Facilitators and barriers to seeking and engaging with antenatal care in high‐income countries: A meta‐synthesis of qualitative research

Abstract

Inadequate attendance to antenatal care has been associated with negative maternal and fetal outcomes, including stillbirth. This study aimed to identify facilitators and barriers to antenatal care attendance. A systematic search was conducted in March 2019 and updated in January 2021. Qualitative studies involving pregnant or post‐partum women up to 12 months from high‐income countries that provided data about facilitators and barriers to antenatal care attendance were sought. Meta‐ethnography was used to inform this meta‐synthesis. Fifteen studies were included in the analysis. Findings indicate that inadequate antenatal care attendance is influenced at different levels. Aspects like sociodemographic factors, difficulties navigating the health system, administrative delays, lack of flexibility and tailored care, constant change of carer and communication issues also act as barriers. These issues affect women's access to knowledge and the formation of women's beliefs and feelings towards seeking care. On the contrary, having a positive attitude towards the pregnancy, encountering empathetic healthcare professionals and availing of social support acted as facilitators. The reasons why women seek or delay attending antenatal care are multifactorial and can be explained using the Social Determinants of Health Framework. Any response needs to be taken across all levels of influence and not just focused on the individual. A better understanding of the barriers and facilitators to antenatal care might contribute to informing intervention or policy development addressing this issue.

Exploring first‐time mothers' experiences and knowledge about behavioural risk factors for stillbirth

“…Women's reasons for engaging in behaviour change were commonly associated with obtaining the best possible outcomes for their babies and themselves. This motivation to make healthy choices and a sense of responsibility driven by the desire to improve the baby's health and reduce risk has been described in the extant literature 26,27,28,38 . Further, women's perception of risk, which can only be accurate with appropriate communication and awareness, will also influence their decision‐making 38,39 .…”

“…This motivation to make healthy choices and a sense of responsibility driven by the desire to improve the baby's health and reduce risk has been described in the extant literature. 26 , 27 , 28 , 38 Further, women's perception of risk, which can only be accurate with appropriate communication and awareness, will also influence their decision‐making. 38 , 39 This highlights the importance of providing accurate information to women about stillbirth related to different behaviours during pregnancy.…”

“…All online one‐to‐one interviews were conducted by T. E. S. The semistructured interviews were guided by a pre‐agreed topic guide developed by the multidisciplinary team and informed by previous work of the research group. 26 , 27 , 28 The topic guide included the following areas: history and health habits, awareness of risk factors for stillbirth, feelings and opinions about receiving education on stillbirth, information sources and interventions (see Supporting Information: File 2 ). Some of the questions in the topic guide were designed to elicit information about specific topics such as knowledge about stillbirth and risk factors associated with stillbirth.…”

“…25 Regarding knowledge of behavioural risk factors, previous studies have also demonstrated that some women held serious misconceptions about the risks of substance use or engaging in weight management behaviours, as well as having limited reproductive knowledge, which interferes with their care‐seeking behaviours and increases their risk of stillbirth. 26 , 27 , 28 …”

“…In the same study, only 30% of respondents were aware that preeclampsia, advanced maternal age, elevated α‐fetoprotein, multiple gestations, cigarette smoking, illicit drug use and being postterm increased risk 25 . Regarding knowledge of behavioural risk factors, previous studies have also demonstrated that some women held serious misconceptions about the risks of substance use or engaging in weight management behaviours, as well as having limited reproductive knowledge, which interferes with their care‐seeking behaviours and increases their risk of stillbirth 26–28 …”