Publication:

Birth preparedness and complication readiness among antenatal women: a scoping review of levels and associated factors

Maternal mortality remains a critical public health challenge in low and middle-income countries, with Birth preparedness and complication readiness (BPCR) recognized as an essential strategy to reduce the third delay of decision-making. Antenatal women represent the optimal intervention window, yet comprehensive evidence mapping across diverse healthcare contexts remains limited. To synthesize global evidence on BPCR levels, component prevalence, danger sign knowledge, and associated factors among antenatal women. A scoping review following PRISMA-ScR guidelines examined PubMed-indexed studies (2010-2026). Ten cross-sectional studies across Africa and Asia (n=4,096 antenatal women) were included using a standardized Population-concept-context framework. Data were extracted systematically and synthesized narratively by component, setting and associated factors. Overall BPCR prevalence ranged 18.8-82.1% (median 57.8%), revealing a critical logistical-knowledge discontinuity: skilled birth attendant identification (32.4%) and transport arrangements (65.7%) exceeded emergency preparedness components-blood donor identification (25.8%) and ≥3 danger signs recognition (20%). Higher maternal education (AOR 2.95), household income (AOR 2.53), ≥4 ANC visits (AOR 2.52) and urban residence (AOR 2.00) consistently predicted better preparedness. Urban tertiary facilities demonstrated higher overall BPCR (71.5%) but equivalent knowledge deficits as rural settings. Counselling interventions improved composite scores by 70% (p<0.05). Moderate BPCR levels mask profound emergency preparedness deficits across global contexts. Targeted interventions must reprioritize antenatal counselling toward danger sign recognition and blood donor coordination while leveraging private tertiary infrastructure serving urban delivery majorities. Standardized BPCR measurement and private sector studies are urgently needed to support SDG 3.1 maternal mortality reduction.