Maternal Healthcare Service Utilization in Low and Middle Income Countries: A Systematic Review and Meta-Analysis

Maternal mortality remains a critical public health challenge in low and middle income countries (LMICs), where 95% of global maternal deaths occur. Quality maternal healthcare services are essential for reducing preventable mortality and morbidity. This systematic review and meta-analysis aimed to determine the prevalence of maternal healthcare utilization indicators and identify key determinants influencing service uptake in LMICs. Following PRISMA 2020 guidelines, we searched PubMed, Scopus, Web of Science, CINAHL, and Cochrane Library for studies published between 2015 and 2024. The review was prospectively registered with PROSPERO (CRD42024612847). Random-effects meta-analysis estimated pooled prevalence for antenatal care (ANC), skilled birth attendance (SBA), institutional delivery (ID), and postnatal care (PNC). Quality was assessed using the Newcastle-Ottawa Scale adapted for cross-sectional studies (Hoy et al., 2012). We included 145 studies from 89 LMICs involving over 2.8 million women. Pooled prevalence was 85.0% (95% CI: 82.3–87.4%) for at least one ANC visit, 50.8% (95% CI: 47.2–54.4%) for four ANC visits, 65.6% (95% CI: 62.1–69.0%) for SBA, 66.9% (95% CI: 63.4–70.3%) for ID, and 48.9% (95% CI: 45.3–52.5%) for PNC. Prediction intervals were wide across all indicators, reflecting genuine between-study variability (I² > 95%). Maternal education (OR = 3.42), household wealth (OR = 4.67), and urban residence (OR = 2.87) were strong positive predictors, while distance to facilities and poor service quality were significant barriers. Despite progress in initial ANC contact, critical gaps persist in comprehensive antenatal care and postnatal services