Changes in maternal health services utilization after industrial mine openings in 23 sub-Saharan African countries

Abstract Background Large-scale mining operations can profoundly shape maternal health through multiple pathways, creating both risks and opportunities for equitable access to maternal health services. While mining-driven population mobility and economic transformation may increase vulnerabilities, including HIV transmission, mining investments can also strengthen healthcare infrastructure and service utilization. This study assesses changes in maternal health service utilization and equity following mine openings across sub-Saharan Africa (SSA). Methods Repeated cross-sectional data from the Demographic Health Surveys in 23 SSA countries between 1986 and 2023 were used. A difference-in-differences approach was applied, comparing areas close to mines (0–10 km) and comparison areas (10–50 km) over time before and after mine openings. Logistic regression models were used to determine the effect of mine openings on the number of antenatal care (ANC) contacts, HIV testing during ANC, facility-based births and skilled birth attendance. Results Among 390,486 pregnancies, women living in mining communities were more likely to attend 4 or more ANC visits than women in comparison areas, accounting for baseline differences and overall temporal trends (adjusted odds ratio (aOR): 1.76; 95% confidence interval (CI): 1.27–2.44). Both, ANC (aOR: 1.51, 95% CI: 1.09–2.08) and child births (aOR: 1.62, 95% CI: 1.27–2.05) were more often attended by a professional healthcare provider. However, these improvements were only seen among the wealthier households. Overall, no significant changes in HIV testing were observed. Conclusion Mining contexts present both opportunities and challenges for equitable maternal healthcare. Mine openings were associated with improved ANC utilization and more professionalized maternal care, but these benefits were largely confined to wealthier households. No effects on HIV testing were observed despite elevated risks in mining settings, underscoring the need to strengthen testing among pregnant women. These findings highlight the need to ensure that industrial development contributes to equitable improvements in maternal health services across SSA.