title: Perceptions of prenatal and obstetric care in Sub-Saharan Africa.
abstract: BACKGROUND
  The maternal mortality ratio in Sub-Saharan Africa remains high, despite progress in reducing maternal mortality in other parts of the world.
  
  
  OBJECTIVE
  To explore the perceptions of women and communities to identify barriers to the uptake of obstetric services.
  
  
  METHODS
  A systematic review of qualitative studies exploring perceptions of pregnancy and obstetric services, with thematic synthesis of the included studies.
  
  
  METHODS
  Qualitative studies reporting findings from focus group discussions and in-depth interviews between 1996 and 2009 were included.
  
  
  METHODS
  Thematic synthesis involved collating and reviewing quotations taken directly from included studies. Themes were generated and clustered for analysis.
  
  
  RESULTS
  Twenty-seven studies were included and 6 major themes identified: perceptions of healthcare workers; perceptions of the hospital environment; cultural perceptions of women; cultural perceptions of pregnancy; perceptions of traditional birth attendants and traditional healers; and role of the community in pregnancy and birth.
  
  
  CONCLUSIONS
  Community attitudes regarding cultural beliefs and interactions with healthcare providers were identified as barriers to the utilization of healthcare services during pregnancy in Sub-Saharan Africa. These prevent engagement with prenatal care and timely use of medical services. Addressing the barriers will be seminal to the success of any healthcare intervention.
authors.affiliation: Palmerston North Hospital, Palmerston North, New Zealand.
authors.forename: Aimee
authors.initials: A
authors.lastname: Brighton
authors.forename: Rhiannon
authors.initials: R
authors.lastname: D'Arcy
authors.forename: Shona
authors.initials: S
authors.lastname: Kirtley
authors.forename: Stephen
authors.initials: S
authors.lastname: Kennedy
mesh_terms: D017954:Africa South of the Sahara; D003469:Culture; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D012111:Residence Characteristics