Systematic review of women's perceptions of skilled maternity care in low- and middle-income countries

Maternal mortality is one of the indicators of the health of a population and the development of a country. Worldwide, nearly 830 women die every day from complications related to pregnancy and childbirth. There is a disparity in maternal deaths between regions of the world and between countries levels of economic development. The maternal mortality rate is 14 times higher in developing countries than in developed countries. Moreover, the countries affected by these maternal deaths are those where there is the most inequality in access to maternal health care. Because of the importance of the maternal health challenge, strategic efforts are set out in MDG 3 (the maternal health domain) to ensure that maternal health is addressed. The objective of this study is to identify the barriers inherent in the perception of the quality of maternal care from the point of view of the patient and/or her close circle, and which are at the origin of the difficulties in accessing qualified obstetric care. The research methodology is based on a systematic review of the existing literature on the perception of skilled maternity care by women and their close circle in LMICs. Out of 1247 documents identified through a search equation, we selected 18 articles to meet these objectives, after three levels of selection and rigorously following the different steps of conducting systematic reviews. In total, we have 15 qualitative studies, 2 cross-sectional studies and 1 mixed study. The tool used to assess the risk of bias of the selected articles was the MMAT tool. The MMAT allowed us to identify low levels of risk of bias, thus raising the quality of the conclusions to be drawn from our research. Using this methodology, we identified 26 barriers that represent the perceptions of women and their husbands or partners regarding skilled maternity care in LMIC’s. The main barriers cited were: lack of privacy and confidentiality; unavailability of care supplies (drugs, materials); lack or inadequacy of health personnel; perception of verbal or physical abuse; perception of abandonment, neglect, retaliation; vulnerability in another environment; perception of a negative attitude from the midwife; perception of limited technical skills of midwives; and lack of health literacy. However, further research is needed to adapt women's perceptions to local realities.