Why do women not use antenatal services in low- and middle-income countries? A meta-synthesis of qualitative studies

Almost 50% of women in low- and middle-income countries (LMICs) don't receive adequate antenatal care. Women's views can offer important insights into this problem. Qualitative studies exploring inadequate use of antenatal services have been undertaken in a range of countries, but the find...

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Bibliographic Details
Published in:PLoS medicine 2013-01, Vol.10 (1), p.e1001373-e1001373
Main Authors: Finlayson, Kenneth, Downe, Soo
Format: Article
Language:English
Subjects:
Babies
Design
Developing Countries - economics
Economic aspects
Female
Health
Health aspects
Health Resources - economics
Health Resources - utilization
Health Services Accessibility - economics
Humans
Income
Low income groups
Management
Medicine
Meta-analysis
Models, Theoretical
Poverty
Pregnancy
Prenatal care
Prenatal Care - economics
Prenatal Care - utilization
Qualitative Research
Social and Behavioral Sciences
Studies
Survival Analysis
Women
Womens health
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Summary:Almost 50% of women in low- and middle-income countries (LMICs) don't receive adequate antenatal care. Women's views can offer important insights into this problem. Qualitative studies exploring inadequate use of antenatal services have been undertaken in a range of countries, but the findings are not easily transferable. We aimed to inform the development of future antenatal care programmes through a synthesis of findings in all relevant qualitative studies. Using a predetermined search strategy, we identified robust qualitative studies reporting on the views and experiences of women in LMICs who received inadequate antenatal care. We used meta-ethnographic techniques to generate themes and a line-of-argument synthesis. We derived policy-relevant hypotheses from the findings. We included 21 papers representing the views of more than 1,230 women from 15 countries. Three key themes were identified: "pregnancy as socially risky and physiologically healthy", "resource use and survival in conditions of extreme poverty", and "not getting it right the first time". The line-of-argument synthesis describes a dissonance between programme design and cultural contexts that may restrict access and discourage return visits. We hypothesize that centralised, risk-focused antenatal care programmes may be at odds with the resources, beliefs, and experiences of pregnant women who underuse antenatal services. Our findings suggest that there may be a misalignment between current antenatal care provision and the social and cultural context of some women in LMICs. Antenatal care provision that is theoretically and contextually at odds with local contextual beliefs and experiences is likely to be underused, especially when attendance generates increased personal risks of lost family resources or physical danger during travel, when the promised care is not delivered because of resource constraints, and when women experience covert or overt abuse in care settings.
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1001373