Barriers to timely and adequate antenatal care: a systematic review of socioeconomic, cultural, psychosocial, and health-system factors across high and low resource settings.

objectiveSignificant disparities remain in prenatal care utilization across countries, the specific socioeconomic and systemic factors contributing to these gaps have not been consistently synthesized. This review evaluates the gap by comparing barriers to timely and adequate prenatal care between high and low resource settings by focusing on the factors affecting prenatal service utilization through socioeconomic status and geography cultural barriers and system-related factors. METHODOLOGY: The systematic review explored databases such as PubMed, Google Scholar, Scopus, Web of Science, and ScienceDirect. The recent studies from 2014 up to 2024 underwent evaluation based on Boolean operators combined with indexed keywords. Eligible studies included quantitative study designs examining barriers to prenatal care among women of reproductive age. Screening was conducted by two reviewers independently by following PRISMA guidelines. A total of 20 studies were included as per the eligibility criteria. Due to heterogeneity in study design, a structured narrative review synthesis was conducted.

resultsThe main barriers identified were Socioeconomic limitations because of low income and insufficient insurance coverage and the challenges of distance to healthcare facilities and inadequate transportation combined with cultural barriers such as traditional gender roles and stigmatization and traditional beliefs. The barriers identified in high-income settings were that immigrant and refugee women faced challenges due to their status uncertainties, difficulties with language and unfamiliarity with healthcare systems. Depression along with abuse and multiple caregiving duties emerged as a major psychological factor that prevented women from accessing healthcare. System-related factors like Long waiting times and inadequate medical personnel along with insufficient respect from healthcare providers were the major identified factors.

conclusionThe utilization of prenatal care is influenced by a multifaceted interplay of the individual, cultural, socioeconomic, and systems factors. It is important to strengthen these community-based measures, including financial and structural assistance, to enhance equitable, timely, and sufficient prenatal care across diverse settings.