Why Do Women Not Use Antenatal Services in Low- and Middle-Income Countries? A Meta-Synthesis of Qualitative Studies
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{"title"=>"Why Do Women Not Use Antenatal Services in Low- and Middle-Income Countries? A Meta-Synthesis of Qualitative Studies", "type"=>"journal", "authors"=>[{"first_name"=>"Kenneth", "last_name"=>"Finlayson", "scopus_author_id"=>"23988749400"}, {"first_name"=>"Soo", "last_name"=>"Downe", "scopus_author_id"=>"7003783438"}], "year"=>2013, "source"=>"PLoS Medicine", "identifiers"=>{"issn"=>"15491277", "arxiv"=>"e1001373.", "scopus"=>"2-s2.0-84873869182", "pui"=>"368227060", "doi"=>"10.1371/journal.pmed.1001373", "isbn"=>"1549-1277", "sgr"=>"84873869182", "pmid"=>"23349622"}, "id"=>"bca75743-f92a-3782-a77e-be72db713d8a", "abstract"=>"BACKGROUND: 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.\\n\\nMETHODS AND FINDINGS: 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.\\n\\nCONCLUSIONS: 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.", "link"=>"http://www.mendeley.com/research/women-not-antenatal-services-low-middleincome-countries-metasynthesis-qualitative-studies-4", "reader_count"=>327, "reader_count_by_academic_status"=>{"Unspecified"=>5, "Professor > Associate Professor"=>7, "Librarian"=>2, "Researcher"=>49, "Student > Doctoral Student"=>25, "Student > Ph. D. 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  • {"files"=>["https://ndownloader.figshare.com/files/503437"], "description"=>"<p>Summary of themes.</p>", "links"=>[], "tags"=>["public health and epidemiology", "women's health", "Non-clinical medicine"], "article_id"=>173961, "categories"=>["Medicine", "Mathematics", "Biotechnology"], "users"=>["Kenneth Finlayson", "Soo Downe"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001373.t002", "stats"=>{"downloads"=>1, "page_views"=>37, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_themes_/173961", "title"=>"Summary of themes.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-01-22 01:06:01"}
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  • {"files"=>["https://ndownloader.figshare.com/files/503342"], "description"=>"<p>Hypothetical model of inadequate access to antenatal care in low and middle income countries.</p>", "links"=>[], "tags"=>["inadequate", "antenatal"], "article_id"=>173862, "categories"=>["Medicine", "Mathematics", "Biotechnology"], "users"=>["Kenneth Finlayson", "Soo Downe"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001373.g002", "stats"=>{"downloads"=>2, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Hypothetical_model_of_inadequate_access_to_antenatal_care_in_low_and_middle_income_countries_/173862", "title"=>"Hypothetical model of inadequate access to antenatal care in low and middle income countries.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-01-22 01:04:22"}
  • {"files"=>["https://ndownloader.figshare.com/files/477124"], "description"=>"<div><h3>Background</h3><p>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.</p> <h3>Methods and Findings</h3><p>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.</p> <h3>Conclusions</h3><p>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.</p> <p> <em>Please see later in the article for the Editors' Summary</em></p> </div>", "links"=>[], "tags"=>["women", "antenatal", "services", "low-", "middle-income", "meta-synthesis", "qualitative", "studies"], "article_id"=>153966, "categories"=>["Medicine", "Mathematics", "Biotechnology"], "users"=>["Kenneth Finlayson", "Soo Downe"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001373", "stats"=>{"downloads"=>18, "page_views"=>80, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Why_Do_Women_Not_Use_Antenatal_Services_in_Low_and_Middle_Income_Countries_A_Meta_Synthesis_of_Qualitative_Studies__/153966", "title"=>"Why Do Women Not Use Antenatal Services in Low- and Middle-Income Countries? A Meta-Synthesis of Qualitative Studies", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-01-22 01:06:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/503466"], "description"=>"a<p>A range is given for these studies, as the authors list the number of focus groups conducted, with a minimum and maximum number of participants; e.g., ten focus groups with 8–12 participants.</p>", "links"=>[], "tags"=>["included"], "article_id"=>173985, "categories"=>["Medicine", "Mathematics", "Biotechnology"], "users"=>["Kenneth Finlayson", "Soo Downe"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001373.t001", "stats"=>{"downloads"=>10, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_included_studies_/173985", "title"=>"Summary of included studies.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-01-22 01:06:25"}

PMC Usage Stats | Further Information

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  • {"unique-ip"=>"72", "full-text"=>"77", "pdf"=>"18", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"1", "year"=>"2018", "month"=>"12"}
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  • {"unique-ip"=>"95", "full-text"=>"119", "pdf"=>"10", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"3"}
  • {"unique-ip"=>"89", "full-text"=>"102", "pdf"=>"15", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"4"}
  • {"unique-ip"=>"120", "full-text"=>"139", "pdf"=>"12", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"5"}
  • {"unique-ip"=>"84", "full-text"=>"93", "pdf"=>"13", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"8"}
  • {"unique-ip"=>"139", "full-text"=>"151", "pdf"=>"16", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"3", "supp-data"=>"1", "cited-by"=>"1", "year"=>"2019", "month"=>"9"}
  • {"unique-ip"=>"216", "full-text"=>"318", "pdf"=>"13", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"4", "supp-data"=>"0", "cited-by"=>"2", "year"=>"2019", "month"=>"10"}
  • {"unique-ip"=>"111", "full-text"=>"137", "pdf"=>"18", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2019", "month"=>"12"}
  • {"unique-ip"=>"225", "full-text"=>"274", "pdf"=>"38", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"1", "cited-by"=>"1", "year"=>"2020", "month"=>"2"}
  • {"unique-ip"=>"193", "full-text"=>"245", "pdf"=>"19", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"4", "supp-data"=>"0", "cited-by"=>"3", "year"=>"2020", "month"=>"3"}
  • {"unique-ip"=>"181", "full-text"=>"221", "pdf"=>"31", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"0", "cited-by"=>"0", "year"=>"2020", "month"=>"4"}
  • {"unique-ip"=>"154", "full-text"=>"210", "pdf"=>"36", "scanned-summary"=>"0", "scanned-page-browse"=>"0", "figure"=>"0", "supp-data"=>"2", "cited-by"=>"1", "year"=>"2020", "month"=>"5"}

Relative Metric

{"start_date"=>"2013-01-01T00:00:00Z", "end_date"=>"2013-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Medicine and health sciences", "average_usage"=>[264, 460, 584, 692, 794, 887, 978, 1067, 1154, 1241, 1328, 1408, 1474]}, {"subject_area"=>"/Medicine and health sciences/Health care", "average_usage"=>[278, 463, 587, 692, 804, 897, 984, 1068, 1165, 1254, 1339, 1429, 1490]}, {"subject_area"=>"/Medicine and health sciences/Public and occupational health", "average_usage"=>[291, 491, 610, 723, 817, 906, 991, 1071, 1153, 1238, 1324, 1411, 1478]}, {"subject_area"=>"/Medicine and health sciences/Women's health", "average_usage"=>[238, 448, 580, 684, 784, 897, 964, 1053, 1134, 1220, 1318, 1401, 1453]}, {"subject_area"=>"/Social sciences", "average_usage"=>[289, 475, 593, 703, 805, 902, 990, 1078, 1158, 1250, 1336, 1417, 1482]}, {"subject_area"=>"/Social sciences/Sociology", "average_usage"=>[310, 523, 656, 780, 900, 1024, 1120, 1219, 1308, 1395, 1468, 1570, 1642]}]}
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