Author: Sydney Martinez – PROMPT! Cohort #1
Abstract
High maternal mortality is a recurring issue in rural areas and stems from limited access to diagnostic tools like ultrasound, creating a “diagnostic desert.” While portable ultrasound’s clinical benefits are recognized, this review synthesizes existing research to address a crucial gap: its broader socio-cultural impact on patient empowerment, maternal-fetal bonding, and trust in local healthcare. The review aims to explore how these devices strengthen maternal-fetal bonding, increase antenatal care engagement, and foster patient agency by empowering informed decision-making through visual information. Crucially, portable ultrasound builds trust in local healthcare by enhancing provider credibility and streamlining referrals, transforming care experiences. Ultimately, low-cost portable ultrasound devices are catalysts for positive socio-cultural change, boosting bonding, empowering patients, and building trust in local systems. While promising, more generalized and longitudinal research is needed, especially considering AI integration, to maximize these human-centered benefits globally.
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Introduction
In remote areas of the world, there are “diagnostic deserts,” where modern medicine fails to reach those in rural communities. In these communities, the joy of motherhood is quickly turned into a silent nightmare, where maternal mortality and morbidity remain high. In rural communities, rural women have a higher predicted probability of severe maternal complications, such as sepsis, pulmonary edema or acute renal failure (Kozhilmannil et al., 2019, 2077). This is largely due to the lack of antenatal care and the diagnostic tools that can detect life-threatening complications that can come face to face with the mother and unborn child.
The gold standard for prenatal imaging, the ultrasound machine, has been an impractical solution for those residing in rural communities. Its prohibitive cost, large size, and dependence on specialized personnel, sonographers, who require specialized training, have created an impassable barrier between quality care at an affordable cost. This disparity has left millions of pregnant women without fundamental information needed to care for their pregnancies safely (Peterman et al., 2022).
However, the emergence of low-cost, portable ultrasound devices is a solution to mitigate this gap. These devices have been lauded for their potential to provide rapid, on-site clinical insights, from confirming gestational age to detecting a breech presentation or placenta previa. A low-cost portable ultrasound device is a handheld ultrasound machine that is compact, lightweight.
While a significant body of research has documented the cost-effectiveness of this technology, an important aspect remains underexplored. The narrative around portable ultrasound has been a technical one, overlooking its impact on society, socially and culturally.
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This literature review seeks to fill this critical gap, moving beyond the technicality to analyze existing research that reveals how portable ultrasound devices empower patients, foster a powerful maternal-fetal bond, and build essential trust in the local healthcare system.
Rationale
The consistent crisis in rural areas of maternal and infant mortality due to lack of quality care remains a pressing issue today. It underscores a global health equity gap. With advanced technology, mothers in these regions continue to face barriers in accessing quality antenatal care because of the lack of availability of these advanced diagnostic tools, such as the ultrasound. Modern ultrasounds, which cost a large sum of money and require specially trained sonographers, remain an obstacle due to their large, bulky structure and high cost that many hospitals in rural areas cannot afford. As a result, it remains an unattained tool in many rural clinics. This long-standing “diagnostic desert” has harmed early detection of pregnancy complications, leading to preventable adverse maternal and infant outcomes.
While the clinical utility and cost-effectiveness of emerging low-cost portable ultrasound devices in addressing this diagnostic void are increasingly well-documented, a more profound, yet often overlooked, dimension of their impact warrants comprehensive exploration. These compact, handheld devices, readily deployable at the point of care by trained local healthcare providers, transcend mere clinical functionality. They hold immense potential to reshape the socio-cultural landscape of maternal health by influencing critical humanistic factors. This literature review is therefore predicated on the urgent need to synthesize existing evidence that delves into the nuanced ways in which portable ultrasound devices contribute to patient empowerment, foster a stronger maternal-fetal bond, and reinforce community trust in local
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healthcare systems. By showing these less-explored benefits, this review aims to provide an understanding of how this technological innovation serves as a catalyst for meaningful systemic change in the pursuit of equitable maternal health outcomes.
Methodology
This literature review will be conducted by evaluating peer-viewed studies and research. In addition, the synthesis and analysis of these studies will also explore the socio-cultural impact of low-cost and portable ultrasound devices on maternal and infant health in rural areas. The search strategy will involve multiple databases, such as Google Scholars, Pubmed and Research Gate to ensure a broad coverage of relevant literature. Keywords such as, “portable ultrasound,” “low-cost ultrasound,” “rural health,” “underserved communities,” “maternal health,” “antenatal care,” “developing countries,” and “maternal-fetal bonding,” will be used to find relevant literature.
Maternal-Fetal Bonding
Maternal-fetal bonding is when a woman engages in behavior that represents an attachment or interaction with their unborn child (Atluru & Appleton, 2012); essentially, when an expectant mother develops an emotional attachment to her unborn child. Ultrasound imaging technology has allowed expecting women to be able to see details of their child before birth. The ultrasound is a tool that reassures new parents of new promised parenthood. Thus, women who have used ultrasound technology have been shown to have more emotional attachment to their unborn child (Alhusen, 2008). Research indicates that this strengthened maternal-fetal bond translates into improved health behaviors. Studies have shown that the emotional attachment
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spurred by ultrasound visualization can motivate pregnant women to increase their attendance at antenatal care (ANC) appointments (Skelton et al, 2022). For example, a study in rural Uganda demonstrated that simply advertising the availability of portable obstetric ultrasound significantly increased the uptake of ANC services, suggesting that the incentive of seeing the baby was a powerful motivator (Cherniak et al., 2017). This indicates that the reward of bonding with an unborn child can overcome traditional barriers such as distance, cost, and time constraints.
Furthermore, the impact extends beyond the mother to involve the broader family and community. While more research is needed on paternal-fetal bonding with portable devices, existing literature on general ultrasound suggests that these visual experiences can deepen the emotional ties of partners as well (Skelton et al, 2022). In a community, the proof of a developing baby can result in increased social support for the pregnant woman, encouraging family members to be more supportive of her health-seeking decisions and adherence to medical advice. This collective acknowledgement and celebration of the new life, facilitated by the ultrasound image, reinforces the importance of the mother’s health for the entire family unit. The emotional reassurance and tangible connection offered by portable ultrasound thus serve as a fundamental, yet often overlooked, driver for enhanced maternal well-being and improved engagement with the healthcare continuum.
Strengthening the healthcare system in rural communities
The introduction of low-cost portable ultrasound devices into rural and underserved communities reshapes the relationship between communities and their healthcare providers,
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thereby strengthening the entire healthcare system from the ground up. This ripple effect of trust and enhanced capacity is an important socio-cultural benefit. These devices empower the standing of local healthcare providers, such as nurses and midwives, within their communities. Historically, the absence of advanced diagnostic tools has meant that complex cases required referral to distant, urban centers, potentially undermining the community’s confidence in local expertise. However, when local health workers are trained and equipped with portable ultrasound, they gain the ability to perform vital scans at the point of care. In a study done in Kenya, POCUS (Point-of-Care Ultrasound) enables trained providers to make more confident and accurate referral decisions, in turn, reinforces their professional credibility and competence in the eyes of the community (Wanjiku et al. 2024). This increased capability transforms local clinics into more reliable and comprehensive points of care, fostering a deeper sense of trust and reliance among the population.
Furthermore, portable ultrasound significantly improves the reliability of referral systems, a critical component of a functional healthcare network. In many underserved regions, patients are often referred to higher-level facilities based on perceived severity rather than definitive diagnosis, leading to unnecessary travel, delayed care, and wasted resources. Studies demonstrate that portable ultrasound can mitigate these “three delays” in seeking, reaching, and receiving care (Abawollo et al., 2022). By providing immediate and accurate diagnostic information, local providers can identify high-risk pregnancies promptly and make targeted referrals. The “Healthy Pregnancy Project” in Guatemala, for instance, showcases how portable ultrasound kits used by rural nurses, with scans transmitted electronically to remote physicians for authoritative advice, led to notable reductions in maternal mortality rates among Indigenous women (The Reach Alliance, 2025). This seamless integration of local diagnostics with remote
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expert interpretation builds confidence in the entire healthcare continuum, as communities witness direct evidence of improved care pathways.
Finally, the sheer accessibility and transparency offered by portable ultrasound devices contribute to overcoming traditional barriers to care, including skepticism or mistrust that may stem from historical neglect or inadequate services. When healthcare services, including the tangible evidence of an ultrasound image, are brought directly to the community, it fosters a sense of being valued and prioritized. The immediate visual feedback not only engages patients but also helps them understand their conditions better, promoting greater adherence to medical advice. This enhanced communication and tangible benefit at the local level systematically break down long-standing hesitancies and build a foundation of trust that is essential for sustainable improvements in maternal health outcomes.
Conclusion
This literature review comprehensively demonstrates that low-cost portable ultrasound devices offer a transformative impact on maternal health in rural and underserved communities, extending significantly beyond their clinical and economic benefits. The evidence highlights that these accessible tools powerfully strengthen maternal-fetal bonding by offering women a tangible connection to their unborn child, which in turn motivates increased engagement in antenatal care and healthier behaviors. Furthermore, portable ultrasound fosters remarkable patient agency, empowering women with visual information that enhances their understanding of their pregnancy and enables more informed decision-making. Crucially, the deployment of this technology also plays a vital role in building trust and strengthening local healthcare systems, elevating the credibility of community-based providers and streamlining essential referral
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pathways. Despite these profound socio-cultural benefits, current literature is often limited by localized studies, necessitating more robust and longitudinal qualitative and mixed-methods research to ensure generalizability and track long-term impacts. Future prospects lie in addressing challenges related to consistent training, logistical support, and responsible implementation (e.g., preventing misuse), while exploring how emerging technologies like AI integration can further enhance accessibility and the humanistic aspects of care, ultimately contributing to a more equitable and holistic maternal healthcare landscape worldwide.
References
Abawollo, H. S., Tsegaye, Z. T., Desta, B. F., Beshir, I. A., Mengesha, B. T., Guteta, A. A., Heyi, A. F., Mamo, T. T., Gebremedhin, Z. K., Damte, H. D., Zelealem, M., & Argaw, M. D. (2022, April 28). Contribution of portable obstetric ultrasound service innovation in averting maternal and neonatal morbidities and mortalities at semi-urban health centers of Ethiopia: a retrospective facility-based study. BMC Pregnancy and Childbirth, 22(1), 368.
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04703-1 Alhusen, J. L. (2008, June). A literature update on maternal-fetal attachment. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37(3), 315-328.
q0.1111/j.1552-6909.2008.00241.x.
Atluru, A., & Appleton, K. (2012, October). Maternal-Fetal Bonding: Ultrasound Imaging’s Role in enhancing This Important Relationship (S. K. Plavsic, Ed.). Donald School Journal of Ultrasound in Obstetrics & Gynecology, 6(4), 408-411. 10.5005/jp-journals-10009-1263
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Cherniak, W., Anguyo, G., Meaney, C., Kong, L. Y., Malhame, I., Pace, R., Sodhi, S., & Silverman, M. (2017, April 12). L. PloS one, 12(4). 10.1371/journal.pone.0175440 Kleinveld, J. H., Timmermans, D. R. M., Van den berg, M., Van Eijk, J. T. M., & Kate, K. P. T. (2007, June 04). Does offering and performing prenatal screening influence women’s attachment to their unborn child? A longitudinal randomized controlled trial. Obstetrics & Gynaecology Journal, 27(8), 757-764. 10.1002/pd.1775
Kozhilmannil, K. B., Interrante, J. D., Henning-Smith, C., & Admon, L. K. (2019, December 3). Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007–15. Health Affairs, 38(12). 10.1377
Peterman, N. J., Yeo, E., Kaptur, B., Smith, E. J., Christen, A., Huang, E., & Rasheed, M. (2022, May 28). Analysis of Rural Disparities in Ultrasound Access (A. Muacevic & J. R. Alder, Eds.). Cureus Journal of Medical Science, 14(5). 10.7759/cureus.25425
Skelton, E., Webb, R., Malamateniou, C., Rutherford, M., & Ayers, S. (2022, June 23). The impact of antenatal imaging on parent experience and prenatal attachment: a systematic review. Journal of Reproductive and Infant Psychology, 22(1), 22-44.
The Research Alliance. (2020-21). Bridging the Maternal Care Gap: Mobile Antenatal Care in Rural and Indigenous Guatemalan Communities. The Reach Alliance. Retrieved August 11, 2025, from https://reachalliance.org/case-study/healthy-pregnancy-project/
Wanjiku, G. W., Bell, G., Kapadia, S., & Wachire, B. W. (2024, February 15). Impact of point-of-care ultrasound use on patient referral decisions in rural Kenya: a mixed methods study. BMC Health Services Research, 24(1), 212.
