Introduction Delayed access to antenatal care (“late booking”) is linked to increased mortality/morbidity for mother and baby: 17% of recent maternal deaths were women who booked after 22 weeks; had missed >4 antenatal visits or did not seek care at all. To address the paucity of explanatory research, we explored the barriers to antenatal care, as perceived by maternity stakeholders.
Method Purposive and snowball sampling of maternity care stakeholders from community/hospital settings: midwives, doctors, social and link workers. Interviews employed a semi-structured format, were taped, data transcribed, coded and organised using NVivo software. An inductive, self-conscious iterative, thematic analysis was undertaken, with independent verification.
Results 42 practitioners were interviewed: 4 focus group, 4 small group and individual interviews were conducted. Main themes that emerged were: stereotypical view of sociocultural and educational status of women who book late; patient factors: lack of pregnancy planning/knowledge; ambivalence re:pregnancy/antenatal care; socio-cultural influences on service utilisation (chaotic lives, substance misuse, immigration and housing issues); vulnerability and support (influence of family, peers and community); fear, denial and avoidance (concealment, relationships with professionals, expectations for care; child safeguarding issues), alongside organisational barriers eg staff shortages, lack of care continuity, communication issues.
Conclusion This study of multiprofessional maternity stakeholders has identified perceived barriers to early booking, and highlights the need for: a multiagency approach to pre-conception and antenatal health promotion, reproductive education; increased practitioner awareness of risk factors and consequences of late booking; a flexible care ethos of continuity for women who book late.
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