Timing of the initiation of antenatal care: An exploratory qualitative study of women and service providers in East London

Abstract

Objectiveto explore the factors which influence the timing of the initiation of a package of publically-funded antenatal care for pregnant women living in a diverse urban settingDesigna qualitative study involving thematic analysis of 21 individual interviews and six focus group discussions.SettingNewham, a culturally diverse borough in East London, UKParticipantsindividual interviews were conducted with 21 pregnant and postnatal women and focus group discussions were conducted with a total of 26 health service staff members(midwives and bilingual health advocates) and 32 women from four community groups (Bangladeshi, Somali, Lithuanian and Polish).Findingsinitial care-seeking by pregnant women is influenced by the perception that the package of antenatal care offered by the National Health Service is for viable and continuing pregnancies, as well as little perceived urgency in initiating antenatal care. This is particularly true when set against competing responsibilities and commitments in women’s lives and for pregnancies with no apparent complications or disconcerting symptoms. Barriers to access to this package of antenatal care include difficulties in navigating the health service and referral system, which are compounded for women unable to speak English, and service provider delays in the processing of referrals. Accessing antenatal care was sometimes equated with relinquishing control, particularly for young women and women for whom language barriers prohibit active engagement with care.Conclusions and implications for practiceif women are to be encouraged to seek antenatal care from maternity services early in pregnancy, the purpose and value to all women of doing so need to be made clear across the communities in which they live. As a woman may need time to accept her pregnancy and address other priorities in her life before seeking antenatal care, it is crucial that once she does decide to seek such care, access is quick and easy. Difficulties found in navigating the system of referral for antenatal care point to a need for improved access to primary care and a simple and efficient process of direct referral to antenatal care, alongside the delivery of antenatal care which is woman-centred and experienced as empowering.

How do women with social risk factors experience United Kingdom maternity care? A realist synthesis

“…“ They said to me, until we are sure that it's safe you see, to carry on with the pregnancy, then you can have a booking ”…”

Better together: A qualitative exploration of women’s perceptions and experiences of group antenatal care

“…Women from socio-economically disadvantaged and minority ethnic groups, many of whom have complex social and medical needs, are less likely to access antenatal care (1), and more likely to report negative experiences of care (2)(3)(4). Lack of engagement with antenatal care and belonging to socially, ethnically or linguistically marginalised groups has been associated with adverse pregnancy outcomes including low birth-weight, neonatal mortality and maternal morbidity and mortality (5,6).…”

Predictors of the Timing and Number of Antenatal Care Visits among Unmarried Compared To Married Youth in Uganda Between 1995 And 2011

“…Low levels have also been reported in prior studies in Uganda (74,75) and in Ethiopia (76). This could be because youth are accessing ANC from informal sources like Traditional Birth Attendants in Uganda (77) or because mothers had no pregnancy complications and take pregnancy as a normal life event (75,(78)(79)(80).…”

“…Also, since most pregnancies among unmarried women are unwanted, they tend to hide the pregnancies due to fear of negative family and society reaction to their pregnancies until late stages (33,42,50,51,54). Some unmarried youth might also be planning an abortion in the early stages of the pregnancy before it is realised by others, therefore, they will not access ANC early (80). Therefore, societal and familial attitudes change to support unmarried youth will help them to disclose their pregnancies early and thus receive the support to seek ANC early.…”