Submission ID 116980
| Issue/Objective | Despite numerous maternal health initiatives, like free healthcare policies, maternal and neonatal mortality rates remain high in low- and middle-income countries (LMICs). A critical challenge in addressing this issue is measuring maternal care quality. Composite indexes integrate indicators to assess quality, yet conventional, objective measures often overlook women's lived experiences. There is growing recognition of the need for participatory and subjective approaches that engage women in defining quality. However, how women's perspectives are incorporated into these measures remains unclear. The aim of this study was to synthesize the literature on composite index construction for maternal care quality in Sub-Saharan Africa, focusing on studies involving women. |
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| Methodology/Approach | A scoping review was conducted following Arksey and O'Malley's five-stage framework and the PRISMA Extension for Scoping Reviews guidelines. Four bibliographic databases were searched for studies conducted in Sub-Saharan Africa and published up to February 14, 2024. Studies were included if they focused on maternal care quality measurement and involved women of reproductive age. Results are presented in three key areas of composite index construction, as identified by the Organization for Economic Co-operation and Development: theoretical framework selection, metric selection, and weighting-steps requiring subjective decisions rather than statistical approaches. |
| Results | Following a systematic screening of 5,347 articles, 112 met the inclusion criteria, published between 2007 and 2023. Studies covered 40 Sub-Saharan African countries, with Ethiopia being the most studied (n=27). The Donabedian framework was the most cited (n=33), yet 52 studies did not mention a framework. Women's involvement was largely limited to survey responses (n=102), with only 8 studies engaging them in result interpretation and 2 in indicator selection. Most studies (n=66) relied on binary content-of-care questions, while 43 used Likert scales. No studies involved women in index weighting, instead relying on statistical methods. |
| Discussion/Conclusion | Despite calls for more subjective approaches in measuring maternal care quality, a significant gap remains in integrating women's perspectives. Even studies in which women are involved most studies rely on objective indicators, with limited use of mixed methods or participatory research. Addressing this gap is crucial for developing gender-responsive policies that reflect women's lived experiences in LMICs. |
| Presenters and affiliations | Sarah Cooper School of Public Health of University of Montreal Ammy Fiadanana School of Public Health of University of Montreal Federica Fregonese School of Public Health of University of Montreal Cheick Oumar Tiendrebeogo School of Public Health of University of Montreal Thomas Druetz School of Public Health of University of Montreal |
