Health system-related barriers to prenatal care management in low- and middle-income countries: a systematic review of the qualitative literature

Abstract

Background: Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not receive it properly. The objective of this review is to identify and summarize the qualitative studies that report on health system-related barriers in PNC management in LMICs. Methods: This systematic review was conducted in 2022. A range of electronic databases including PubMed, Web of Knowledge, CINHAL, SCOPUS, Embase, and Science Direct were searched for qualitative studies conducted in LMICs. The reference lists of eligible studies also were hand searched. The studies that reported health system-related barrier of PNC management from the perspectives of PNC stakeholders were considered for inclusion. Study quality assessment was performed applying the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. Results: Of the 32 included studies, 25 (78%) were published either in or after 2013. The total population sample included 1677 participants including 629 pregnant women, 122 mothers, 240 healthcare providers, 54 key informed, 164 women of childbearing age, 380 community members, and 88 participants from other groups (such as male partners and relatives). Of 32 studies meeting inclusion criteria, four major themes emerged: (1) healthcare provider-related issues; (2) service delivery issues; (3) inaccessible PNC; and (4) poor PNC infrastructure. Conclusion: This systematic review provided essential findings regarding PNC barriers in LMICs to help inform the development of effective PNC strategies and public policy programs.

Early postnatal care contact within 24 hours by skilled providers and its determinants among home deliveries in Myanmar: Further analysis of the Myanmar Demographic and Health Survey 2015–16

“…The findings reveal a relatively low rate of early PNC contact, with 22% of home deliveries receiving care from skill providers. The potential reasons for low use of PNC are due to lack of knowledge of pregnancy-related complications or difficulties in accessing and reaching care [ 21 ]. Many women may be unaware of the importance of PNC or the potential risks and complications that can arise during the postnatal period for both them and their babies and hindering motivation to seek PNC services.…”

Neurological disorders in pregnant women in low- and middle-income countries—Management gaps, impacts, and future prospects: A review perspective

“…13 Inadequate healthcare equipment also impedes the prompt diagnosis and management of pregnant women with specific diseases in LMICs by severely limiting access to vital medical supplies and diagnostic tools. 14 This is then exacerbated by a lack of oxygen, ventilators, and anesthetic machines, resulting in insufficient care for pregnant patients. These elements are especially important in cases of cerebral hemorrhage caused by an increase in antenatal cardiac output and vasodilation.…”