394 Facilitators and barriers to seeking and engaging with antenatal care in high-income countries: a meta-synthesis

Abstract

Previous studies have associated inadequate attendance to antenatal care with negative maternal and foetal outcomes, including higher risk of stillbirth. The aim of this study is to identify facilitators and barriers to antenatal care in developed countries. A meta-synthesis was undertaken whereby a systematic search was conducted in six different databases in March 2019. 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 were sought. Meta-ethnography was used to facilitate the synthesis of the data. Fourteen studies were included in the review. The analysis of the studies indicates that the inadequate antenatal care attendance is influenced at different levels beyond the individual. Aspects like sociodemographic factors, difficulties navigating the health system, administrative delays, lack of flexibility and tailored care, constant change of carer and communication issues with healthcare professionals also act as barriers. These issues influence women’s access to knowledge and influence the formation of womens’ and healthcare professionals’ beliefs, perceptions and emotional processes. The perceived balance between barriers and benefits, depending on the woman’s circumstances, will influence her decision to either seek or delay access to antenatal care. The reasons why women seek or delay attending antenatal care are multifactorial and any response needs to be taken across all levels of society not just focused on the individual. The findings from this synthesis could be used for intervention or policy development addressing this issue.