Kliniken &… Institute Heidelberger Institut… Groups & Projects Working Groups Research Maternal and child… Distance_delivery…

Distance to delivery care and service use in Zambia and Malawi

Project team: Sabine Gabrysch, Terhi Lohela

External collaborators: Oona Campbell, Simon Cousens, Jonathan Cox

Funding: Rahel Goitein-Straus fellowship for Sabine Gabrysch from the Medical Faculty of Heidelberg University

Maternal and perinatal mortality are alarmingly high in Sub-Saharan Africa, with little progress over the last decades. If all women delivered in settings where skilled attendants can provide Emergency Obstetric Care in the event of complications, most lives could be saved. Yet many African women, in particular in rural areas, continue to give birth at home without skilled care, the alternative often being substandard facilities unable to provide life-saving interventions.

The factors influencing whether women use health facilities for giving birth include demographic and socioeconomic characteristics of the mother and her household, but also health system aspects such as geographic accessibility of facilities and quality of care. While epidemiological research has extensively studied individual and household factors, the role of the health system has been largely neglected, in part due to a lack of data on health services in the same datasets containing individual service use information.

In Zambia and Malawi, we can take advantage of existing georeferenced national Health Facility Census data and Demographic and Health Survey household data, linking the two datasets in a Geographic Information System and thus combining detailed individual and household information with detailed facility information. This allowed us to quantify the strong influences of distance and level of care on women’s use of health facilities for delivery in both countries. In Zambia, we could also show that the population impact of poor geographic access to quality emergency obstetric care is at least of similar magnitude as that of education or wealth.


Gabrysch S, Simushi V, Campbell OMR. (2011): Availability and distribution of, and geographic access to emergency obstetric care in Zambia. International Journal of Gynecology & Obstetrics, 114: 174-179.

Gabrysch S, Cousens S, Cox J, Campbell OMR. (2011): The Influence of Distance and Level of Care on Delivery Place in Rural Zambia: A Study of Linked National Data in a Geographic Information System. PLoS Medicine, 8(1): e1000394. doi:10.1371/journal.pmed.1000394.