A Scoping Review of Skilled Birth Attendance Trends Following User Fee Removal for Maternity Services in Monrovia, Liberia

User fees for maternity services are a known barrier to accessing skilled birth attendance in low-resource settings. A policy intervention removed these fees in selected districts of Monrovia, Liberia, offering an opportunity to examine its impact on service utilisation. This scoping review aimed to map and synthesise available evidence on trends in skilled birth attendance rates following user fee removal for maternity services in Monrovia, Liberia. The objective was to identify key patterns, data sources, and gaps in the literature. A scoping review was conducted following established frameworks. Systematic searches were performed across multiple academic databases and grey literature sources. Studies and reports discussing skilled birth attendance and user fee removal in the specified context were screened for inclusion. Data were charted and analysed thematically. The review identified a limited but consistent body of evidence. The primary finding was a reported increase in facility-based deliveries following the policy change. Common themes included initial surges in demand that strained health system capacity and the importance of concurrent improvements in service quality for sustaining utilisation. Available evidence suggests user fee removal was associated with a positive trend in skilled birth attendance in Monrovia. However, the sustainability of this increase appears closely linked to parallel investments in health system strengthening. Further primary research is needed to quantify long-term trends and causal relationships. Future policy initiatives should integrate fee removal with robust plans for health workforce and supply chain support. Researchers should prioritise standardising outcome measures for better comparative analysis. skilled birth attendance, user fees, maternity services, health financing, Liberia, scoping review This review consolidates fragmented evidence on the relationship between user fee removal and skilled birth attendance in Monrovia, providing a foundation for future research and policy planning.