Modeling geographical accessibility and inequalities to childbirth services in the Grand Nokoue metropolitan area, Benin

Timely access to comprehensive, high-quality emergency obstetric and neonatal care can prevent maternal and neonatal mortality, but remains challenging in Benin. We examine geographic accessibility to childbirth care in Grand Nokoue, the largest conurbation with five urban areas in Benin. We gathered data on boundaries, health facilities, road network, elevation, land cover, relative wealth, urbanicity and geo-traced travel speeds in Grand Nokoue. We modelled travel times to health facility offering childbirth care (stratified by level and sector) using the least-cost path algorithm, based on slowest, average and fastest travel speeds. We estimated the percentage of women of childbearing age (WoCBA) within 30, 60, and 120 minutes of the nearest facility by subnational area used for decision making. We explored inequalities in travel time by wealth quintiles and urbanicity gradient. Travel time was 8-minutes (31-minutes for hospital) at average speed and 24 minutes (106-minutes for hospital) at slowest speed to nearest facility. All and 71.6% of WoCBA live within 30 minutes of a health facility and hospital, respectively at average speeds. This decreases to 84.9% and 22.9%, respectively at slowest speed. There were substantial variations in travel time and geographic coverage at subnational units. The poorest travelled 5 times longer than the richest quintile, while travel time was shorter in the core urban relative to peri-urban. Travel time to childbirth care in Grand Nokoue, varies by wealth and residence area type and is longer at the slowest speeds. Targeting peri-urban areas and poorest WoCBA with longer travel time will reduce inequities.