‘Weighing up and balancing out’: a meta‐synthesis of barriers to antenatal care for marginalised women in high‐income countries

Abstract

Background In high-resource settings around 20% of maternal deaths are attributed to women who fail to receive adequate antenatal care. Epidemiological evidence suggests many of these women belong to marginalised groups often living in areas of relative deprivation. Reasons for inadequate antenatal attendance have yet to be fully evaluated.Objectives To identify the factors affecting access to antenatal care for marginalised pregnant women living in developed countries.Search strategy We included qualitative studies from developed countries published in English language journals .Selection criteria Qualitative studies exploring the views of marginalised women living in developed countries who either failed to attend for any antenatal care or did so late or irregularly.Data collection and analysis Eight studies fulfilled the selection criteria and were synthesised in accord with the techniques derived from meta-ethnography.Main results Initial access is influenced by late pregnancy recognition and subsequent denial or acceptance. Continuing access appears to depend on a strategy of weighing up and balancing out of the perceived gains and losses. Personal resources in terms of time, money and social support are considered alongside service provision issues including the perceived quality of care, the trustworthiness and cultural sensitivity of staff and feelings of mutual respect.Conclusions A nonthreatening, nonjudgemental antenatal service run by culturally sensitive staff may increase access to antenatal care for marginalised women. Multiagency initiatives aimed at raising awareness of, and providing access to, antenatal care may also increase uptake.

Vulnerable birth mothers and repeat losses of infants to public care: is targeted reproductive health care ethically defensible?

“…Where mothers lack mental capacity, misuse substances or are homeless, they may struggle to exercise informed reproductive choice leading to unplanned pregnancies (D' Souza and Garcia, 2004;Hepburn, 2004;Downe, et al, 2008). That teenagers are at greater risk of unplanned pregnancy is also a very well established finding (Ryan et al, 2008;Harden et al, 2009).…”

Targeting the Use of Reminders and Notifications for Uptake by Populations (TURNUP): a systematic review and evidence synthesis

“…For example, the meta-synthesis of qualitative work by Downe et al 154 on antenatal care uptake identified several shared perceptions among marginalised groups relating to quality of care, the trustworthiness and cultural sensitivity of staff and feelings of mutual respect that shaped attendance. Similarly, Manderson and Allotey 155 report of the 'story-telling' about health services that takes place within immigrant communities in Australia and shapes their uptake of health care.…”

Maternal characteristics and pregnancy outcomes in women presenting with decreased fetal movements in late pregnancy

“…Minority or marginalized women in a high-income country do not appear to display a "healthism" approach to their lives [50]; normative assumptions in antenatal guidelines do not apply. This may be in part due to a lack of trust in caregivers among minority women in Western countries [50,51], the authoritative source often are their husband [51] or their mother [52], instead of the health care services. While printed educational materials are widely used to improve knowledge, awareness and attitudes, especially in developed countries, other methods for information Table 5 and education may be needed for cultural minority groups.…”

“…Two of these trials were conducted in total populations (114;119), while two were conducted in mixed low-and high-risk populations within single institutions (116-118). Three studies (Neldam 1983 (50) and the study by Lobb and coworkers in 1985 (116) were both conducted in mixed low-and high-risk populations within single institutions. Even though the study by Neldam is the only randomized controlled trial (RCT) to date of antepartum testing of any kind versus no testing that has found reduced mortality, it has been found by some researchers to be methodologically substandard since the randomization procedure was based on the mother's initial even or odd booking number when included in the study (57).…”