Abstract for: Capturing Complexities in Urban Maternal and Newborn Healthcare Systems: A Scoping Review on Application of System Dynamics Modelling

Healthcare systems in urban areas are shaped by complex interactions between socioeconomic, infrastructure-related and governance factors. System dynamics modelling (SDM) offers a valuable approach to explore how these complex interrelated elements shape health outcomes. However, its application in maternal and newborn health (MNH) research remains limited. We synthesised SDM applications in healthcare and examined how elements and discontinuities (unexpected breaks disrupting continuity of healthcare) are incorporated, informing urban MNH SDM. We conducted a scoping review following the PRISMA-ScR reporting guidelines. We searched 5 databases including PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus. Eligible studies examined SDM applications for healthcare in urban/peri-urban areas and published in English or French. Non-peer-reviewed publications were excluded. Three reviewers independently screened titles/abstracts and full texts. Data were extracted and summarised using descriptive statistics and narrative synthesis. Of 10,900 records identified, 32 studies published between 2009 and 2025 were included, with 69% published after 2020. Included studies reflected six healthcare fields, with a third focusing on MNH (31%). Most SDM frameworks were conceptualised de novo (71%), with 29% adapted, and based on primary (93%) and secondary (63%) data. Qualitative SDM approach dominated (75%). Most studies (81%) used causal loop diagrams (CLDs); 19% combined CLDs with stock-and-flow diagrams in mixed approaches. The application of SDM for urban healthcare research has increased over the past decade. Urban MNH outcomes are driven by interlinked factors across governance, resources, service delivery, and care-seeking. The generated CLD offers a holistic view of these relationships, highlighting interdependencies and serves as a starting point for developing SDM for researchers seeking to generate results which can effectively inform policy.