Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

ERS Congress 2024

Keep up to date on the latest news from the annual European Respiratory Society conference.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in:

Open Access 01-12-2023 | Care | Research article

Ethnic minority women’s experiences of accessing antenatal care in high income European countries: a systematic review

Authors: Esther Sharma, Pei-Ching Tseng, Angela Harden, Leah Li, Shuby Puthussery

Published in: BMC Health Services Research | Issue 1/2023

Login to get access

Abstract

Background

Women from ethnic minority backgrounds are at greater risk of adverse maternal outcomes. Antenatal care plays a crucial role in reducing risks of poor outcomes. The aim of this study was to identify, appraise, and synthesise the recent qualitative evidence on ethnic minority women’s experiences of accessing antenatal care in high-income European countries, and to develop a novel conceptual framework for access based on women’s perspectives.

Methods

We conducted a comprehensive search of seven electronic databases in addition to manual searches to identify all qualitative studies published between January 2010 and May 2021. Identified articles were screened in two stages against the inclusion criteria with titles and abstracts screened first followed by full-text screening. Included studies were quality appraised using the Critical Appraisal Skills Programme checklist and extracted data were synthesised using a ‘best fit’ framework, based on an existing theoretical model of health care access.

Results

A total of 30 studies were included in this review. Women’s experiences covered two overarching themes: ‘provision of antenatal care’ and ‘women's uptake of antenatal care’. The ‘provision of antenatal care’ theme included five sub-themes: promotion of antenatal care importance, making contact and getting to antenatal care, costs of antenatal care, interactions with antenatal care providers and models of antenatal care provision. The ‘women's uptake of antenatal care’ theme included seven sub-themes: delaying initiation of antenatal care, seeking antenatal care, help from others in accessing antenatal care, engaging with antenatal care, previous experiences of interacting with maternity services, ability to communicate, and immigration status. A novel conceptual model was developed from these themes.

Conclusion

The findings demonstrated the multifaceted and cyclical nature of initial and ongoing access to antenatal care for ethnic minority women. Structural and organisational factors played a significant role in women’s ability to access antenatal care. Participants in majority of the included studies were women newly arrived in the host country, highlighting the need for research to be conducted across different generations of ethnic minority women taking into account the duration of stay in the host country where they accessed antenatal care.

Protocol and registration

The review protocol was registered on PROSPERO (reference number CRD42021238115).
Appendix
Available only for authorised users
Literature
1.
Guglielminotti J, Wong CA, Friedman AM, Li G. Racial and ethnic disparities in death associated with severe maternal morbidity in the United States. Obstet Gynecol. 2021;137(5):791–800.PubMedCrossRef
2.
Schutte J, Steegers E, Schuitemaker N, Santema J, de Boer K, Pel M, et al. Rise in maternal mortality in the Netherlands. BJOG An Int J Obstet Gynaecol. 2010;117(4):399–406.CrossRef
3.
Knight M, Bunch K, Tuffnell D, Shakespeare J, Kotnis R, Kenyon S, et al. Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2016–18. on behalf of MBRRACE-UK. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2020.
4.
Puthussery S. Perinatal outcomes among migrant mothers in the United Kingdom: Is it a matter of biology, behaviour, policy, social determinants or access to health care? Best Pract Res Clin Obstet Gynaecol. 2016;32:39–49.PubMedCrossRef
5.
Rowe RE, Magee H, Quigley MA, Heron P, Askham J, Brocklehurst P. Social and ethnic differences in attendance for antenatal care in England. Public Health. 2008;122(12):1363–72.PubMedCrossRef
6.
Corbett S, Chelimo C, Okesene-Gafa K. Barriers to early initiation of antenatal care in a multi-ethnic sample in South Auckland. New Zealand N Z Med J. 2014;127(1404):53–62.PubMed
7.
Alderliesten M, Vrijkotte T, Van Der Wal M, Bonsel G. Late start of antenatal care among ethnic minorities in a large cohort of pregnant women. BJOG An Int J Obstet Gynaecol. 2007;114(10):1232–9.CrossRef
8.
9.
Downe S, Finlayson K, Walsh D, Lavender T. ‘Weighing up and balancing out’: a meta-synthesis of barriers to antenatal care for marginalised women in high-income countries. BJOG An Int J Obstet Gynaecol. 2009;116(4):518–29.CrossRef
10.
Hollowell J, Oakley L, Vigurs C, Barnett-Page E, Kavanagh J, Oliver S. Increasing the early initiation of antenatal care by Black and Minority Ethnic women in the United Kingdom: a systematic review and mixed methods synthesis of women’s views and the literature on intervention effectiveness. Oxford: University of Oxford: National Perinatal Epidemiology Unit; 2012.
11.
Higginbottom GMA, Evans C, Morgan M, Bharj KK, Eldridge J, Hussain B. Experience of and access to maternity care in the UK by immigrant women: a narrative synthesis systematic review. BMJ Open. 2019;9(12):1–23.CrossRef
12.
13.
14.
Santana IR, Mason A, Gutacker N, Kasteridis P, Santos R, Rice N. Need, demand, supply in health care: working definitions, and their implications for defining access. Heal Econ Policy Law. 2021;18(1):1–13.
15.
Braun V, Clarke V. Successful Qualitative research: a practical guide for beginners. London: Sage Publications Ltd; 2013.
16.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:1–9.
17.
18.
Hannes K. Critical appraisal of qualitative research. In: Noyes J, Booth A, Hannes K, Harris J, Lewin S, Lockwood C, editors. Supplementary Guidance for Inclusion of Qualitative Research in Cochrane Systematic Reviews of Interventions. Cochrane Collaboration Qualitative Methods Group; 2011. Available from: http://​cqrmg.​cochrane.​org/​supplemental-handbook-guidance
19.
Carroll C, Booth A, Cooper K. A worked example of “best fit” framework synthesis: a systematic review of views concerning the taking of some potential chemopreventive agents. BMC Med Res Methodol. 2011;11(29):1–9.
20.
Carroll C, Booth A, Leaviss J, Rick J. “Best fit” framework synthesis: refining the method. BMC Med Res Methodol. 2013;13(37):1–16.
21.
Levesque J-F, Harris M, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12(18):1–9.
22.
QSR International. NVivo v12. Cambridge: QSR International; 2020.
23.
Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8(4):1–10.
24.
Puthussery S, Twamley K, Macfarlane A, Harding S, Baron M. “You need that loving tender care”: maternity care experiences and expectations of ethnic minority women born in the United Kingdom. J Health Serv Res Policy. 2010;15(3):156–62.PubMedCrossRef
25.
Binder P, Borné Y, Johnsdotter S, Essén B. Shared language is essential: communication in a multiethnic obstetric care setting. J Heal Commun Int Perspect. 2012;17(10):1171–86.CrossRef
26.
Hassan SM, Leavey C, Rooney JS. Exploring English speaking Muslim women’s first-time maternity experiences: a qualitative longitudinal interview study. BMC Pregnancy Childbirth. 2019;19(1):1–10.CrossRef
27.
Filby A, Robertson W, Afonso E. A service evaluation of a specialist migrant maternity service from the user’s perspective. Br J Midwifery. 2020;28(9):652–9.CrossRef
28.
Binder P, Johnsdotter S, Essén B. Conceptualising the prevention of adverse obstetric outcomes among immigrants using the ‘three delays’ framework in a high-income context. Soc Sci Med. 2012;75(11):2028–36.PubMedCrossRef
29.
Alshawish E, Marsden J, Yeowell G, Wibberley C. Investigating access to and use of maternity health-care services in the UK by Palestinian women. Br J Midwifery. 2013;21(8):571–7.CrossRef
30.
Phillimore J. Migrant maternity in an era of superdiversity: New migrants’ access to, and experience of, antenatal care in the West Midlands. UK Soc Sci Med. 2016;148:152–9.PubMedCrossRef
31.
Phillimore J. Delivering maternity services in an era of superdiversity: the challenges of novelty and newness. Ethn Racial Stud. 2015;38(4):568–82.CrossRef
32.
Moxey JM, Jones LL. A qualitative study exploring how Somali women exposed to female genital mutilation experience and perceive antenatal and intrapartum care in England. BMJ Open. 2016;6(e009846):1–8.
33.
Lephard E, Haith-Cooper M. Pregnant and seeking asylum: Exploring women’s experiences ‘from booking to baby.’ Br J Midwifery. 2016;24(2):130–6.
34.
Chinouya MJ, Madziva C. Late booking amongst African women in a London borough, England: implications for health promotion. Health Promot Int. 2019;34(1):123–32.PubMedCrossRef
35.
Nellums LB, Powis J, Jones L, Miller A, Rustage K, Russell N, et al. “It’s a life you’re playing with”: a qualitative study on experiences of NHS maternity services among undocumented migrant women in England. Soc Sci Med. 2021;270:1–9.CrossRef
36.
Coutinho E, Rocha A, Pereira C, Silva A, Duarte J. Experiences of motherhood: unmet expectations of immigrant and native mothers, about the Portuguese health system. Atención primaria. 2014;46:140–4.PubMedPubMedCentralCrossRef
37.
Almeida LM, Caldas JP, Ayres-de-Campos D, Dias S. Assessing maternal healthcare inequities among migrants: a qualitative study. Cad Saude Publica. 2014;30(2):333–40.PubMedCrossRef
38.
Almeida LM, Casanova C, Caldas J, Ayres-de-Campos D, Dias S. Migrant women’s perceptions of healthcare during pregnancy and early motherhood: addressing the social determinants of health. J Immigr Minor Heal. 2014;16(4):719–23.CrossRef
39.
Topa JB, Nogueira CO, Neves SA. Maternal health services: an equal or framed territory? Int J Hum Rights Healthc. 2017;10(2):110–22.CrossRef
40.
Almeida LM, Caldas JP. Migration and maternal health: experiences of Brazilian women in Portugal. Rev Bras Saúde Matern Infant. 2013;13(4):309–16.CrossRef
41.
Barkensjö M, Greenbrook JTV, Rosenlundh J, Ascher H, Elden H, Barkensjo M, et al. The need for trust and safety inducing encounters: a qualitative exploration of women’s experiences of seeking perinatal care when living as undocumented migrants in Sweden. BMC Pregnancy Childbirth. 2018;18(217):1–17.
42.
Robertson EK. “To be taken seriously”: Women’s reflections on how migration and resettlement experiences influence their healthcare needs during childbearing in Sweden. Sex Reprod Healthc. 2015;6(2):59–65.PubMedCrossRef
43.
Ahrne M, Schytt E, Andersson E, Small R, Adan A, Essén B, et al. Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives. Midwifery. 2019;74:107–15.PubMedCrossRef
44.
Origlia Ikhilor P, Hasenberg G, Kurth E, Asefaw F, Pehlke-Milde J, Cignacco E. Communication barriers in maternity care of allophone migrants: Experiences of women, healthcare professionals, and intercultural interpreters. J Adv Nurs. 2019;75(10):2200–10.PubMedPubMedCentralCrossRef
45.
Sami J, Quack Lotscher KC, Eperon I, Gonik L, Martinez de Tejada B, Epiney M, et al. Giving birth in Switzerland: a qualitative study exploring migrant women’s experiences during pregnancy and childbirth in Geneva and Zurich using focus groups. Reprod Health. 2019;16(112):1–9.
46.
Degni F, Suominen SB, El Ansari W, Vehviläinen-Julkunen K, Essen B. Reproductive and maternity health care services in Finland: perceptions and experiences of Somali-born immigrant women. Ethn Health. 2014;19(3):348–66.PubMedCrossRef
47.
Wikberg A, Eriksson K, Bondas T. Intercultural caring from the perspectives of immigrant new mothers. J Obstet Gynecol neonatal Nurs JOGNN. 2012;41(5):638–49.PubMedCrossRef
48.
Ceulemans M, Chaar R, Van Calsteren K, Allegaert K, Foulon V. Arabic-speaking pregnant women with a migration background: a vulnerable target group for prenatal counseling on medicines. Res Soc Adm Pharm. 2020;16(3):377–82.CrossRef
49.
Henry J, Beruf C, Fischer T. Access to health care for pregnant arabic-speaking refugee women and mothers in Germany. Qual Health Res. 2020;30(3):437–47.PubMedCrossRef
50.
Funge JK, Boye MC, Johnsen H, Nørredam M. “No Papers. No Doctor”: A Qualitative Study of Access to Maternity Care Services for Undocumented Immigrant Women in Denmark. Int J Environ Res Public Health. 2020;17(18):1–14.CrossRef
51.
Peters IA, Posthumus AG, Steegers EAP, Denktaş S. Satisfaction with obstetric care in a population of low-educated native Dutch and non-western minority women. Focus group research. PLoS One. 2019;14(1):1–22.
52.
Utne R, Antrobus-Johannessen CL, Aasheim V, Aasekjær K, Vik ES. Somali women’s experiences of antenatal care: a qualitative interview study. Midwifery. 2020;83:1–7.CrossRef
53.
Barona-Vilar C, Más-Pons R, Fullana-Montoro A, Giner-Monfort J, Grau-Muñoz A, Bisbal-Sanz J. Perceptions and experiences of parenthood and maternal health care among Latin American women living in Spain: a qualitative study. Midwifery. 2013;29(4):332–7.PubMedCrossRef
54.
55.
Forster DA, McLachlan HL, Davey MA, Biro MA, Farrell T, Gold L, et al. Continuity of care by a primary midwife (caseload midwifery) increases women’s satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial. BMC Pregnancy Childbirth. 2016;16(1):1–13.CrossRef
56.
57.
Rayment-Jones H, Dalrymple K, Harris J, Harden A, Parslow E, Georgi T, et al. Project20: Does continuity of care and community-based antenatal care improve maternal and neonatal birth outcomes for women with social risk factors? A prospective, observational study. PLoS ONE. 2021;16(5):1–30.CrossRef
58.
Kildea S, Gao Y, Hickey S, Kruske S, Nelson C, Blackman R, et al. Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: a prospective cohort study, Brisbane, Australia. EClinicalMedicine. 2019;12:43–51.
59.
Sfregola G, Laganà AS, Granese R, Sfregola P, Lopinto A, Triolo O. Work load and management in the delivery room: changing the direction of healthcare policy. J Obstet Gynaecol. 2016;7:1–6.CrossRef
60.
61.
Kupek E, Petrou S, Vause S, Maresh M. Clinical, provider and sociodemographic predictors of late initiation of antenatal care in England and Wales. BJOG An Int J Obstet Gynaecol. 2002;109(3):265–73.CrossRef
62.
63.
Puthussery S, Twamley K, Harding S, Mirsky J, Baron M, Macfarlane A. “They’re more like ordinary stroppy British women”: attitudes and expectations of maternity care professionals to UK-born ethnic minority women. J Health Serv Res Policy. 2008;13(4):195–201.PubMedCrossRef
64.
Dos Santos SLS. Undeserving mothers? Shifting rationalities in the maternal healthcare of undocumented Nicaraguan migrants in Costa Rica. Anthropol Med. 2015;22(2):191–201.PubMedCrossRef
65.
Marcelin JR, Siraj DS, Victor R, Kotadia S, Maldonado YA. The Impact of unconscious bias in healthcare: how to recognize and mitigate it. J Infect Dis. 2019;220(Supplement_2):S62-73.PubMedCrossRef
66.
Byrom S, Downe S. The roar behind the silence. London: Pinter and Martin Ltd; 2015.
67.
68.
Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health. 2022;22:1–22.CrossRef
69.
Curtis E, Jones R, Tipene-Leach D, Walker C, Loring B, Paine S-J, et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health. 2019;18(174):1–17.
70.
De Freitas C de, Massag J, Amorim M, Fraga S. Involvement in maternal care by migrants and ethnic minorities: a narrative review. Public Health Rev. 2020;41(5):1-18.
71.
Sharma E, Howard N, Duclos D. Navigating new lives: a scoping review and thematic synthesis of forced migrant women’s perinatal experiences. J Migr Heal. 2020;1–2:1–11.
72.
Fair F, Raben L, Watson H, Vivilaki V, van den Muijsenbergh M, Soltani H, et al. Migrant women’s experiences of pregnancy, childbirth and maternity care in European countries: a systematic review. PLoS One. 2020;15(2):1–26.
73.
Redshaw M, Martin CR, Savage-McGlynn E, Harrison S. Women’s experiences of maternity care in England: preliminary development of a standard measure. BMC Pregnancy Childbirth. 2019;19(167):1–13.
74.
Russo A, Lewis B, Joyce A, Crockett B, Luchters S. A qualitative exploration of the emotional wellbeing and support needs of new mothers from Afghanistan living in Melbourne, Australia. BMC Pregnancy Childbirth. 2015;15(197):1–13.
75.
Agbemenu K, Banke-Thomas A, Ely G, Johnson-Agbakwu C. Avoiding obstetrical interventions among US-based Somali migrant women: a qualitative study. Ethn Health. 2019;26(7):1082–97.PubMedCrossRef
76.
Rohwer A, Hendricks L, Oliver S, Garner P. Testing for saturation in qualitative evidence syntheses: an update of HIV adherence in Africa. PLoS One. 2021;16:1–20.CrossRef
Metadata
Title
Ethnic minority women’s experiences of accessing antenatal care in high income European countries: a systematic review
Authors
Esther Sharma
Pei-Ching Tseng
Angela Harden
Leah Li
Shuby Puthussery
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2023
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-023-09536-y

Other articles of this Issue 1/2023

BMC Health Services Research 1/2023 Go to the issue

Research

Response to patient safety incidents in healthcare settings in Ghana: the role of teamwork, communication openness, and handoffs

Research

Variations in the impact of the new case-based payment reform on medical costs, length of stay, and quality across different hospitals in China: an interrupted time series analysis

Research

Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria

Research

Guideline documents on caesarean section on maternal request in Sweden: varying usability with a restrictive approach

Research

The impact of COVID-19 on the interpretation of psycho-oncological support trial results: a quasi-experimental approach using the data from the new form of care “Integrated cross-sectoral psycho-oncology (nFC-isPO)”

Research

Matching medical staff to long term care facilities to respond to COVID-19 outbreak