Beyond Physical Accessibility, Bypassing Health Facilities Offering Caesarean Section: Insights from Women in Dakar's Slums.

Abstract

This study examines the geographic accessibility of Comprehensive Emergency Obstetric Care (CEmONC) among women residing in the slums of Dakar. Participants included 763 women living in urban slums who had undergone a caesarean section in six health facilities in Dakar between July and December 2022. Key findings show that most women in Dakar's urban slums live within 5 min from a health facility offering caesarean services, with an average travel time of 6.3 min. However, 44.3% bypassed nearby facilities, often travelling outside their district. Medical referral was the primary reason for bypassing (43.2%), followed by the search for higher quality care (13.5%) and reliance on family or social networks (14.9%). Only a small proportion (1.4%) cited more affordable treatment costs as a reason for bypassing.