Evidence map›Paper›PMID 41551999›Full record

ArticleEClinicalMedicine2026

Location of births by health facility type: a time trend analysis from 1995 to 2023 in 130 low- and middle-income countries.

Anna Gage, Madeleine Conrad, Chiara Sumich, Wes Warriner, Aduragbemi Banke-Thomas, Corinne Bintz, Kelly Bienhoff, Jessica Bishai, Rakhi Dandona, Mae Ashworth Dirac and 15 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in EClinicalMedicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

25 authors.

Anna GageInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Madeleine ConradInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Chiara SumichInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Wes WarrinerInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Aduragbemi Banke-ThomasThinkwell Burkina Faso, Ouagadougou.
Corinne BintzInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Kelly BienhoffInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Jessica BishaiInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Rakhi DandonaInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Mae Ashworth DiracInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Thomas GlucksmanInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Simon I HayInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Megan KnightInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Rafael LozanoInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Ali H MokdadInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Abdu MohiddinCentre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya.
Bancy NgatiaCentre for Maternal Adolescent Reproductive and Child Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Marie-Jeanne OffosseThinkwell Burkina Faso, Ouagadougou.
Jamilu TukurUmaru Musa Yar'adua University, Federal Teaching Hospital Katsina, Katsina, Nigeria.
Marleen TemmermanCentre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya.
Bridget StollfusInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Asnake WorkuThe National Data Management Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Enis BarışInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Nicholas J KassebaumInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Annie HaakenstadInstitute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: With major increases in facility births in low- and middle-income countries (LMICs) since 1995, a key question is what types of facilities met the increased demand. Understanding the evolving delivery landscape is crucial to informing debates about optimal models for balancing access, quality, and equity. We studied the distribution of delivery location by health facility level and sector (private versus public) in 130 LMICs from 1995 to 2023. Methods: We used 745 data sources with delivery location information in our analysis. We first categorised births as in-facility or not, then further classified facility births by level (hospital or lower-level) and sector (public or private). We used spatiotemporal Gaussian process regression to model the share of births by facility type from 1995 to 2023 and compared delivery patterns to development and health indicators. Findings: In 2023, 47.5% (95% uncertainty interval [UI] 46.4-48.6) of deliveries in LMICs were in public hospitals, 19.2% (18.3-20.2) were in private hospitals, 13.0% (12.3-13.8) were in lower-level public facilities, 2.0% (1.9-2.2) were in private lower-level facilities, and the remaining 18.2% (17.3-19.2) were outside health facilities. In 106 countries, more than half of deliveries were in public hospitals, while in 12 countries, public lower-level facilities provided care for more than half of births. In only two countries were private hospitals used for more than half of births, while in the remaining ten countries no facility type provided the majority of care. Between 1995 and 2023, nearly two-thirds (62.1%) of the 41.0 percentage-point increase in facility births was borne by public hospitals. Delivery in lower-level facilities was more common in countries with lower levels of development and higher neonatal mortality rates. Interpretation: The mix of delivery locations represents the diversity of health systems worldwide. Our analysis highlights the pivotal and growing role of public hospitals in delivery care, though public lower-level delivery care is common in high-mortality contexts. Policy makers should account for the facility mix and the complex roles of public and private sectors when designing strategies to improve maternal and perinatal outcomes. Funding: The Gates Foundation.

Indexed as

Facility deliveryHealth care facilitiesHealth systemsLow- and middle-income countriesMaternal healthNeonatal health

Identifiers

PMID41551999
PMCPMC12804159

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.