Geographical Access to Health Facilities and Maternal Healthcare Utilization in Benin: A Cross-sectional Study

Abstract Background: The world is making progress toward achieving maternal and child health (MCH) related components of the Sustainable Development Goals. Nevertheless, the progress of many countries in Sub-Saharan Africa is lagging. Geographical accessibility from residence to health facilities is suspected to be a major obstacle hampering the use of appropriate MCH services. Benin, a country with unique geographical characteristics whereby the southern and northern parts belong to different climatic zones, sees the highest maternal mortality rate among the world. Adequate use of MCH care is important to save lives of women and their babies. This study assessed the effect of distance to health facilities on maternal healthcare utilization in Benin, with an emphasis on geographical zones.Methods: We pooled two rounds of Benin Demographic and Health Surveys (BDHS). The sample included 32,727 women aged 15–49 years (16,599 from BDHS-2011/2012 and 15,928 from BDHS-2017/2018). We measured the distance from residential areas to the closest health center by merging the BDHS datasets with Benin’s geographic information system data. Multivariate logistic regression analysis was performed to estimate the effect of distance on maternal healthcare utilization. We conducted a propensity score-matching analysis to check for robustness.Results: Regression results showed that the distance to the closest health center had adverse effects on the likelihood of a woman receiving appropriate maternal healthcare. The estimates showed that one km increase in distance to the nearest health center reduces the odds of the woman receiving at least one antenatal care by 0.034, delivering in facility by 0.020, and delivering her baby with assistance of skilled birth attendants by 0.028. Nonetheless, these effects were mainly seen in the northern part of Benin.Conclusions: Geographical accessibility to health facilities is critically important for the improvement of appropriate maternal healthcare, particularly in the northern part of Benin. Investment in transport infrastructure should be prioritized for further improvements in the MCH.