Did the "Saving Mothers, Giving Life" Initiative Expand Timely Access to Life-Saving Care in Uganda? A Spatial District-Level Analysis of Travel Time to Emergency Obstetric and Newborn Care

Michelle Schmitz , Centers for Disease Control and Prevention (CDC)
Florina I. Serbanescu, Centers for Disease Control and Prevention (CDC)
Vincent Kamara, Baylor College of Medicine
Joan Kraft, Centers for Disease Control and Prevention (CDC)
Marc Cunningham, U.S. Agency for International Development (USAID)
Gregory Opio, Infectious Diseases Institute, Uganda
Patrick Komakech, Uganda Country Office, Centers for Disease Control and Prevention, Entebbe, Uganda
Claudia Morrissey Conlon, U.S. Agency for International Development (USAID)
Mary M. Goodwin, Centers for Disease Control and Prevention (CDC)

The Saving Mothers, Giving Life (SMGL) initiative sought to ensure all pregnant women in SMGL-supported districts had access to emergency obstetric and neonatal care (EmONC) within 2 hours. We used health facility assessments and geolocated population estimates of women of reproductive age (WRAs) in a spatial travel time analysis, comparing estimated travel time to EmONC health facilities in western Uganda in 2012, 2013, and 2016. The estimated proportion of WRAs who could access EmONC and comprehensive EmONC (CEmONC) facilities by motorcycle within 2 hours increased by 18% (EmONC) (p<0.01) and 37% (CEmONC) (p<0.01) across the program implementation period. Similar increases occurred for four-wheeled vehicles (EmONC: 14%; CEmONC: 31%), walking and biking, largely due to EmONC facility expansion (all p<0.01). Policymakers can use spatial travel time analyses to target the strategic increase of adequate EmONC facilities and deployment of motorized transportation to improve EmONC access for underserved populations.

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 Presented in Session 1. Fertility, Family Planning, Sexual Behavior, & Reproductive Health 1