation-practicing countries in high-income contexts: A systematic review and meta-synthesis. Birth. 2019 Mar; 46(1): 3-14. doi:10.1111/birt.12367. DOI: https://doi.org/10.1111/birt.12367

Braithwaite J, Zurynski Y, Ludlow K, Holt J, Augustsson H, Campbell M. Towards sustainable healthcare system performance in the 21st century in high-income countries: a protocol for a systematic review of the grey literature. BMJ Open. 2019 Jan; 9(1): e025892. doi: 10.1136/bmjopen-2018-025892. DOI: https://doi.org/10.1136/bmjopen-2018-025892

Gauld R, Burgers J, Dobrow M, Minhas R, Wendt C, Cohen AB, et al. Healthcare system performance improvement: a comparison of key policies in seven high-income countries. Journal of health organization and management. 2014 Mar; 28(1): 2-20. doi: 10.1108/jhom-03-2013-0057. DOI: https://doi.org/10.1108/JHOM-03-2013-0057

Henson C, Chapman F, Shepherd G, Carlson B, Rambaldini B, Gwynne K. How Older Indigenous Women Living in High-Income Countries Use Digital Health Technology: Systematic Review. Journal of Medical Internet Research. 2023 Apr; 25: e41984. doi: 10.2196/41984. DOI: https://doi.org/10.2196/41984

Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews. 2017 Jul; 7(7): Cd003766. doi: 10.1002/14651858.CD003766.pub6. DOI: https://doi.org/10.1002/14651858.CD003766.pub6

Armour M, Parry K, Al-Dabbas MA, Curry C, Holmes K, MacMillan F, et al. Self-care strategies and sources of knowledge on menstruation in 12,526 young women with dysmenorrhea: A systematic review and meta-analysis. PLoS One. 2019 Jul; 14(7): e0220103. doi: 10.1371/journal.pone.0220103. DOI: https://doi.org/10.1371/journal.pone.0220103

Sanogo NdA, Fantaye AW, Yaya S. Universal health coverage and facilitation of equitable access to care in Africa. Frontiers in Public Health. 2019 Apr; 7: 102. doi: 10.3389/fpubh.2019.00102. DOI: https://doi.org/10.3389/fpubh.2019.00102

Zephyrin LC, Katon JG, Yano EM. Strategies for transforming reproductive healthcare delivery in an integrated healthcare system: a national model with system-wide implications. Current Opinion in Obstetrics and Gynecology. 2014 Dec; 26(6): 503-10. doi: 10.1097/gco.0000000000000124. DOI: https://doi.org/10.1097/GCO.0000000000000124

Rojas-Rueda D, de Nazelle A, Andersen ZJ, Braun-Fahrländer C, Bruha J, Bruhova-Foltynova H, et al. Health Impacts of Active Transportation in Europe. PLoS One. 2016 Mar; 11(3): e0149990. doi: 10.1371/journal.pone.0149990. DOI: https://doi.org/10.1371/journal.pone.0149990

Akter S, Davies K, Rich JL, Inder KJ. Community perspectives of barriers indigenous women face in accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh. Ethnicity & Health. 2022 Jul; 27(5): 1222-40. doi: 10.1080/13557858.2020.1862766. DOI: https://doi.org/10.1080/13557858.2020.1862766

Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews. 2017 Jun; 6(6): Cd000072. doi: 10.1002/14651858.CD000072.pub3. DOI: https://doi.org/10.1002/14651858.CD000072.pub3

Papanicolas I, Woskie LR, Jha AK. Health Care Spending in the United States and Other High-Income Countries. JAMA. 2018 Mar; 319(10): 1024-39. doi: 10.1001/jama.2018.1150. DOI: https://doi.org/10.1001/jama.2018.1150

De Pietro C, Camenzind P, Sturny I, Crivelli L, Edwards-Garavoglia S, Spranger A, et al. Switzerland: Health System Review. Health System Transition. 2015; 17(4): 1-288.

Wainberg ML, Scorza P, Shultz JM, Helpman L, Mootz JJ, Johnson KA, et al. Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. Current Psychiatry Reports. 2017 May; 19(5): 28. doi: 10.1007/s11920-017-0780-z. DOI: https://doi.org/10.1007/s11920-017-0780-z

Downloads

Published

2023-12-31
CITATION
DOI: 10.54393/nrs.v3i02.47
Published: 2023-12-31

How to Cite

Saxena, S., Arsh, A., Ashraf, S., & Gupta, N. (2023). Factors Influencing Women’s access to Healthcare Services in Low- and Middle-Income Countries: A Systematic Review : Women’s access to Healthcare in LMICs . NURSEARCHER (Journal of Nursing & Midwifery Sciences), 3(02), 67–75. https://doi.org/10.54393/nrs.v3i02.47

Issue

Section

Systematic Review

Plaudit