Uncovering women’s healthcare access challenges in low- and middle-income countries using mixed effects modelling approach: Insights for achieving the Sustainable Development Goals

Bewuketu Terefe, Belayneh Shetie Workneh, Gebreeyesus Abera Zeleke, Enyew Getaneh Mekonen, Alebachew Ferede Zegeye, Agazhe Aemro, Berhan Tekeba, Tadesse Tarik Tamir, Mulugeta Wassie and Mohammed Seid Ali

PLOS ONE, 2025, vol. 20, issue 1, 1-21

Abstract: Background: Access to healthcare services for women in low- and middle-income countries (LMICs) is crucial for maternal and child health and achieving the Sustainable Development Goals (SDGs). However, women in LMICs face barriers to accessing healthcare, leading to poor health outcomes. This study used Demographic and Health Survey (DHS) data from 61 LMICs between 2010–2023 to identify women’s healthcare access challenges. Methods: This study used data from the DHS conducted in 61 LMICs to identify women’s healthcare access challenges from 2010 to 2023. A weighted sample of 1,722,473 women was included in the study using R-4.4.0 version software. A mixed-effects modeling approach was used to analyze access to healthcare, considering individual-level factors and contextual factors. The mixed-effects model takes into account clustering within countries and allows for the examination of fixed and random effects that influence women’s healthcare access across LMICs. For the multivariable analysis, variables with a p-value ≤0.2 in the bivariate analysis were considered. The Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and a P value 59 months as compared to 10 members, female household heads, living in rural areas, women living in South/Central Africa, Middle East/North Africa, Europe/Central Asia, and living in Latin America/Caribbean were associated with higher odds of having problems accessing healthcare respectively. Conclusions: Approximately two-thirds of women face healthcare access problems. Sociodemographic factors such as age, education, marital status, wealth, media exposure, and health insurance are associated with lower odds of experiencing healthcare access issues. On the other hand, factors such as divorce/widowhood, the number of young children, household size, female household heads, rural residence, and region have been linked to higher odds of facing healthcare access challenges. To address these disparities, policies, and interventions should focus on vulnerable populations by improving access to health insurance, increasing educational attainment, and providing support for single mothers and large households. Additionally, tailored regional approaches may be necessary to overcome barriers to healthcare access.

Date: 2025
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0314309

DOI: 10.1371/journal.pone.0314309

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