Exploring Digital Innovations to Address Third Delay Factors in Facility-Based Perinatal Care: A Systematic Literature Review

Third delay factors, defined as delays in receiving timely, appropriate, and quality care after arrival at a health facility, remain a major contributor to preventable maternal and newborn morbidity and mortality, particularly in low- and middle-income countries. These delays arise from systemic weaknesses such as delayed triage, inadequate monitoring, slow clinical decision-making, poor coordination, and limited resources. Although access to facility-based childbirth services has increased globally, maternal and neonatal outcomes have not improved proportionately, highlighting a persistent gap between access and quality of care. Digital health innovations have been proposed as potential solutions to improve responsiveness and efficiency of perinatal care within health facilities, yet evidence of their effectiveness in addressing third delay mechanisms remains fragmented and inconsistent. This systematic literature review synthesised evidence on digital innovations targeting third delay factors in facility-based perinatal care. The objectives were to identify types of digital interventions, examine the delay dimensions addressed, assess their effects on clinical processes and perinatal outcomes, and explore key facilitators and barriers to implementation. Following PRISMA 2020 guidelines, electronic databases including PubMed, MEDLINE, CINAHL, Embase, Cochrane Library, and Google Scholar, as well as grey literature, were searched for studies published between 2020 and 2026. Eligible studies focused on intrapartum and immediate postpartum care within health facilities and evaluated digital tools aimed at improving timeliness, decision making, monitoring, communication, referral, triage, or emergency response. Data extraction and quality appraisal were conducted using standardised tools, and a narrative synthesis approach was applied due to variation in study designs and reported outcomes. Seventy-two studies met the inclusion criteria, identifying four categories of digital innovations: decision support and labour monitoring systems, electronic health information and documentation systems, communication and referral platforms, and multicomponent digital interventions. Across studies, digital tools improved the timeliness of care, early recognition of complications, adherence to clinical guidelines, and coordination of services. However, evidence linking these improvements to reductions in maternal and neonatal mortality was limited and inconsistent. The effectiveness of implementation was influenced by infrastructure, workforce capacity, training, and system integration. Digital innovations show strong potential to address third delay factors and improve the quality of perinatal care, but their impact is constrained by contextual challenges, particularly infrastructure limitations and variable staff readiness. Standardised indicators for delay measurement and clinical outcomes are needed to strengthen evaluation and comparability across studies. Effective scale-up will require context-appropriate implementation strategies, sustained capacity building, and integration into existing health systems. Future research should prioritise rigorous evaluation, sustainability, and scalability to inform policy and practice aimed at reducing preventable maternal and newborn deaths.