ArticleBMJ public health2026
Barriers and facilitators to the accessibility of maternal healthcare services in rural Southeast Asia: a systematic review.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Objectives: To identify the key barriers and facilitators affecting access to maternal healthcare services in rural Southeast Asia (SEA). Design: Systematic review. Data sources: PubMed, Scopus, Embase, CINAHL and PsycINFO were searched for studies published between 1 January 2000 and 25 February 2025. Eligibility criteria: Studies were included if they were conducted in rural regions of SEA, examined access to maternal healthcare services and were published in English. Data extraction and synthesis: Two reviewers independently screened studies, extracted data and assessed the risk of bias using the Mixed Methods Appraisal Tool. Quantitative findings were transformed into textual descriptions and synthesised with qualitative findings using thematic analysis. Themes were mapped onto Levesque's framework across demand and supply-side dimensions of healthcare access. Results: A total of 9673 records were screened, with 52 studies (27 quantitative, 21 qualitative and 4 mixed methods) meeting the inclusion criteria for analysis. Key barriers to seeking care included limited awareness of services, cultural preferences for traditional birth practices and language barriers. Financial burden, geographic distance and inadequate transport infrastructure were barriers to reaching care. Key facilitators included family support, perceived importance of maternal and child safety, trust in healthcare providers and family involvement in decision-making. Culturally sensitive care, community outreach and health promotion efforts were key in improving women's ability to use maternal health services. Conclusions: This review highlights the complex and multifaceted challenges in maternal healthcare access in rural SEA. Addressing financial, geographical and sociocultural barriers is crucial for improving access to maternal healthcare, especially in underserved and rural regions. Limitations include restriction to English language studies, study heterogeneity and limited grey literature representation. Future interventions should adopt a holistic, community-based approach to foster an integrated and effective health system. PROSPERO registration number: CRD420261305602.
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