Determinants of transport exclusion among pregnant women in selected locations of southwestern Nigeria
Unequal access to transport is an outcome of several factors which play a significant role in access to maternal healthcare services. This study examines the factors contributing to transport exclusion among pregnant women in southwestern Nigeria, with the objective of ascertaining lived experience among the respondents. A survey was conducted among 357 registered pregnant women from 113 hospitals across three local government areas in Oyo State. The analysis employed both descriptive and inferential statistics. Results revealed that transport exclusion is prevalent among pregnant women in the study area, with factors such as lack of money (95.0%), transport cost (72.0%), and the affordability of transportation means (60.2%) being key determinants. The study concluded that factors contributing to transport exclusion among pregnant women may have far-reaching effects on their ability to meet daily social needs, particularly healthcare access, given their vulnerable status, which in turn impacts their overall well-being. Further research may be needed to explain the connection between the transport exclusion of pregnant women and the ease of accessing medical care, as well as their overall well-being.
Adeola, O., Evans, O., & Ngare, I. (2024). Gender and climate issues in Africa. In: Gender Equality, Climate Action, and Technological Innovation for Sustainable Development in Africa. Sustainable Development Goals Series. Germany: Springer Nature.
Adlakha, D., & Parra, D.C. (2020). Mind the gap: Gender differences in walkability, transportation and physical activity in urban India. Journal of Transport and Health, 18:100875. https://doi.org/10.1016/j.jth.2020.100875
Banister, D., & Bowling, A. (2004). Quality of life for the elderly: The transport dimension. Transport Policy, 11(2):105-115. https://doi.org/10.1016/j.tranpol.2003.12.004
Bergstad, C.J., Gamble, A., Gärling, T., Hagman, O., Polk, M., Ettema, D., et al. (2011). Subjective well-being related to satisfaction with daily travel. Transportation, 38:1-15. https://doi.org/10.1007/s11116-010-9301-0
Bivina, G.R., Gupta, A., & Parida, M. (2020). Walk accessibility to metro stations: An analysis based on meso- or micro-scale built environment factors. Sustainable Cities and Society, 55:102047. https://doi.org/10.1016/j.scs.2020.102047
Bhattacharjee, S. (2023). Deprivation and social exclusion of the dalits: An anthropological observation. Contemporary Voice of Dalit, 1-7. https://doi.org/10.1177/2455328X231172345
Börjesson, M., & Rubensson, I. (2019). Satisfaction with crowding and other attributes in public transport. Transport Policy, 79:213-222. https://doi.org/10.1016/j.tranpol.2019.06.007
Börjesson, M. (2012). Valuing perceived insecurity associated with use of and access to public transport. Transport Policy, 22:1-10. https://doi.org/10.1016/j.tranpol.2012.03.005
Borker, G. (2022). Constraints to Women’s use of Public Transport in Developing Countries, Part I: High Costs, Limited Access, and Lack of Comfort. United States: World Bank Group.
Bossert, T.J., Bowser, D.M., & Amenyah, J.K. (2007). Decentralization good for logistics systems? Evidence on essential medicine logistics in Ghana and Guatemala. Health Policy and Planning, 22(2):73-82. https://doi.org/10.1093/heapol/czm002
Brady, P.J., Askelson, N.M., Ashida, S., Nothwehr, F., Janssen, B., & Frisvold, D. (2021). The relationship between political, economic, social, and cultural vulnerability and food insecurity among adults aged 50 years and older. Nutrients, 13(11):3896. https://doi.org/10.3390/nu13113950
Braveman, P. (2014). What are health disparities and health equity? We need to be clear. Public Health Reports, 129(Suppl 2):5-8.
Brown, C.A., Sohani, S.B., Khan, K., Lilford, R., & Mukhwana, W. (2008). Antenatal care and perinatal outcomes in Kwale district, Kenya. BMC Pregnancy and Childbirth, 8(1):1-11. https://doi.org/10.1186/1471-2393-8-2
Carmien, S., Dawe, M., Fischer, G., Gorman, A., Kintsch, A., & Sullivan, J.F. Jr. (2005). Socio-technical environments supporting people with cognitive disabilities using public transportation. ACM Transactions on Computer-Human Interaction, 12(2):233-262. https://doi.org/10.1145/1067860.1067865
Chalermpong, S., Kato, H., Thaithatkul, P., Ratanawaraha, A., Fillone, A., Hoang Tung, N., et al. (2023). Ride-hailing applications in Southeast Asia: A literature review. International Journal of Sustainable Transportation, 17(3):298-318. https://doi.org/10.1080/15568318.2023. 2187105
Charnavalau, A., Szymańska, E.J., & Czapski, G. (2022). The impact of transport exclusion on the local development of Biała County. Sustainability, 14(9):5674. https://doi.org/10.3390/su14095674
Charan, J., & Biswas, T. (2013). How to calculate sample size for different study designs in medical research? Indian Journal of Psychological Medicine, 35(2):121-126. https://doi.org/10.4103/0253-7176.116232
Church, A., Frost, M., & Sullivan, K. (2000). Transport and social exclusion in London. Transport Policy, 7(3):195-205.
Cole, B.L., MacLeod, K.E., & Spriggs, R. (2019). Health impact assessment of transportation projects and policies: Living up to aims of advancing population health and health equity? Annual Review of Public Health, 40:305-318. https://doi.org/10.1146/annurev-publhealth-040218-044037
Cuesta, J., López-Noval, B., & Niño-Zarazúa, M. (2024). Social exclusion concepts, measurement, and a global estimate. PLoS One, 19(2):e0298085. https://doi.org/10.1371/journal.pone.0287623
Delbosc, A., & Currie, G. (2011). Exploring the relative influences of transport disadvantage and social exclusion on well-being. Transport Policy, 18(4):555-562. https://doi.org/10.1016/j.tranpol.2011.01.011
De Madariaga, I.S. (2013). From women in transport to gender in transport: Challenging conceptual frameworks for improved policymaking. Journal of International Affairs, 67(1):43-65.
Enders, A., & Seekins, T. (2009). A Review of FTA Section 5310 Program’s State Management Plans: A Legacy Program in Transition. Missoula, MT: University of Montana Rural Institute.
Flaubert, J.L., Le Menestrel, S., Williams, D.R., & Wakefield, M.K. (2021). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. United States: National Academies Press.
Gao, Q.L., Yue, Y., Zhong, C., Cao, J., Tu, W., & Li, Q.Q. (2022). Revealing transport inequality from an activity space perspective: A study based on human mobility data. Cities, 131:104036. https://doi.org/10.1016/j.cities.2022.103205
Gross, I.T., Whitfill, T., Redmond, B., Couturier, K., Bhatnagar, A., & Joseph, M. (2020). Comparison of two telemedicine delivery modes for neonatal resuscitation support: A simulation-based randomized trial. Neonatology, 117(2):159-166.
Habib, M., Maryam, H., & Pathik, B.B. (2014). Research Methodology-contemporary Practices: Guidelines for Academic Researchers. Cambridge: Cambridge Scholars Publishing.
Hamilton, K., & Jenkins, L. (1992). Women and transport. In: Roberts, J., Cleary, J., Hamilton, K., & Hanna J. (eds). Travel Sickness. United Kingdom: Lawrence and Wishart, p.57-74.
Hussin, H., Osama, A., El-Dorghamy, A., & Abdellatif, M.M. (2021). Towards an integrated mobility system: The first and last mile solutions in developing countries; the case study of New Cairo. Transport Research Interdisciplinary Perspectives, 12:100469. https://doi.org/10.1016/j.trip.2021.100469
International Transport Forum. (2019). ITF Transport Outlook 2019. Paris: OECD Publishing. Available from: https://www. transp_outlook-en-2019-en [Last accessed on 2024 Aug 12].
Jahangir, S., Bailey, A., Hasan, M.U., & Hossain, S. (2024). “We do not go outside, though we want to”: Unequal access to public transport and transport-related social exclusion of older adults in Dhaka, Bangladesh. Journal of Applied Gerontology, 43(8):1165-1176.
Khisty, C.J. (1993). Transportation in developing countries: Obvious problems, possible solutions. Transportation Research Record, 1396:44-49.
Kohler, A.D. (2019). Ensure more Texas Mothers and Babies are Healthy: Remove Obstacles Preventing Transportation to Prenatal and Postpartum Care. Testimony to the Senate Committee on Health and Human Services in Support of House Bill. Vol. 25. Texas: Texans Care for Children, p.1-4.
Koukoufikis, G., & Uihlein, A. (2022). Energy Poverty, Transport Poverty and Living Conditions: An Analysis of EU Data and Socioeconomic Indicators. Brussels: European Commission, Joint Research Centre. https://doi.org/10.2760/144241
Levitas, R., Pantazis, C., Fahmy, E., Gordon, D., Lloyd, E., & Patsios, D. (2007). The Multi-Dimensional Analysis of Social Exclusion. Townsend Centre for the International Study of Poverty and Bristol Institute for Public Affairs. England: University of Bristol.
Lucas, K. (2004). Running on Empty: Transport, Social Exclusion and Environmental Justice. England: The Policy Press.
Lucas, K., & Jones, P. (2009). The Car in British Society. RAC Foundation. Available from:https://www.racfoundation.org [Last accessed on 2024 Jun 17].
Lucas, K., Mattioli, G., Verlinghieri, E., & Guzman, A. (2016). Transport poverty and its adverse social consequences. Proceedings of the Institution of Civil Engineers-Transport, 169(6):353-365. https://doi.org/10.1680/jtran.15.00073
Luke, R. (2024). Transport-related social exclusion and mobility in developing countries: The South African case. Frontiers in Sustainable Cities, 6:1199055. https://doi.org/10.3389/frsc.2024.1199055
Kenyon, S., Lyons, G., & Rafferty, J. (2002). Transport and social exclusion: Investigating the possibility of promoting inclusion through virtual mobility. Journal of Transport Geography, 10(3):207-219. https://doi.org/10.1016/S0966-6923(02)00012-1
MacLeod, K.E., Kamruzzaman, L., & Musselwhite, C. (2022). Transport and health equity, social inclusion and exclusion. Journal of Transport and Health, 27:101543. https://doi.org/10.1016/j.jth.2022.101543
Mattioli, G. (2017). “Forced car ownership” in the UK and Germany: Socio-spatial patterns and potential economic stress impacts. Social Inclusion, 5(4):147-160.
Marmot, M., Friel, S., Bell, R., Houweling, T.A.J., & Taylor, S. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. The Lancet, 372(9650):1661-1669. https://doi.org/10.1016/S0140-6736(08)61690-6
Mishra, V.K. (2024). Dynamics of social exclusion in urban spheres in India. Journal of Social Inclusion Studies, 10(1):39-52.
Musumeci, M., Watts, M.O., & Chidambaram, P. (2020). Key State Policy Choices about Medicaid Home and Community- Based Services. United States: Kaiser Family Foundation.
Musselwhite, C., Avineri, E., & Susilo, Y. (2021). Restrictions on mobility due to the coronavirus COVID19: Threats and opportunities for transport and health. Journal of Transport and Health, 20:101042.
National Bureau of Statistics (NBS) [Nigeria]. (2023). Nigeria Multidimensional Poverty Index Report. Available from: https://nigerianstat.gov.ng [Last accessed on 2025 Apr 04].
Nimi, T., Fraga, S., Costa, D., Campos, P., & Barros, H. (2016). Prenatal care and pregnancy outcomes: A cross-sectional study in Luanda, Angola. International Journal of Gynecology and Obstetrics, 135(S1):S72-S78. https://doi.org/10.1016/j.ijgo.2016.08.005
Nwanze, L.D., Siuliman, A., & Ibrahim, N. (2023). Factors associated with infant mortality in Nigeria: A scoping review. PLoS One, 18(11):e0294434. https://doi.org/10.1371/journal.pone.0294434
Organization for Economic Cooperation and Development & International Transport Forum. (2015). Improving Safety for Motorcycle, Scooter and Moped Riders. France: OECD Publishing.
Potoglou, D., Robinson, N., Kim, C.W., Burge, P., & Warnes, R. (2010). Quantifying individuals’ trade-offs between privacy, liberty and security: The case of rail travel in the UK. Transportation Research Part A: Policy and Practice, 44(3):169-181. https://doi.org/10.1016/j.tra.2010.01.008
Porter, L., Stone, J., Legacy, C., Curtis, C., Harris, J., Fishman, E., et al. (2018). The autonomous vehicle Revolution: Implications for planning/the driverless city?/autonomous vehicles-a planner’s response/autonomous vehicles: Opportunities, challenges and the need for government action/three signs autonomous vehicles will not lead to less car ownership and less car use in car dependent cities-a case study of Sydney, Australia/planning for autonomous vehicles? Questions of purpose, place and pace/ensuring good governance: The role of planners in the development of autonomous vehicles. Planning Theory and Practice, 19(5):753-778. https://doi.org/10.1080/14649357.2018.1537599
Ravallion, M., & Chen, S. (2013). A proposal for truly global poverty measures. Global Policy, 4(3):258-265. https://doi.org/10.1111/1758-5899.12028
Raza, H. (2023). Unspoken Words Beyond the Numbers: Lived Experiences of Low Socioeconomic Status Post-secondary Students [Master’s thesis, Queen’s University, Canada].
Runciman, W.G. (1966). Relative Deprivation and Social Justice. England, UK: Routledge and Kegan Paul.
Roberts, M.A., & Abery, B.H. (2023). A person-centered approach to home and community-based services outcome measurement. Frontiers in Rehabilitation Science, 4:1056530. https://doi.org/10.3389/fresc.2023.1056530
Roy, S., Bailey, A., & Van Noorloos, F. (2024). Understanding the barriers affecting women’s mobility in the first-and last-mile stretches in low-and middle-income countries: A systematic review. Journal of Transport Geography, 121:104036. https://doi.org/10.1016/j.jtrangeo.2024.104036
Schwanen, T., Lucas, K., Akyelken, N., Solsona, D.C., Carrasco, J.A., & Neutens, T. (2015). Rethinking the links between social exclusion and transport disadvantage through the lens of social capital. Transportation Research Part A: Policy and Practice, 74:123-135. https://doi.org/10.1016/j.tra.2015.02.004
Seekins, T., Bernier, B., Innes, J., McCleary, T., & Yoshioka, K. (2007). Allocation and use of Section 5310 funds in urban and rural America. Journal of Public Transportation, 10(1):81-101.
Sen, A. (2000). Social Exclusion: Concept, Application, and Scrutiny. Philippines: Asian Development Bank.
Social Exclusion Unit. (2004). Breaking the Cycle: Taking Stock of Progress and Priorities for the Future. Available from: https://www.cabinetoffice.gov.uk/social_exclusion_task_force/~/media/assets/www.cabinetoffice.gov.uk/social_exclusion_task_force/publications_1997_to_2006/ breaking_report%20pdf [Last accessed on 2025 Apr 04].
Stafford, J. (2003). Briefing: Safer travel by design: Reducing crime on public transport. Proceedings of the Institution of Civil Engineers - Municipal Engineer, 156(2):87-88. https://doi.org/10.1680/muen.2003.156.2.87
Starkey, P. (2016). Provision of Rural Transport Services: User Needs, Practical Constraints and Policy Issues. In: Transport and Communications Bulletin for Asia and the Pacific. Vol. 86. Thailand: United Nations Economic and Social Commission for Asia and the Pacific. p6-22.
Stoltzfus, M., Kaur, A., Chawla, A., Vasu Gupta, A., Anamika, F.N.U., & Rohit Jain, R. (2023). The role of telemedicine in healthcare: An overview and update. Egyptian Journal of Internal Medicine, 35:49. https://doi.org/10.1186/s43162-023-00234-z
UNICEF. (2020). Global Status Report on Preventing Violence Against Children 2020. Switzerland: World Health Organization.
Varo, A. (2024). From deserving to denied: Exploring the social construction of energy excluded citizens. Energy Research and Social Science, 113:103544. https://doi.org/10.1016/j.erss.2024.103005
World Health Organization. (2019). WHO Guidelines on Tuberculosis Infection Prevention and Control: 2019 Update (No. WHO/CDS/TB/2019.1). Switzerland: World Health Organization.