Timely antenatal care access and uptake among migrant and ethnically diverse women in England: a qualitative study of barriers and facilitators.

abstractIntroduction: Timely antenatal care (ANC) is a critical determinant of maternal and neonatal outcomes. In the UK, women from migrant and ethnic minority backgrounds are more likely to initiate ANC later, attend fewer appointments and experience poorer maternal and infant outcomes. This study aimed to describe barriers and facilitators to timely ANC access and uptake from the perspectives of migrant and ethnically diverse women who initiated care late. Methods: We conducted a qualitative study using semi-structured interviews with 20 women from migrant and/or ethnically diverse backgrounds who initiated ANC late (>10 weeks' gestation) in the East of England, UK. Women, recruited through purposive and snowball sampling, were interviewed between October 2024 and January 2025 in-person, online or by telephone. All interviews were transcribed and analysed using a framework approach. Results: Four interconnected themes, comprising 12 subthemes, captured women's perspectives: perceptions about ANC, perceived facilitators and barriers to timely access and uptake, information needs and preferences and strategies to improve ANC access and uptake. All women recognised the importance of ANC. However, many reported limited awareness of when and how to initiate care and found ANC pathways difficult to navigate, particularly those unfamiliar with the UK healthcare system. Key facilitators of access and uptake included awareness of the importance of ANC, supportive healthcare professionals, relational continuity and support from family and friends. Barriers included uncertainty about care pathways, long waiting times, rushed appointments and language and logistical challenges. Suggested strategies to improve ANC access included accessible information on ANC pathways, stronger community and peer support, greater opportunities for direct engagement with professionals and integration of digital technologies into ANC services. Conclusions: Findings highlight need for easy-to-navigate ANC pathways, with targeted community outreach and supported navigation, culturally responsive communication with effective interpretation services and greater relational continuity to improve equitable ANC access and uptake.