Digital health and the promise of equity in maternity care: A mixed methods multi-country assessment on the use of information and communication technologies in healthcare facilities in Latin America and the Caribbean

Introduction: Timely access to maternity care is critical to saving lives. Digital health may serve to bridge the care chasm and advance health equity. This study aimed to describe the prevalence of information and communication technology (ICT) use in maternity care, the types of ICTs used, and the services provided using ICTs in a sample of health facilities in 9 countries of Latin America and the Caribbean (LAC); understand changes in the use of ICTs as a result of the COVID-19 pandemic; and identify the main factors associated with ICT use in maternity care. Methods: This is a cross-sectional mixed methods study. Data for 8 countries were collected between April and September 2021, and for Colombia between July and September 2022. An online survey was disseminated among healthcare institutions that provided maternity care in the countries under consideration. Results: Most of the 1877 institutions that answered the survey reported using ICTs in maternity care (N = 1536, 82%), ranging from 96% in Peru to 64% in the Dominican Republic. Of institutions that used ICTs, 59% reported using them more than before or for the first time since the pandemic began. ICTs were most commonly used to provide family planning (64%) and breastfeeding (58%) counselling, mainly by phone (82%). At the facility level, availability of equipment and internet coverage, coupled with skilled human resources, were the main factors associated with ICT use. At the country level, government-led initiatives to develop digital health platforms, alongside national investments in digital infrastructure, were the main determinants of the adoption of ICTs in healthcare provision. Conclusion: Digital health for maternity care provision relied on commonly available technology and did not necessitate highly sophisticated systems, making it a sustainable and replicable strategy. However, disparities in access to digital health remain, and many facilities in rural and remote areas lacked connectivity. The use of ICTs in maternity care depended on countries' long-term commitments to achieving universal health and digital coverage.