Research into Childbirth and Health Unit, School of Health, University of Central Lancashire, Preston, UK.
PLoS Med. 2013;10(1):e1001373. doi: 10.1371/journal.pmed.1001373. Epub 2013 Jan 22.
Almost 50% of women in low- and middle-income countries (LMICs) don't receive adequate antenatal care. Women's views can offer important insights into this problem. Qualitative studies exploring inadequate use of antenatal services have been undertaken in a range of countries, but the findings are not easily transferable. We aimed to inform the development of future antenatal care programmes through a synthesis of findings in all relevant qualitative studies.
Using a predetermined search strategy, we identified robust qualitative studies reporting on the views and experiences of women in LMICs who received inadequate antenatal care. We used meta-ethnographic techniques to generate themes and a line-of-argument synthesis. We derived policy-relevant hypotheses from the findings. We included 21 papers representing the views of more than 1,230 women from 15 countries. Three key themes were identified: "pregnancy as socially risky and physiologically healthy", "resource use and survival in conditions of extreme poverty", and "not getting it right the first time". The line-of-argument synthesis describes a dissonance between programme design and cultural contexts that may restrict access and discourage return visits. We hypothesize that centralised, risk-focused antenatal care programmes may be at odds with the resources, beliefs, and experiences of pregnant women who underuse antenatal services.
Our findings suggest that there may be a misalignment between current antenatal care provision and the social and cultural context of some women in LMICs. Antenatal care provision that is theoretically and contextually at odds with local contextual beliefs and experiences is likely to be underused, especially when attendance generates increased personal risks of lost family resources or physical danger during travel, when the promised care is not delivered because of resource constraints, and when women experience covert or overt abuse in care settings.
在中低收入国家（LMICs），近 50%的女性没有得到足够的产前护理。女性的观点可以为解决这一问题提供重要的见解。已经在多个国家开展了探讨产前服务利用不足的定性研究，但这些研究结果不容易转移。我们旨在通过综合所有相关定性研究的发现，为未来的产前保健计划提供信息。
我们使用预定的搜索策略，确定了报告 LMIC 中接受不足产前护理的妇女观点和经验的稳健定性研究。我们使用元人种学技术生成主题和论点综合。我们从研究结果中得出了与政策相关的假设。我们纳入了 21 篇论文，代表了来自 15 个国家的 1230 多名妇女的观点。确定了三个关键主题：“怀孕在社会上是有风险的，但在生理上是健康的”、“在极端贫困条件下的资源利用和生存”和“第一次没有做对”。论点综合描述了方案设计与文化背景之间的不和谐，这可能会限制获得服务的机会并阻止再次就诊。我们假设，集中、以风险为重点的产前保健方案可能与利用产前服务不足的孕妇的资源、信仰和经验不符。
我们的研究结果表明，当前的产前保健服务与一些 LMIC 中妇女的社会和文化背景之间可能存在错位。与当地背景信念和经验在理论和背景上不一致的产前保健服务可能会被利用不足，特别是当参加产前护理会导致家庭资源流失或旅行中身体受到威胁的个人风险增加时，当由于资源限制而无法提供承诺的护理时，当妇女在护理环境中遭受隐性或显性虐待时。
