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

Background and Objective: Women from ethnic minority background are at greater risk of adverse maternal outcomes. Timely antenatal care is crucial in reducing risks of poor outcomes. The aim of this study was to identify, appraise, and synthesise recent qualitative evidence on ethnic minority women’s experiences of accessing antenatal care in high-income European countries, and to develop a novel conceptual access framework based on women’s perspectives. Methods: We searched eight 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 abstract 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. Results: Thirty studies conducted in 11 European countries were included. Participants in majority of studies were women newly arrived in the host country. Women’s experiences covered two overarching themes: ‘provision of antenatal care’ and ‘uptake of antenatal care’. The ‘provision of antenatal care’ theme included five sub-themes: promotion of antenatal care importance, getting to antenatal care, costs of antenatal care, interactions with care providers and models of antenatal provision. The ‘uptake of antenatal care’ theme included seven sub-themes: delaying initiation of antenatal care, seeking antenatal care, reaching antenatal care, engaging with antenatal care, previous experiences of interacting with maternity services, ability to communicate and immigration status. Conclusions: Findings demonstrated 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. Need for research on experiences across different generations of ethnic minority women, taking into account duration of stay in the host country in the host country was evident.