Unearthing Inequities: Mapping Access to Childbirth Care in Grand Conakry, Guinea
In the sprawling metropolitan area of Grand Conakry, Guinea, a pioneering study has shed new light on the dimensions of spatial access to childbirth care, revealing stark inequities that permeate the urban and peri-urban landscape. As Guinea steadily urbanizes—with over a third of its population now living in cities, and more than half concentrated in Conakry—the challenges of equitable health service delivery become increasingly acute. Against a backdrop marked by rugged hills, coastal plains, and infrastructural fragility, this investigation harnesses advanced geospatial techniques and rich demographic data to unmask the accessibility gaps faced by women at the frontline of maternal health.
Grand Conakry, home to approximately 2.6 million people as of 2024, embodies both promise and complexity. Its urban conurbation includes nine primary communes within Conakry city, plus five additional urban communes in the adjoining prefectures of Dubréka and Coyah, forming a multifaceted urban mosaic. This demographic dominance, almost one-fifth of Guinea’s total population, brings glaring concerns around infrastructure, transport, and health equity. Roads serve as the primary veins for movement, yet many remain underdeveloped, complicating travel—especially during seasonal rains. Overlaying this reality are chronic traffic jams whose economic toll amounted to an estimated 5% of Guinea’s GDP in 2017, hampering timely access to critical health services.
Within this challenging context, health infrastructure is a patchwork offering. The Grand Conakry area hosts 155 health facilities distributed across the public and private sectors, including health posts, centers, clinics, and hospitals. Public institutions provide the bulk of maternal and childbirth care, particularly regarding antenatal and emergency obstetric services, while private and faith-based organizations deliver complementary services. Notably, public hospitals stand out as hubs for comprehensive emergency obstetric care, available free of charge to women facing complications. Despite this, facility-based births in Conakry reached 90% by 2018, suggesting high healthcare utilization but not necessarily equitable access.
To robustly quantify spatial accessibility, the research team embarked on a multi-step approach grounded in geographic information systems (GIS) and empirical data. Central to their methodology was the painstaking definition of Grand Conakry’s boundaries—a task complicated by the absence of openly available vector files demarcating the urban conurbation and its communes. Researchers relied on secondary metadata and hard-copy urban sector maps, which they digitized and georeferenced against OpenStreetMap datasets and authoritative shapefiles. This hybrid mapping established an accurate digital framework enabling the analysis of travel times and health facility coverage with refined precision.
Simultaneously, a master list of 86 geocoded health facilities offering childbirth services was compiled by harmonizing multiple administrative datasets from Guinea’s Ministry of Health and Public Hygiene. Leveraging the Spatial Systems in Africa (SSA) database, online gazetteers, and field GPS measurements, the researchers assembled a spatially precise health infrastructure map. The facility list spanned various levels of care—public and private health posts, centers, hospitals, and faith-based clinics—allowing nuanced scenario modeling distinguishing between different tiers of care access and service ownership.
Crucial to human mobility assessments, the team integrated several geospatial layers that influence travel times: high-resolution Sentinel-2 land cover data, Shuttle Radar Topography Mission digital elevation models, delineations of water bodies and flooded vegetation that present natural barriers, and an exhaustive OpenStreetMap-based road network classification. Roads were meticulously stratified from major trunks to minor, non-motorized pathways, with local context guiding reclassification alongside empirical travel speed data. This intricate representation of the physical landscape offered the backbone for sophisticated modeling of the spatiotemporal journey to childbirth care.
Innovatively, actual travel speeds were captured through field-based geotracing by eighteen local researchers across Grand Conakry during the dry season of 2024. Utilizing GPS-enabled devices and KoboCollect software, the team recorded 176 unique trajectories reflecting diverse transport modes, times of day, and road conditions. Stringent quality controls excluded outlier data where time logs and GPS points did not align, yielding a reliable dataset from which average speeds per road segment emerged. By establishing minimum, maximum, and interquartile travel speed percentiles, the researchers created five distinct mobility scenarios, embodying real-world variability from severe traffic congestion to relatively free-flowing conditions.
Walking speeds, essential for traversing non-road areas, were contextualized using established global estimates, and the impact of terrain slope was dynamically modeled via Tobler’s hiking function. This formula correctly adjusts walking pace to account for uphill and downhill gradients, reflecting nuanced anisotropic travel patterns. Together, these datasets facilitated the application of a least-cost path algorithm implemented in AccessMod, a widely recognized World Health Organization tool for spatial accessibility modeling. This enabled the calculation of travel times from every inhabited cell within Grand Conakry to the nearest health facility, stratified by facility type and ownership under varied travel-time scenarios.
The demographic patterns feeding into access calculations were equally detailed. Female populations of childbearing age (15-49 years) were derived from WorldPop’s high-resolution grids for 2020, updated to 2024 through growth projections. These estimates were further refined to approximate pregnancy distributions by applying age-specific urban fertility rates and adjusting for factors such as pregnancy loss and multiples, resulting in spatially explicit mappings of women at critical risk. This confluence of granular population and infrastructure data empowered not only estimates of mean travel times but also metrics of population coverage within clinically relevant thresholds of 15, 30, and 60 minutes.
An indispensable element of the analysis was the linkage of spatial access data with socio-economic stratification using Meta’s Relative Wealth Index (RWI). This machine-learning-derived index evaluates the relative wealth status across micro-regions based on satellite imagery, telecommunications data, and topography, previously trained on Demographic and Health Survey benchmarks. The RWI allowed the researchers to stratify accessibility results by wealth quintiles, unveiling intersections between poverty, geography, and healthcare access. Resampling techniques harmonized the disparate spatial resolutions of travel time and RWI data for rigorous statistical correlation within and across communes.
The study’s findings, detailed elsewhere but rooted in this robust methodology, underscore profound inequities. Women residing in lower wealth quintiles faced significantly longer travel times to reach essential childbirth services, especially comprehensive emergency obstetric care typically available only in public hospitals. The peri-urban communes neighboring Conakry exhibited marked disparities, with segments of the population living beyond timely reach of health facilities under all patient transport scenarios. Such findings reinforce the narrative that urban proximity is no guarantor of equitable healthcare, particularly amid infrastructural and socio-economic heterogeneity.
These spatial inequities carry urgent public health implications. Maternal mortality and morbidity risk escalates with delays in accessing skilled birth attendants and emergency interventions. The economic implications extend beyond health, encroaching upon productivity and social wellbeing. Moreover, traffic congestion, poor road quality, and natural barriers magnify these challenges in unpredictable ways, demanding integrated urban planning, infrastructural investment, and health system strengthening. Importantly, the study’s nuanced travel speed scenarios illuminate the critical sensitivity of accessibility to daily socio-spatial dynamics, suggesting that targeted interventions could alleviate bottlenecks with substantial impact.
By marrying high-resolution geospatial analysis with demographic and socio-economic overlays, this study exemplifies the power of interdisciplinary approaches to urban health inequities. The fine-scale digitization of administrative boundaries, empirical field data collection, and the deployment of advanced modeling tools collectively forged a comprehensive spatial narrative of childbirth care access in one of West Africa’s largest conurbations. The approach holds immense potential for replication across similar urbanizing contexts confronted by healthcare disparities, offering a blueprint for data-driven policy and program design.
While the results highlight challenges, they also illuminate avenues for progress. Expanding and upgrading health infrastructure, optimizing transport networks, and integrating socio-economic data into health planning frameworks could capitalize on the insights generated. Furthermore, embracing emerging technologies and crowd-sourced data might refine dynamic accessibility monitoring and emergency response capabilities. The core lesson emerging from Grand Conakry is the imperative of embedding equity at the heart of urban health services, especially as African cities grow rapidly and unevenly.
As urbanization accelerates globally, demands on maternal health systems intensify in complexity and scale. Guinea’s Grand Conakry stands as a microcosm of metropolitan challenges that transcend borders—from infrastructural deficits and socio-economic divides to environmental barriers and mobility constraints. Understanding and quantifying these challenges with precision is a cornerstone of effective interventions. This study not only advances scientific knowledge on spatial healthcare inequities but also equips stakeholders with evidence needed to chart equitable, resilient urban health futures.
In summary, the exploration of spatial access to childbirth care in Grand Conakry reveals a tapestry of challenges woven from geographic, infrastructural, and socio-economic threads. The innovative fusion of detailed mapping, travel speed measurement, population dynamics, and wealth stratification offers a compelling portrait of healthcare inequity in a rapidly urbanizing African setting. By shining a spotlight on who can reach care, how fast, and at what economic cost, the research compels a reevaluation of urban health governance focused on accessibility, equity, and maternal wellbeing.
Subject of Research: Spatial access and inequities in childbirth care services in Grand Conakry, Guinea
Article Title: Inequities in spatial access to childbirth care in the Grand Conakry conurbation, Guinea
Article References: Grovogui, F.M., Dioubate, N., Manet, H. et al. Inequities in spatial access to childbirth care in the Grand Conakry conurbation, Guinea. Nat Cities 2, 422–433 (2025). https://doi.org/10.1038/s44284-025-00220-2
Image Credits: AI Generated
DOI: https://doi.org/10.1038/s44284-025-00220-2
Tags: access to childbirth careConakry urban health dynamicsdemographic disparities in childbirth servicesgeospatial analysis of healthcarehealthcare delivery in urban settingsinequities in health servicesinfrastructure and health accessmaternal care accessibilitymaternal health inequities in Guineatransport issues in Grand Conakryurban health challenges in Conakryurbanization and maternal health
