title: Unmet reproductive health needs among women in some West African countries: a systematic review of outcome measures and determinants.
abstract: BACKGROUND
  Identifying relevant measures of women's reproductive health needs is critical to improve women's chances of service utilization. The study aims to systematically review and analyze the adequacy of outcome measures and determinants applied in previous studies for assessing women reproductive health needs across West Africa.
  
  
  METHODS
  Evidence on outcomes and determinants of unmet reproductive health needs among women of childbearing age in diverse multicultural, religious, and ethnic settings in West African countries was systematically reviewed. The review included recent English language publications (from January 2009 - March 2014). Clinical studies particularly on obstetric care services and reproductive services in relation to HIV/AIDS were excluded. We acknowledge the possibility to have excluded non-English publications and yet-to-be-published articles related to the study aim and objectives. Outcomes and determinants were assessed and defined at three main levels; contraceptive use, obstetric care, and antenatal care utilization.
  
  
  RESULTS
  Results show increasing unmet need for women's reproductive health needs. Socio-cultural norms and practices resulting in discontinuation of service use, economic constraints, travel distance to access services and low education levels of women were found to be key predictors of service utilization for contraception, antenatal and obstetric care services. Outcome measures were mainly assessed based on service utilization, satisfaction, cost, and quality of services available as core measures across the three levels assessed in this review.
  
  
  CONCLUSIONS
  Evidence from this review indicates that currently applied measures of women's reproductive health needs might be inadequate in attaining best maternal outcomes since they appear rather broad. More support and research for developing and advancing context-related measures may help to improve women's maternal health.
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. m.ayanore@maastrichtuniversity.nl.
authors.forename: Martin Amogre
authors.initials: MA
authors.lastname: Ayanore
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. m.pavolva@maastrichtuniversity.nl.
authors.forename: Milena
authors.initials: M
authors.lastname: Pavlova
authors.affiliation: Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. w.groot@maastrichtuniversity.nl.|Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands. w.groot@maastrichtuniversity.nl.
authors.forename: Wim
authors.initials: W
authors.lastname: Groot
mesh_terms: D000293:Adolescent; D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D036861:Delivery, Obstetric / Q000592:standards; D003906:Developing Countries; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008507:Medically Underserved Area; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control*; D011253:Pregnancy in Adolescence; D011295:Prenatal Care / Q000592:standards; D011787:Quality of Health Care; D060728:Reproductive Health; D034121:Reproductive Health Services / Q000592:standards / Q000600:supply & distribution*; D012307:Risk Factors; D055815:Young Adult