Many studies examining maternal health care around the world have found urban residence to be a protective factor, suggesting that women who live in cities are better off than those in rural areas. Researchers have observed that health services are often more easily accessible to women in cities due to higher density of health care workers and facilities. But this discourse oversimplifies the complexity of health care in urban settings, where women still experience barriers related to transportation, socioeconomic status and quality.
Despite the relatively short distance to health facilities in cities compared to rural areas, getting to a facility in time for delivery remains an issue for many women. Limited access to financial and material resources can also delay women from receiving timely care. Inequities in socioeconomic status within cities are a major contributor to maternal and newborn health disparities. Hospital fees can result in catastrophic expenditures for women seeking maternity care in urban settings, and poor women are sometimes at greater risk of incurring the costs of bribes or informal payments. In addition to low socioeconomic status as a barrier to health care access and utilization, the effects of urban poverty on maternal health are far-reaching and extend well beyond common obstetric indicators such as antenatal care attendance and facility-based delivery.
For women who manage to reach a health facility, poor quality of maternal health care remains a challenge in many urban areas—particularly in slums and informal settlements. For example, less than 30% of the health facilities in the slums of Nairobi, Kenya have magnesium sulfate readily available, only 20% can perform cesarean section surgeries and a mere 8% offer assisted vaginal delivery. Another study on the urban poor in Nairobi found that while 70% of women reported delivering in a health facility, only 48% did so with a skilled birth attendant. Whether a facility is private or public can also influence the quality of maternal health care provided. In a study from urban India, 86% of women surveyed who delivered in a private hospital reported that the bed was clean, compared to 43% of women who delivered in a public hospital. Women delivering in urban facilities have also reported experiences of disrespect and abuse, even in the presence of a skilled birth attendant, likely related to severe overcrowding and a limited health workforce.
Fifteen years ago, 39% of births occurred in urban areas, and by 2030, more than half of women will deliver in cities. Health care systems will need to adjust their resources, strategies and priorities in order to effectively respond to the impacts of urbanization and ensure high quality maternal health care for all women.
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