Timing of the initiation of antenatal care: An exploratory qualitative study of women and service providers in East London.
OBJECTIVE
to explore the factors which influence the timing of the initiation of a package of publically-funded antenatal care for pregnant women living in a diverse urban setting


METHODS
a qualitative study involving thematic analysis of 21 individual interviews and six focus group discussions.


METHODS
Newham, a culturally diverse borough in East London, UK PARTICIPANTS: individual interviews were conducted with 21 pregnant and postnatal women and focus group discussions were conducted with a total of 26 health service staff members(midwives and bilingual health advocates) and 32 women from four community groups (Bangladeshi, Somali, Lithuanian and Polish).


RESULTS
initial care-seeking by pregnant women is influenced by the perception that the package of antenatal care offered by the National Health Service is for viable and continuing pregnancies, as well as little perceived urgency in initiating antenatal care. This is particularly true when set against competing responsibilities and commitments in women's lives and for pregnancies with no apparent complications or disconcerting symptoms. Barriers to access to this package of antenatal care include difficulties in navigating the health service and referral system, which are compounded for women unable to speak English, and service provider delays in the processing of referrals. Accessing antenatal care was sometimes equated with relinquishing control, particularly for young women and women for whom language barriers prohibit active engagement with care.


CONCLUSIONS
if women are to be encouraged to seek antenatal care from maternity services early in pregnancy, the purpose and value to all women of doing so need to be made clear across the communities in which they live. As a woman may need time to accept her pregnancy and address other priorities in her life before seeking antenatal care, it is crucial that once she does decide to seek such care, access is quick and easy. Difficulties found in navigating the system of referral for antenatal care point to a need for improved access to primary care and a simple and efficient process of direct referral to antenatal care, alongside the delivery of antenatal care which is woman-centred and experienced as empowering.
Institute for Health and Human Development (IHHD), University of East London, Water Lane, London E15 4LZ, UK. Electronic address: b.hatherall@uel.ac.uk.
Bethan
B
Hatherall
Barts Health NHS Trust, Newham University Hospital, Glen Rd, London E13 8SL, UK. Electronic address: joanne.morris@bartshealth.nhs.uk.
Joanne
J
Morris
Department of Social Science, UCL Institute of Education, 20 Bedford Way, London WC1H 0AL, UK.
Farah
F
Jamal
Institute for Health and Human Development (IHHD), University of East London, Water Lane, London E15 4LZ, UK. Electronic address: l.sweeney@uel.ac.uk.
Lorna
L
Sweeney
Department of Social Science, UCL Institute of Education, 20 Bedford Way, London WC1H 0AL, UK. Electronic address: m.wiggins@ioe.ac.uk.
Meg
M
Wiggins
Barts Health NHS Trust, Royal London Hospital, Women's Services, Whitechapel Road, E1 1BB London, UK. Electronic address: inderjeet.kaur@bartshealth.nhs.uk.
Inderjeet
I
Kaur
Institute for Health and Human Development (IHHD), University of East London, Water Lane, London E15 4LZ, UK. Electronic address: a.renton@uel.ac.uk.
Adrian
A
Renton
Institute for Health and Human Development (IHHD), University of East London, Water Lane, London E15 4LZ, UK; Barts Health NHS Trust, Newham University Hospital, Glen Rd, London E13 8SL, UK. Electronic address: a.harden@uel.ac.uk.
Angela
A
Harden
D000328:Adult; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D008131:London; D008427:Maternal Health Services / Q000639:trends; D008880:Midwifery; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010465:Perception; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology; D011295:Prenatal Care / Q000379:methods* / Q000523:psychology; D036301:Qualitative Research; D013997:Time Factors; D014505:Urban Population
Access to health care; Antenatal care; Developed countries; Pregnancy