Incentives for pregnant mothers during antenatal care for better maternal and neonatal health outcomes in low and middle income countries: A Systematic Review and Meta-Analysis

Background: Universal access to maternal, newborn, and child healthcare is essential for achieving Sustainable Development Goal 3, but the effectiveness of various incentive-based programs for pregnant mothers in low- and middle-income countries (LMICs) remains uncertain. Objective of this systematic review was to determine if incentive-based interventions influenced maternal and neonatal health outcomes. Methods: We conducted a search in various databases from inception. All incentive-based interventional studies conducted on pregnant women in LMICs were included. Evidence from the included trials was synthesized using risk ratios (RRs) to compare the outcomes between groups receiving incentives and not receiving incentives. The meta-analysis was conducted using random-effects model. We assessed the quality of the included studies using the Cochrane Risk of Bias 2.0 tool and reviewed the collected data to determine its suitability for meta-analysis. This study is registered in PROSPERO (CRD42021247681). Results: Of the 3,897 records that were identified, 11 met eligibility criteria, all of which exhibited varying degrees of risk of bias, ranging from high to some concerns. Analysis of maternal outcomes across studies revealed no significant differences in the likelihood of delivering at a healthcare facility (RR 1.13, 95% CI: 0.86 to 1.47) and in frequency of prenatal care (RR 0.99, 95% CI: 0.88 to 1.12) between intervention and control groups. However, high levels of statistical heterogeneity were observed for both outcomes indicating variability among study results. Similarly, analysis of tetanus vaccine coverage showed no significant difference between groups (RR 1.00, 95% CI: 0.92 to 1.08), with moderate statistical heterogeneity observed. Conclusion: The maternal and neonatal outcomes examined in this review did not have any significant differences in intervention group when compared to the control group. The interventions to address maternal health concerns need to follow a multifactorial approach. There is a need for extensive primary research studies in the future.