title: Understanding delayed access to antenatal care: a qualitative interview study.
abstract: BACKGROUND
  Delayed access to antenatal care ('late booking') has been linked to increased maternal and fetal mortality and morbidity. The aim of this qualitative study was to understand why some women are late to access antenatal care.
  
  
  METHODS
  27 women presenting after 19 completed weeks gestation for their first hospital booking appointment were interviewed, using a semi-structured format, in community and maternity hospital settings in South Yorkshire, United Kingdom. Interviews were transcribed verbatim and entered onto NVivo 8 software. An interdisciplinary, iterative, thematic analysis was undertaken.
  
  
  RESULTS
  The late booking women were diverse in terms of: age (15-37 years); parity (0-4); socioeconomic status; educational attainment and ethnicity. Three key themes relating to late booking were identified from our data: 1) 'not knowing': realisation (absence of classic symptoms, misinterpretation); belief (age, subfertility, using contraception, lay hindrance); 2) 'knowing': avoidance (ambivalence, fear, self-care); postponement (fear, location, not valuing care, self-care); and 3) 'delayed' (professional and system failures, knowledge/empowerment issues).
  
  
  CONCLUSIONS
  Whilst vulnerable groups are strongly represented in this study, women do not always fit a socio-cultural stereotype of a 'late booker'. We report a new taxonomy of more complex reasons for late antenatal booking than the prevalent concepts of denial, concealment and disadvantage. Explanatory sub-themes are also discussed, which relate to psychological, empowerment and socio-cultural factors. These include poor reproductive health knowledge and delayed recognition of pregnancy, the influence of a pregnancy 'mindset' and previous pregnancy experience, and the perceived value of antenatal care. The study also highlights deficiencies in early pregnancy diagnosis and service organisation. These issues should be considered by practitioners and service commissioners in order to promote timely antenatal care for all women.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Haddrill
authors.affiliation: School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. g.l.jones@sheffield.ac.uk.
authors.forename: Georgina L
authors.initials: GL
authors.lastname: Jones
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Mitchell
authors.forename: Dilly O C
authors.initials: DO
authors.lastname: Anumba
mesh_terms: D000293:Adolescent; D000328:Adult; D057210:Delayed Diagnosis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology*; D011209:Power, Psychological; D011247:Pregnancy; D011295:Prenatal Care; D036301:Qualitative Research; D013997:Time Factors; D006113:United Kingdom; D055815:Young Adult