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 interrelated elements shape health outcomes, yet its application in maternal and newborn health (MNH) remains limited. We conducted a scoping review to synthesise the application of SDM in healthcare and examine how elements and discontinuities are incorporated to inform an urban MNH SDM. Following the PRISMA-ScR reporting guidelines, we searched PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus. 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 conceptualized de novo (71%), with 29% adapted, and based on primary (93%) and secondary (63%) data. A qualitative SDM approach dominated (75%), followed by mixed methods (19%) and quantitative only (6%). Most studies (81%) utilised causal loop diagrams (CLDs); 19% additionally used stock-and-flow diagrams to investigate their research question. Among ten MNH studies, we grouped elements into six sub-systems and generated a CLD illustrating their relationships, serving as a basis for developing SDMs that have implications for policy.