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

Spoorthi Basavaraju; G. Hari Prakash; Tejaswini B. Darukaradhya

doi:10.18203/2394-6040.ijcmph20262315

Authors

Spoorthi Basavaraju Department of Allied Health Sciences, M. S. Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
G. Hari Prakash Department of Allied Health Sciences, M. S. Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
Tejaswini B. Darukaradhya Department of Allied Health Sciences, M. S. Ramaiah University of Applied Sciences, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20262315

Keywords:

Birth preparedness and complication readiness, BPCR, Antenatal women, Maternal health, Danger signs, Skilled birth attendant, Emergency preparedness, Low and middle-income countries

Abstract

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.

References

United Nations Children's Fund. Levels and trends in child mortality: report 2015: estimates developed by the UN Inter-agency Group for Child Mortality Estimation. New York: United Nations Children's Fund. 2015. Available at: https://digitallibrary.un.org/record/3968642. Accessed on 13 February 2026.

WHO. Standards for improving quality of maternal and newborn care in health facilities. Geneva: World Health Organization. 2016. Available at: https://cdn.who.int/media/docs/default-source/mca-documents/qoc/quality-of-care/standards-for-improving-quality-of-maternal-and-newborn-care-in-health-facilities_1a22426e-fdd0-42b4-95b2-4b5b9c590d76.pdf. Accessed on 13 February 2026.

WHO. United Nations Children’s Fund, United Nations Population Fund, World Bank Group, United Nations Population Division. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization. 2015. Available at: https://iris.who.int/bitstream/handle/10665/194254/9789241565141_eng.pdf. Accessed on 13 February 2026.

Office of the registrar general and census commissioner, India. Sample registration system (SRS) special bulletin on maternal mortality in India 2016–18. New Delhi: Government of India. 2020. Available at: https://censusindia.gov.in/nada/index.php/catalog/34781. Accessed on 13 February 2026.

Haile D, Wolde J, Yohannes D. Determinants of practice of birth preparedness and complication readiness among pregnant women in Sodo Zuria District, Southern Ethiopia: Content analysis using Poisson’s regression. SAGE Open Med. 2022;10:20503121221079479.

Jhpiego. Monitoring birth preparedness and complication readiness: tools and indicators for maternal and newborn health. Baltimore: Jhpiego/maternal and neonatal health program. 2004. Available at: https://healthynewbornnetwork. org/hnn-content/uploads/Jhiego_Monitoring-Birth-Preparedness-and-Complication-Readiness-Tools-and-Indicators-for-Maternal-and-Newborn.pdf. Accessed on 13 February 2026.

Singh T, Tripathy B, Pandey AK, Gautam D, Mishra SS. Examining birth preparedness and complication readiness: a systematic review and meta-analysis of pregnant and recently delivered women in India. BMC Women’s Health. 2024;24(1):119.

Agarwal S, Sethi V, Srivastava K, Jha PK, Baqui AH. Birth Preparedness and Complication Readiness among Slum Women in Indore City, India. J Health Popul Nutr. 2010;28(4):383-91.

Alamrew A, Sisay A, Ayele M, Shitie Lake E, Kumie G, Hailu Mossie H, et al. Determinants of birth preparedness and complication readiness practice among reproductive-age women in Africa a systematic review and meta-analysis. BMC Public Health. 2024;24:3154.

Moinuddin M, Christou A, Hoque DME, Tahsina T, Salam SS, Billah SM, et al. Birth preparedness and complication readiness (BPCR) among pregnant women in hard-to-reach areas in Bangladesh. PLoS One. 2017;12(12):e0189365.

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-73.

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32.

Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119-26.

Ijang YP, Cumber SNN, Nkfusai CN, Venyuy MA, Bede F, Tebeu PM. Awareness and practice of birth preparedness and complication readiness among pregnant women in the Bamenda Health District, Cameroon. BMC Pregnancy Childbirth. 2019;19(1):371.

Abubakar D, Aremu-Kasumu YB, Yakubu M, Fasanu OT, Baidoo-Adeiza SO. Birth preparedness and complication readiness among antenatal attendees in a tertiary hospital in Northern Nigeria. Int J MCH AIDS. 2024;13(1):e017.

Kiataphiwasu N, Kaewkiattikun K. Birth preparedness and complication readiness among pregnant women attending antenatal care at the Faculty of Medicine Vajira Hospital, Thailand. Int J Womens Health. 2018;10:797-804.

Girma D, Waleligne A, Dejene H. Birth preparedness and complication readiness practice and associated factors among pregnant women in Central Ethiopia, 2021: a cross-sectional study. PLoS One. 2022;17(10):e0276496.

Mutiso SM, Qureshi Z, Kinuthia J. Birth preparedness among antenatal clients. East Afr Med J. 2008;85(6):275-83.

Ekabua JE, Ekabua KJ, Odusolu P, Agan TU, Iklaki CU, Etokidem AJ. Awareness of birth preparedness and complication readiness in southeastern Nigeria. ISRN Obstet Gynecol. 2011;2011:560641.

Kamineni V, Murki AD, Kota VL. Birth preparedness and complication readiness in pregnant women attending urban tertiary care hospital. J Family Med Prim Care. 2017;6(2):297-300.

Shukla M, Khan NZ, Agarwal A, Dwivedi AD, Singh JV, Alam S. Effect of focused birth preparedness and complication readiness counseling on pregnancy outcome among females attending tertiary care hospital in Barabanki district, Uttar Pradesh, India. J Educ Health Promot. 2019;8:113.

Sabageh AO, Adeoye OA, Adeomi AA, Sabageh D, Adejimi AA. Birth preparedness and complication readiness among pregnant women in Osogbo Metropolis, Southwest Nigeria. Pan Afr Med J. 2017;27:74.

Sandberg J, Odberg Pettersson K, Asp G, Kabakyenga J, Agardh A. Inadequate knowledge of neonatal danger signs among recently delivered women in southwestern rural Uganda: a community survey. PLoS One. 2014;9(5):e97253.