Understanding care-seeking of pregnant women from underserved groups: A systematic review and meta-ethnography

Understanding care-seeking of pregnant women from underserved groups: A systematic review and meta-ethnography | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Understanding care-seeking of pregnant women from underserved groups: A systematic review and meta-ethnography View ORCID Profile Tisha Dasgupta , View ORCID Profile Hannah Rayment-Jones , View ORCID Profile Gillian Horgan , View ORCID Profile Yesmin Begum , View ORCID Profile Michelle Peter , View ORCID Profile Sergio A. Silverio , View ORCID Profile Laura A Magee doi: https://doi.org/10.1101/2025.07.24.25332124 Tisha Dasgupta 1 Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London , London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Tisha Dasgupta For correspondence: tisha.dasgupta{at}kcl.ac.uk Hannah Rayment-Jones 1 Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London , London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Hannah Rayment-Jones Gillian Horgan 1 Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London , London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Gillian Horgan Yesmin Begum 2 The ENGAGE Study Patient and Public Involvement and Engagement Advisory Group, King’s College London , London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Yesmin Begum Michelle Peter 2 The ENGAGE Study Patient and Public Involvement and Engagement Advisory Group, King’s College London , London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Michelle Peter Sergio A. Silverio 1 Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London , London, UK 3 Department of Psychology, Institute of Population Health, University of Liverpool , Liverpool, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Sergio A. Silverio Laura A Magee 1 Department of Women & Children’s Health, School of Life Course & Population Sciences, King’s College London , London, UK Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Laura A Magee Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Background Delayed or reduced antenatal care use by pregnant women may result in poorer outcomes. ‘Candidacy’ is a synthetic framework which outlines how people’s eligibility for healthcare is jointly negotiated. This meta-ethnography aimed to identify – through the lens of candidacy – factors affecting experiences of care-seeking during pregnancy by women from underserved communities in high-income countries (HICs). Methods Six electronic databases were systematically searched, extracting papers published from January 2018 to January 2023, updated to May 2025, and having relevant qualitative data from marginalised and underserved groups in HICs. Methodological quality of included papers was assessed using the Critical Appraisal Skills Programme. Meta-ethnography was used for analytic synthesis and findings were mapped to the Candidacy Framework. Results Studies (N=51), with data from 1,347 women across 14 HICs were included. A total of 12 sub-themes across five themes were identified: (1) Autonomy, dignity, and personhood; (2) Informed choice and decision-making; (3) Trust in and relationship with healthcare professionals; (4) Differences in healthcare systems and cultures; and (5) Systemic barriers. Candidacy constructs to which themes were mapped were predominantly joint- (navigation of health system), health system- (permeability of services), and individual-level (appearances at health services). Mapping to Candidacy Framework was partial for seven sub-themes, particularly for individuals with a personal or family history of migration. The meta-ethnography allowed for the theory: ‘Respect, informed choice, and trust enhances candidacy whilst differences in healthcare systems, culture, and systemic barriers have the propensity to diminish it’. Conclusion Improvements in antenatal care utilisation must focus on the joint (service-user and -provider) nature of responsibility for care-seeking, through co-production. We suggest two additional Candidacy Framework constructs: ‘intercultural dissonance’ and ‘hostile bureaucracy’, which reflect the multi-generational impact of migration on healthcare utilisation and the intersection of healthcare utilisation with a hostile and bureaucratic environment. Funding ESRC Doctoral training fellowship (ES/P000703/1) Registration This review was registered with PROSPERO [CRD42023389306]. Evidence before the study Delayed or reduced utilisation of healthcare during the perinatal period can be detrimental for both the mother and baby. Women from marginalised and underserved communities face increased barriers to seeking and engaging with care during pregnancy, which were likely further exacerbated, disproportionately, by global changes in maternity care services during the COVID-19 pandemic. A search of six electronic databases was conducted for eligible qualitative research studies published between 2018-2025 in high-income countries (HICs), to investigate factors affecting experiences of care-seeking during pregnancy, by women and birthing people from underserved communities. The Candidacy framework was used as a theoretical lens to interrogate the data, to understand the dynamic process by which people’s eligibility for healthcare is jointly negotiated between themselves and the health system. Added value of this study Drawing from 51 published studies with data from 1,347women in 14 countries, this systematic review and meta-ethnography led to the development of a theory: Respect, informed choice, and trust enhances candidacy whilst differences in healthcare systems, culture, and systemic barriers have the propensity to diminish it. We add to the existing literature by providing an in-depth analysis of barriers and facilitators of care-seeking behaviour amongst a population with high levels of social complexity. Using the lens of Candidacy, we observed a dominance of connections across joint- and health system-level factors as compared to individual-level ones, emphasising joint responsibility for positive experiences of maternity care-seeking. Furthermore, we propose two new constructs of ‘intercultural dissonance’ and ‘hostile bureaucracy’ to be added to the Candidacy framework, as emerging of particular relevance to migrants, reflecting intergenerational relationship changes and hostile immigration policies faced by these individuals. Implications of all the available evidence The present synthesis emphasises the need for policy and practice improvements in maternity care utilisation, which focus on the joint (service-user and -provider) nature of responsibility for care-seeking, through co-production. In particular, events of the last decade have emphasised the underserved nature of migrants, refugees, and asylum seekers; a population which has grown exponentially in the recent past due to various humanitarian crises, and are in need of additional support in maternity care services in HICs. Introduction Routine antenatal care is a globally recommended public health service enabling healthcare professionals (HCPs) to provide essential information, counselling, maternal and fetal assessments, and encourage use of maternity services. 1 , 2 Delayed or reduced antenatal care use, in both high- (HICs) and low-/middle-income countries (LMICs), is linked to adverse pregnancy outcomes, including stillbirth, 3 and neonatal morbidity. 4 Research on maternity care-seeking has largely focused on LMICs, where barriers are often financial, geographic, or linked to knowledge gaps beliefs about the importance of maternity care. 5 In contrast, many HICs offer free healthcare at point of access, yet barriers remain. Even with structurally accessible services, uptake remains low in certain communities, including those of lower socio-economic status (SES), minority ethnic groups, sexual minorities, and people living with disabilities. 6 – 8 A recent meta-synthesis of qualitative studies in HICs highlighted multiple barriers (e.g., socio-demographic disadvantage, system navigation, lack of tailored care, frequent carer changes) and facilitators (e.g., positive pregnancy attitudes, good HCP interactions, social support). 9 Furthermore, the pandemic introduced additional barriers to care-seeking (i.e., social isolation, personal infection risk, 10 poorer mental well-being, 11 continuing restrictions for perinatal populations after lockdowns, 12 and navigating healthcare service reconfigurations 13 , 14 ), with experiences of care being reported more negatively with poorer mental health outcomespoorer. 11 – 18 ‘Candidacy’ refers to people’s eligibility for accessing healthcare. It was developed to explain unequal access to healthcare, despite universal health coverage, and to go beyond simple measurement of health utilisation, particularly by marginalised groups. 19 The theoretical framework of ‘candidacy’ refers to healthcare access as negotiated jointly between service-user and healthcare system. It describes a dynamic process, subject to external influences, from people and their social context, as well as available resources and service structure. 19 There are seven constructs of: identification, navigation, permeability of services, appearances at health services, adjudication, offers and resistance, and local production of candidacy. 19 As used previously in healthcare research, this framework lends itself well to understanding the latent factors influencing care-seeking amongst marginalised groups, for which it was first developed. 20 – 25 The aim of this systematic review and meta-ethnography was to synthesise qualitative evidence from HICs, to identify – through the lens of candidacy – factors affecting experiences of care-seeking during pregnancy, by women and birthing people from underserved communities. We expand on previous work by focusing solely on underserved groups known to face additional barriers to care access, utilisation, and engagement. Methods This review was registered with PROSPERO [CRD42023389306] and adheres to the PRISMA 2020 statement ( Table S1 ). 26 Inclusion and exclusion criteria The PEO (Population, Exposure, Outcome) framework was used to formulate the search strategy as per the research aim ( Table S2 ). Study designs included: descriptive, exploratory, and interpretive qualitative studies; ethnographies; and observational or mixed-methods studies (including surveys with open-ended questions) where qualitative data had been formally analysed and presented. 24 Studies were published between Jan 2018-23, updated to May 2025, and only considered if published in English-language. Studies of postnatal care were excluded due to its variation between countries, and its fragmented nature, often spanning services in primary through to quaternary care settings. Search strategy and selection Electronic databases of SCOPUS, MEDLINE, EMBASE, CINAHL, Global Health, PsychINFO, and MIDRIS were systematically searched for articles published between 1 January 2018 and 1 January 2023, updated to May 2025. Dates were selected to align with the wider study’s quantitative data analysis time-frame. 27 For details of the search terms and keywords used, see Table S2 . Duplicate references were removed using Mendeley reference manager software, and citations were uploaded to Rayyan, 28 a web-based tool for conducting systematic reviews. At least two members of the study team (TD, HRJ, GH, SAS, LAM) independently screened each record, by title and abstract, followed by full-text review. Regular discussions were held to resolve by consensus any disagreements in screening decisions. Data extraction Data extraction was randomly allocated to one of two reviewers (TD, GH), with 20% of included studies extracted independently by both reviewers to check between-reviewer reliability. A bespoke Microsoft Excel spreadsheet was used to abstract study characteristics (i.e., title, reference, publication year, study setting, aim, participant inclusion criteria, intersectional approach, data collection and analytic methodologies), and any impact of the pandemic on care-seeking. Regular discussions were organised to discuss any disagreements, and to collaborate on the creation of a consolidated set of themes with consistent labels. Quality assessment The Critical Appraisal Skills Programme (CASP) was used to assess the quality of included studies 29 across ten items: clearly-stated objective, appropriateness of using qualitative study design, justification of research design, recruitment strategy, data collection method, author reflexivity, ethical considerations, data analysis method, clear findings, and value of the findings. CASP does not assign a score, but for ease of interpretation, we assigned points to answers for each checklist item: 0 points for ‘No’, 1 for ‘Cannot tell’, and 2 for ‘Yes’. Data synthesis Meta-ethnography 30 was employed for analytic data synthesis, which is a particularly useful approach when addressing complex questions, as it enables comparison between and across published studies, and creates higher-order themes which can be newly-interpreted, based on the wealth of integrated data. 30 , 31 Syntheses can be reciprocal (studies are similar to each other and shared themes across the studies are summarised), refutational (studies refute each other and themes are juxtaposed against each other), or ‘line of argument’ (studies interpret the same phenomenon but from different aspects, the synthesis creating a whole greater than the sum of its individual parts). 31 Typically, there are four main steps, as employed by other researchers 32 , 33 , outlined below in Figure 1 : 31 – 33 Download figure Open in new tab Figure 1. Steps of meta-ethnography Intersectional approaches in included studies were considered to compare participant groups. Synthesised themes and sub-themes were mapped to one or more of the seven components of the Candidacy Framework, 19 as in Table 1 below, with the weight of each theme contributing to candidacy was calculated. View this table: View inline View popup Download powerpoint Table 1: Candidacy framework constructs Results Search and selection Of 3,098 records identified, 2,493 underwent title and abstract screening, 68 underwent full-text review, and 45 were included. 34 – 78 (see Figure S1 ). An updated search to May 2025, identified six additional records for analysis. 79 – 84 Description of included studies The 51 included studies provided data from 1,347 service-users. Studies were published between 2018-2025, from 14 countries, most commonly the USA (n=13 studies) 35 – 37 , 45 , 51 , 52 , 56 , 60 , 63 , 66 , 67 , 79 and the UK (n=13), 57 , 69 – 78 , 83 , 84 followed in frequency by Australia (n=5), 42 , 48 , 55 , 65 , 81 Norway, 46 , 49 , 68 Denmark, 44 , 61 , 62 Sweden, 34 , 47 , 50 Switzerland, 40 , 41 Netherlands, 39 , 64 New Zealand, 43 , 80 Canada, 38 Germany, 59 Israel, 54 Russia, 82 and Saudi Arabia. 58 The most common data collection method was in-depth interviews (n=34), 34 , 38 – 40 , 42 , 44 , 47 – 50 , 52 – 59 , 61 – 63 , 66 – 68 , 70 , 74 , 75 , 77 – 82 , 84 followed by focus groups (n=13), 35 – 37 , 41 , 43 , 45 , 46 , 51 , 60 , 64 , 69 , 71 , 73 surveys with open-ended questions, 65 , 72 , 76 , 83 and ethnographic observations. 69 Some studies used multiple methods (n=6). 35 , 43 , 45 , 46 , 69 , 73 Most studies utilised thematic analyses (n=31); 36 , 37 , 40 , 41 , 43 , 46 , 51 , 53 – 58 , 60 , 62 , 64 , 65 , 67 – 70 , 72 , 73 , 76 – 81 , 83 , 84 others used framework analyses (n=5), 39 , 63 , 71 , 74 , 75 content analyses (n=5), 34 , 47 , 50 , 59 , 66 grounded theory analysis (n=4), 35 , 38 , 45 , 52 interpretative phenomenological analysis, 48 , 82 systematic text condensation, 44 , 49 qualitative comparative analysis, 42 , 56 or interpretive description analysis. 67 Two studies 50 , 66 evaluated the impact of the pandemic on care-seeking experiences. Social risk factors included: being migrants, refugees, or asylum-seekers (n=18); 34 , 35 , 41 , 44 – 47 , 49 , 50 , 55 , 59 , 64 , 66 – 69 , 73 , 74 , 78 , 38 , 42 , 63 – 65 , 73 – 75 , 78 , 81 being racial, ethnic or religious minorities (n=9); 36 – 38 , 43 , 51 , 53 , 54 , 71 , 80 , 55 , 59 , 60 , 64 , 65 , 68 , 81 , 83 , 85 – 87 having medical complexity (n=9); 35 , 37 , 39 , 47 , 51 , 55 , 60 – 62 having low SES (n=8); 70 – 72 , 75 , 78 – 81 not being able to speak the local language (n=7); 40 , 50 , 53 , 56 , 57 , 59 , 65 , 84 having previous interaction with social services or child protection services (n=4); 61 , 62 , 75 , 83 having substance abuse issues (n=4); 52 , 61 , 62 , 83 , 55 , 64 , 65 , 86 having learning, intellectual, or physical disability or impairment (n=3); 76 , 80 , 83 being a victim of domestic abuse or intimate partner violence (n=3); 42 , 78 , 83 being a young mother (n=3); 78 , 80 , 83 living in a rural setting (n=3); 51 , 81 , 82 , 64 , 65 , 78 , 86 having missed or delayed antenatal care (n=2); 58 , 63 experiencing homelessness (n=2); 77 , 83 or having transgender pregnancy (n=1). 80 For further details, see Table S3 . Quality Assessment Study quality was moderate-to-high ( Table S4 ). Of a possible score of 20, all studies scored ≥14, as follows: 60 14/20 (n=2), 38 , 65 15/20 (n=4), 34 , 53 , 74 , 83 16/20 (n=4), 52 , 60 , 68 , 72 17/20 (n=15), 35 , 43 , 46 – 48 , 56 , 58 , 59 , 62 , 64 , 66 , 73 , 75 , 77 , 78 18/20 (n=13), 40 , 41 , 44 , 49 , 51 , 54 , 55 , 63 , 70 , 71 , 76 , 82 , 84 19/20 (n=5), 36 , 42 , 45 , 57 , 79 , 80 and 20/20 (n=7). 37 , 39 , 50 , 61 , 67 , 69 , 81 Those highest-scoring studies which did not reach 20/20 often fell short by missing consideration of the relationship between researchers and participants and associated ethical issues. Analytic Synthesis and Findings Figure 2 depicts the theory developed: ‘Respect, informed choice, and trust enhances candidacy whilst differences in healthcare systems, culture, and systemic barriers have the propensity to diminish it’. The 12 sub-themes were grouped into five main themes: (1) Autonomy, dignity, and personhood; (2) Informed choice and decision-making; (3) Trust in and relationship with HCP; (4) Differences in healthcare systems and cultures; and (5) Systemic factors. Excerpts of text from individual studies are presented in Table 2 to support the synthesised findings (direct participant quotations are in italics). Download figure Open in new tab Figure 2. Findings of factors affecting women’s experience of care-seeking View this table: View inline View popup Table 2. Key quotations to support thematic findings 1. Theme 1: Loss of autonomy, dignity and personhood This theme was identified in 16 studies, 34 , 37 , 41 , 44 , 45 , 54 , 58 , 62 , 66 , 70 , 75 – 78 and had two sub-themes. 1.1 Not listened to Participants expressed they were not listened to, their concerns were dismissed, or they were made to feel unintelligent and judged for asking questions. 37 Some attributed this treatment to personal characteristics, such as ethnicity. This led women to hesitate to ask further questions, attending appointments unless absolutely necessary, or engaging with maternity care overall. 77 Some were unaware of their rights and the level of care to expect and request. This made women accept poor quality-of-care and discriminatory practices as part of standard maternity care. 54 1.2 Wish to be seen as an individual Women wished to be respected and treated as individuals. They valued when effort was made to understand their background and life beyond pregnancy; 78 this often had a protective effect on care-seeking and engagement and built capacity for positive parenting and health. 75 2. Theme 2: Lack of informed choice and decision-making This theme was identified in 25 studies, 35 , 36 , 39 , 42 , 43 , 45 , 47 – 50 , 55 – 58 , 60 , 68 , 69 , 71 – 73 , 75 , 78 and had three sub-themes. 2.1 Insufficient information Women felt information was inadequate, and lacked justification for recommendations, which left them wanting more control over their care. 55 Some studies found HCPs’ own implicit bias and their perceptions of patients influenced the information they provided, so they offered only the information they deemed would be relevant for the patient. 59 Women felt it fell to them to seek-out information (via friends and family, or online sources, often unofficial 74 ), and make decisions about which recommendations to follow, although they felt those decisions were seldom fully-informed. 39 2.2 Authoritative knowledge struggle Women often faced balancing information from various sources. 69 This included differences in care between their home countries and their current healthcare system, between friends/family and HCPs, between care-providers, or between protocols in different hospitals. 57 , 69 2.3 Personalised counselling Women emphasised the value of personalised counselling by their HCP, peer support from their communities, and HCPs having the right tools to support women and families, such as knowledge of cultural practices. 42 , 73 3. Theme 3: Trust in and relationship with HCPs This theme was identified in 25 studies, 34 , 37 – 40 , 47 , 49 – 52 , 57 , 61 , 62 , 65 , 67 , 70 , 75 – 78 and had two sub-themes. 3.1 Stigma and mistrust The underserved populations studied were often already anxious about being pregnant, so trust played a particularly important role in determining if they attended appointments, disclosed their circumstances, or participated in maternity care. 57 Many had established mistrust in HCPs and institutions in general, due to prior negative interactions with social care, immigration, or law enforcement. 62 , 77 Some feared being reported and their child being removed to services, and so they did not engage honestly with maternity HCPs. 77 Women reported feeling unfit as mothers, and stigmatised when honest about social risk factors (e.g., prior drug use or homelessness). 52 , 67 3.2 Early initiation, relational care, and practical support When maternity care was initiated early and there was relational care, this built trusting relationships with HCPs and facilitated open discussions. 65 , 77 Women with mental health issues felt more likely to fully disclose during psychosocial assessments, and those with disabilities did not have to reiterate their accessibility requirements at every appointment. 65 , 77 Practical support (e.g., with baby food, blankets, or pushchairs), or emotional support when attending social care appointments helped women embrace new motherhood. 47 , 67 When they were supported in such ways, it enabled women to make long-lasting changes and prevent relapse to pre-pregnancy habits such as substance abuse. 4. Theme 4: Differences in healthcare systems and cultures This theme was identified in 21 studies, 36 – 38 , 41 , 44 , 46 , 47 , 51 , 55 – 57 , 59 , 60 , 68 – 72 , 74 and had three sub-themes. 4.1 Conceptualisation of pregnancy Studies emphasised how pregnancy is conceptualised differently by setting. In some countries, antenatal care was described as highly-medicalised, with multiple appointments and ultrasound scans. In other settings, there may be only two or three contacts throughout pregnancy, even though official guidelines and recommendations may suggest more. 41 , 59 Such differences often concerned mothers who had migrated from one country to another and altered their health literacy and ability to risk-assess their pregnancies. Some women did take on board new opportunities; when given the choice and relevant information, women from minority ethnic communities in the UK expressed a desire to have more home births. 71 4.2 Lack of cultural competency Differences in social norms around pregnancy, information shared, standard practice, role of the birth partner or other family members, and religious beliefs, greatly-influenced women’s views of the acceptability of care offered, or even the decision to attend appointments. 38 , 46 , 55 A lack of cultural understanding and respect by HCPs may have led them to perceive women’s behaviour negatively. 4.3 Systems knowledge and social capital Migrant women had trouble understanding how to access or use maternity care services in their host country, including when and how to make appointments. 36 , 46 Many such women lacked social capital, described as playing a protective role, particularly postnatally. Often, they lacked support from wider familial networks during maternity care, and in life generally, to interpret for them if they did not speak the local language. 68 5. Theme 5: Systemic barriers This theme was identified in 24 studies, 36 – 38 , 41 , 43 , 46 , 47 , 50 , 51 , 54 , 57 – 60 , 63 , 65 , 70 , 74 – 76 and had two sub-themes. 5.1 Structural inadequacies Lack of flexibility in scheduling appointments, long wait-times in hospital, and rushed appointments with HCPs, posed barriers to engagement with maternity care. 43 , 60 , 70 Studies reported poor communication between women and HCPs, due to a lack of interpreters or availability of healthcare information in other languages. Often, women resorted to methods such as Google Translate, which is not reliable for translating medical terminology, jargon, or medications. 74 For those with physical disabilities and accessibility needs, lack of relevant provision left some women feeling that they had lost their dignity. 76 Staff were reported as unaware of service users’ accessibility requirements (having not read their file beforehand), or unaccommodating. 5.2 Environmental factors Social, economic, political, and religious aspects played roles in how women from underserved groups were treated in hospital. 54 Societal prejudices and systemic discriminatory practices were reported to permeate personal care interactions. 47 In systems where care is not free-to-access at the point-of-contact (such as in the USA), even with certain health insurance plans, financial constraints deterred women from seeking care until absolutely necessary. 36 Contribution to the Candidacy Framework The 12 sub-themes of this meta-ethnography mapped onto all seven components of the Candidacy Framework, with two key observations: First, most sub-themes aligned with ‘navigation’ (n=9) and ‘permeability of services’ (n=6), which are joint and health system-level influences. Fewer connections were observed with other constructs: ‘adjudication’ (n=6), ‘local production of candidacy’ (n=3), ‘offers and resistance’ (n=2), ‘appearances at health services’ (n=5), and ‘identification’ (n=3). Second, seven sub-themes only partially mapped to existing constructs: ‘authoritative knowledge struggle’, ‘stigma and mistrust’, ‘conceptualisation of pregnancy’, ‘lack of cultural competency’, ‘systems knowledge and social capital’, ‘structural inadequacies’, and ‘environmental factors’. This was especially true for those with a migrant background, suggesting the need for two additional constructs: intercultural dissonance (individual-level) and hostile bureaucracy (health system-level). Intercultural dissonance encompasses additional barriers faced by those who are not native-born and experience a distinct difference in social norms and culture, medical and social knowledge and expectations, and language. Here, intergenerational relationships are altered by migration; for example, children (but not their parents) often speak (or speak more proficiently) the host country’s language, and are more familiar with the system, by virtue of having grown up there from a young age. As such, children take on more active roles in their parents’ healthcare decisions, such as acting as unofficial interpreters at care appointments, which may affect their parents’ ‘appearances at health services’ and ‘offers and resistance’ to care, as well as expose them to uncomfortable and potentially traumatic conversations and experiences. Hostile bureaucracy sees migrant women often subject to discriminatory policies and precarious administrative practices in the host-country as compared to their home-country. 85 These hostile, discriminatory immigration policies exist in most HICs, such as: restrictions on health coverage, welfare support, and right to rental properties; high visa application costs; and limits on qualifying employment. These policies, alongside negative societal attitude towards migrants and refugees, pose further barriers to integration into the host country, establishing a thriving life there, and accessing and engaging with healthcare. ‘Local production of candidacy’ is particularly diminished by these policies for migrant and refugee women. Figure 3 shows a visual representation of the thematic contribution of our sub-themes to the original seven and extended 7+2 components of the Candidacy framework respectively. For further details of the mapping process and candidacy framework components, see Table S5 and Table S6 respectively. Download figure Open in new tab Download figure Open in new tab Figure 3. Thematic contribution to the original and extended 7+2 Candidacy Framework respectively Discussion Main findings This systematic review identified 51 qualitative studies documenting, across 14 HICs, maternity care-seeking experiences of more than 1,300 women from minoritised and underserved groups. Twelve sub-themes emerged across five themes: (1) Loss of dignity, autonomy, and personhood; (2) Lack of informed choice and decision-making; (3) Trust in and relationships with HCPs; (4) Differences between healthcare systems and cultures; and (5) Systemic barriers. Experiences were largely negative. While sub-themes aligned with all seven components of the Candidacy Framework, most mapped to ‘navigation’, ‘permeability of services’, and ‘appearances at health services’, highlighting shared responsibility for improving care. Two new constructs— intercultural dissonance and hostile bureaucracy — emerged, particularly affecting migrants through altered intergenerational roles and exclusionary immigration policies. The meta-ethnography provided an analytic synthesis, rendering the theory: ‘Respect, informed choice, and trust enhances candidacy whilst differences in healthcare systems, culture, and systemic barriers have the propensity to diminish it’ . Comparison with the literature To our knowledge, this is the first systematic review focused exclusively on care-seeking experiences of diverse minoritised and underserved groups in HICs. Unlike our qualitative approach, most care-seeking research is quantitative, measuring attendance, visit frequency, or utilisation—often inconsistently defined 86 —and linking these to pregnancy outcomes. Frameworks like the social determinants of health (SDoH) model have been used to assess drivers of care-seeking, especially non-attendance, 19 , 25 including socio-cultural, political, and economic factors. 19 We build on a small number of reviews examining antenatal care among underserved groups (e.g., ethnic minorities, immigrants), which highlight complex barriers such as limited language skills, poor awareness of services, immigration and financial constraints, prior negative care experiences, and structural or organisational challenges. 6 , 87 , 88 This review found that care-seeking experiences were largely negative. A key issue was the lack of respectful treatment—dismissed concerns, unanswered questions, and unkind interactions—which left women feeling dehumanised. 75 , 78 , 89 Prior research in LMICs shows that disrespectful care erodes trust and delays healthcare use. 90 , 91 For women with physical disabilities, inadequate attention to accessibility worsened this, leading to a loss of dignity. 76 Stigma, discrimination, and insufficient information further undermined autonomy. 55 , 78 Quantitative studies also associate physical disability and one or more social risk factors to increased experiences of identity-related disrespect and reduced autonomy in maternity care. 92 , 93 Our work demonstrates barriers to healthcare-seeking in pregnancy are jointly-driven, based on how frequently our sub-themes map to factors within the Candidacy Framework 19 . Previous studies support this, identifying both system-level factors (e.g., organisational processes and system policies) 94 – 97 and individual-level factors (e.g., poor doctor-patient relationship, 98 stigmatisation, 99 or being dismissed). 100 Improving care engagement for underserved women requires joint negotiation and co-production of services—such as the UK’s Maternity and Neonatal Voices Partnerships (MNVPs). The limited literature speaking to the constructs of the Candidacy Framework: ‘offers and resistance’ and ‘identification’ – joint- and individual-level factors – often places blame on women for low engagement attributing it to poor health literacy, 57 problematising their language skils, 101 , 102 and further stigmatising this already marginalised population. A unique contribution of our study is the identification of intercultural dissonance and hostile bureaucracy as additions to the Candidacy Framework, reflecting the lasting and intergenerational effects of migration on care-seeking, including during pregnancy. Events of the last decade have emphasised the underserved nature of this population which has grown exponentially in the recent past due to various humanitarian crises. Differences in healthcare systems and cultures between ‘home’ countries and ‘host’ countries, significantly shape decisions about when and how to seek care, navigate services, and act on medical advice. 69 This can lead to an authoritative knowledge struggle , where contradictory information, 59 , 103 may cause women to disengage from care altogether. 44 Additionally, psychological research highlights how generational trauma and inherited knowledge influence wellbeing and behaviour. 104 A UK review of eight studies on asylum-seeking women identified barriers such as poor awareness of services, communication struggles, and stigma but did not explore how differing healthcare norms affect maternity experiences. 97 Our meta-ethnographic approach, being generative and interpretive, was likely more attuned to these dynamics. While our synthesis identifies common themes in migrant women’s experiences, the 13 HICs represented (e.g., UK, USA, Saudi Arabia) vary widely in healthcare models, migrant entitlements, and cultural expectations. For instance, healthcare fees in the US or restrictions on undocumented migrants in Europe may intensify systemic barriers compared to countries with universal access. These structural and cultural differences affect the transferability of findings, particularly in relation to how barriers manifest and are addressed. Tools such as the WHO Health Financing Progress Matrix or Migrant Integration Policy Index which examines how well a country’s health financing policies align with achieving universal coverage, 105 and policies to integrate migrants and other marginalised groups into society 106 respectively show marked difference between our 14 included countries. Only two countries (Sweden and Canada) ranked highly in both assessments. Such factors are likely to influence care-seeking behaviour, shaping the relevance of our findings. Additionally, while our sample includes a diverse group of marginalised communities with several complex social risk factors, only two 54 , 80 of the 51 studies consider the idea of intersectionality. It has now been well-established that individuals with multiple marginalised identities face compounded barriers to care access and utilisation, 107 and future research is crucial to understanding these unique intersections of disadvantage. Strengths, limitations, and future directions A key strength of our review is the use of meta-ethnography, allowing us to build on themes from individual studies—all of which were of moderate-to-high quality—and identify gaps in existing theory. Notably, we highlight the multi-generational impact of immigration on care-seeking as a missing component of the Candidacy Framework, supporting its expansion. Our focus on women’s care-seeking excluded perspectives of fathers, partners, non-gestational parents, providers, and policymakers. While we observed similarities across groups and countries, we may have missed group-specific or system-level differences, which we plan to explore further. A planned sub-group analysis on the pandemic’s impact was not possible due to limited studies; questions remain on how service reconfigurations and misinformation shaped care-seeking during this time and will be explored by is in future qualitative work. Future research should also examine the roles of families, professionals, and health systems, and empirically validate the proposed construct of intercultural dissonance. Conclusion In HICs, maternity care-seeking is a joint responsibility between service-users and service-providers. As such, interventions to remove barriers to care-seeking should be co-produced through collaborative means between stakeholders. Efforts to improve utilisation of, and engagement with, antenatal care services should prioritise alleviating system-level barriers. We suggest an expansion of the Candidacy Framework to include two further dimensions which reflect the multigenerational effect of migration on care experience and the often hostile and precarious bureaucratic environment in which women find themselves when attempting to seek maternity care. Data Availability Not applicable- this is a systematic review. Declarations Patient and Public Engagement and Involvement (PPIE) The study was reviewed by an established PPIE group at the NIHR Applied Research Collaboration [ARC] in South London, to ensure coherence with service users’ lived experience and ensuring relevance of the research question and search criteria. The study PPIE advisory group (YB,MP) have been involved in editing and review of this manuscript. Ethics approval and consent to participate Not applicable. Consent to publication Not applicable. Availability of data and materials Not applicable. Competing Interests None to declare. Funding Tisha Dasgupta is in receipt of an Economic and Social Research Council [ESRC] doctoral training fellowship from the London Interdisciplinary Social Science Doctoral Training Partnership [LISS DTP], (ES/P000703/1). Hannah Rayment-Jones is funded by a NIHR Advanced Fellowship (NIHR 303183). Author contributions Conceptualization: TD, HRJ, LAM, SAS; Data curation: TD, HRJ; Formal analysis: TD, GH, HRJ; Funding acquisition: TD; Investigation: TD, HRJ, SAS, LAM; Methodology: TD, SAS; Project administration: TD; Software: TD, GH; Resources: LAM, HRJ, SAS; Supervision: LAM, HRJ, SAS; Validation: TD, HRJ, SAS, LAM, YB, MP; Visualization: TD, HRJ; Writing – original draft: TD; Writing – review & editing: SAS, LAM, HRJ, GH, YB, MP Authors’ information The ENGAGE Study, to which this systematic review contributes, has been adopted by the National Institute for Health and Care Research Applied Research Collaboration South London [NIHR ARC South London] at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. During the preparation of this work the author(s) used ChatGPT in order to make the manuscript more concise and reduce words. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication. Abbreviations UK United Kingdom HIC High-income country LMIC Low- and middle-income country HCP Healthcare professional SES Socioeconomic status USA United States of America WHO World Health Organization SDoH Social determinants of Health CASP Critical Appraisal Skills Programme IPV Intimate partner violence References 1. ↵ World Health Organization . WHO recommendations on antenatal care for a positive pregnancy experience . 2016 . 2. ↵ Tunçalp , Pena-Rosas JP , Lawrie T , Bucagu M , Oladapo OT , Portela A , et al. WHO recommendations on antenatal care for a positive pregnancy experience—going beyond survival . BJOG . 2017 May 1 ; 124 ( 6 ): 860 – 2 . OpenUrl CrossRef PubMed 3. ↵ Stacey T , Thompson JMD , Mitchell EA , Zuccollo JM , Ekeroma AJ , McCowan LME . Antenatal care, identification of suboptimal fetal growth and risk of late stillbirth: Findings from the Auckland Stillbirth Study . Australian and New Zealand Journal of Obstetrics and Gynaecology [Internet] . 2012 Jun 1 [cited 2024 May 22 ]; 52 ( 3 ): 242 – 7 . Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1479-828X.2011.01406.x OpenUrl 4. ↵ Kuhnt J , Vollmer S . Antenatal care services and its implications for vital and health outcomes of children: Evidence from 193 surveys in 69 low-income and middle-income countries . BMJ Open . 2017 Nov 1 ; 7 ( 11 ). 5. ↵ Sarikhani Y , Najibi SM , Razavi Z . Key barriers to the provision and utilization of maternal health services in low-and lower-middle-income countries; a scoping review . BMC Womens Health . 2024 Dec 1 ; 24 ( 1 ). 6. ↵ Downe S , Finlayson K , Tunçalp Ö , Gülmezoglu AM . Provision and uptake of routine antenatal services: A qualitative evidence synthesis . Cochrane Database of Systematic Reviews . 2019 Jun 12 ; 2019 ( 6 ). 7. Mamrath S , Greenfield M , Turienzo CF , Fallon V , Silverio SA . Experiences of postpartum anxiety during the COVID-19 pandemic: A mixed methods study and demographic analysis . PLoS One [Internet] . 2024 Mar 1 [cited 2024 Jul 17 ]; 19 ( 3 ): e0297454 . Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0297454 OpenUrl 8. ↵ Redshaw M , Heikkila K . Delivered with care: Delivered with care: a national survey of women’s experience of maternity care 2010 . 2010 . 9. ↵ Escañuela Sánchez T , Linehan L , O’Donoghue K , Byrne M , Meaney S . Facilitators and barriers to seeking and engaging with antenatal care in high-income countries: A meta-synthesis of qualitative research . Health Soc Care Community . 2022 Nov 1 ; 30 ( 6 ): e3810 – 28 . OpenUrl 10. ↵ Peterson L , Bridle L , Dasgupta T , Easter A , Ghobrial S , Ishlek I , et al. Oscillating autonomy: A grounded theory study of women’s experiences of COVID-19 infection during pregnancy, labour and birth, and the early postnatal period . BMC Pregnancy Childbirth [Internet] . 2024 Jul 8 [cited 2024 Jul 17 ]; Available from: https://kclpure.kcl.ac.uk/portal/en/publications/oscillating-autonomy-a-grounded-theory-study-of-womens-experience 11. ↵ Jackson L , Greenfield M , Payne E , Burgess K , Oza M , Storey C , et al. A consensus statement on perinatal mental health during the COVID-19 pandemic and recommendations for post-pandemic recovery and re-build . Front Glob Womens Health . 2024 Feb 21 ; 5 : 1347388 . OpenUrl 12. ↵ Silverio SA , Harris EJ , Jackson L , Fallon V , Easter A , Dadelszen P von , et al. Freedom for some, but not for Mum: the reproductive injustice associated with pandemic ‘Freedom Day’ for perinatal women in the United Kingdom . Front Public Health . 2024 ; 12 . 13. ↵ Montgomery E , De Backer K , Easter A , Magee LA , Sandall J , Silverio SA . Navigating uncertainty alone: A grounded theory analysis of women’s psycho-social experiences of pregnancy and childbirth during the COVID-19 pandemic in London . Women and Birth . 2023 Feb 1 ; 36 ( 1 ): e106 – 17 . OpenUrl 14. ↵ Jardine J , Relph S , Magee LA , von Dadelszen P , Morris E , Ross-Davie M , et al. Maternity services in the UK during the coronavirus disease 2019 pandemic: a national survey of modifications to standard care . BJOG [Internet] . 2021 Apr 1 [cited 2023 Jul 7 ]; 128 ( 5 ): 880 – 9 . Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.16547 OpenUrl 15. Bridle L , Walton L , van der Vord T , Adebayo O , Hall S , Finlayson E , et al. Supporting Perinatal Mental Health and Wellbeing during COVID-19 . Int J Environ Res Public Health . 2022 Feb 4 ; 19 ( 3 ): 1777 . OpenUrl 16. Dasgupta T , Horgan G , Peterson L , Mistry HD , Balls E , Wilson M , et al. Women’s experiences of maternity care in the United Kingdom during the COVID-19 pandemic: A follow-up systematic review and qualitative evidence synthesis . Women and Birth . 2024 ; 37 ( 3 ). 17. Jackson L , De Pascalis L , Harrold JA , Fallon V , Silverio SA . Postpartum women’s experiences of social and healthcare professional support during the COVID-19 pandemic: A recurrent cross-sectional thematic analysis . Women and Birth . 2022 Sep 1 ; 35 ( 5 ): 511 – 20 . OpenUrl 18. ↵ Silverio SA , De Backer K , Easter A , von Dadelszen P , Magee LA , Sandall J . Women’s experiences of maternity service reconfiguration during the COVID-19 pandemic: A qualitative investigation . Midwifery . 2021 Nov 1 ; 102 : 103116 . 19. ↵ Dixon-Woods M , Cavers D , Agarwal S , Annandale E , Arthur A , Harvey J , et al. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups . BMC Med Res Methodol [Internet] . 2006 Jul 26 [cited 2022 Nov 4 ]; 6 ( 1 ): 1 – 13 . Available from: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-6-35 OpenUrl 20. ↵ Tookey S , Renzi C , Waller J , Von Wagner C , Whitaker KL . Using the candidacy framework to understand how doctor-patient interactions influence perceived eligibility to seek help for cancer alarm symptoms: A qualitative interview study . BMC Health Serv Res [Internet] . 2018 Dec 4 [cited 2025 Jun 13 ]; 18 ( 1 ): 1 – 8 . Available from: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3730-5 OpenUrl 21. Koehn S . Negotiating candidacy: ethnic minority seniors’ access to care . Ageing Soc [Internet] . 2009 [cited 2025 Jun 13 ]; 29 ( 4 ): 585 – 608 . Available from: https://www.cambridge.org/core/journals/ageing-and-society/article/abs/negotiating-candidacy-ethnic-minority-seniors-access-to-care/EF7CC467B08637DDE2D72680FE5EA04B OpenUrl 22. Mackenzie M , Conway E , Hastings A , Munro M , O’Donnell C . Is ‘Candidacy’ a Useful Concept for Understanding Journeys through Public Services? A Critical Interpretive Literature Synthesis . Soc Policy Adm [Internet] . 2013 Dec 1 [cited 2025 Jun 13 ]; 47 ( 7 ): 806 – 25 . Available from: /doi/pdf/10.1111/j.1467-9515.2012.00864.x OpenUrl 23. Liberati E , Richards N , Parker J , Willars J , Scott D , Boydell N , et al. Qualitative study of candidacy and access to secondary mental health services during the COVID-19 pandemic . Soc Sci Med [Internet] . 2022 Mar 1 [cited 2025 Jun 13 ]; 296 : 114711 . Available from: https://www.sciencedirect.com/science/article/pii/S0277953622000144#bib8 OpenUrl 24. ↵ Rayment-Jones H , Silverio SA , Harris J , Harden A , Sandall J . Project 20: Midwives’ insight into continuity of care models for women with social risk factors: what works, for whom, in what circumstances, and how . Midwifery . 2020 May 1 ; 84 : 102654 . OpenUrl PubMed 25. ↵ Hinton L , Kuberska K , Dakin F , Boydell N , Martin G , Draycott T , et al. A qualitative study of the dynamics of access to remote antenatal care through the lens of candidacy . J Health Serv Res Policy . 2023 Oct 1 ; 28 ( 4 ): 222 – 32 . OpenUrl CrossRef PubMed 26. ↵ Page MJ , McKenzie JE , Bossuyt PM , Boutron I , Hoffmann TC , Mulrow CD , et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews . Syst Rev [Internet] . 2021 Dec 1 [cited 2023 Sep 16 ]; 10 ( 1 ). Available from: https://pubmed.ncbi.nlm.nih.gov/33781348/ 27. ↵ Tisha Dasgupta - LISS DTP [Internet] . [cited 2025 Jan 17 ]. Available from: https://liss-dtp.ac.uk/students/tisha-dasgupta/ 28. ↵ Ouzzani M , Hammady H , Fedorowicz Z , Elmagarmid A . Rayyan—a web and mobile app for systematic reviews . Syst Rev . 2016 Dec 5 ; 5 ( 1 ): 210 . OpenUrl CrossRef PubMed 29. ↵ Critical Appraisal Skills Programme . CASP Qualitative Checklist [Internet] . 2018 [cited 2024 May 22 ]. Available from: https://casp-uk.net/checklists/casp-qualitative-studies-checklist-fillable.pdf 30. ↵ W.Noblit G , DwightHare R. Meta-Ethnography . Meta-Ethnography . 1988 May 18 ; 31. ↵ Sattar R , Lawton R , Panagioti M , Johnson J . Meta-ethnography in healthcare research: a guide to using a meta-ethnographic approach for literature synthesis . [ cited 2024 May 13 ]; Available from : doi: 10.1186/s12913-020-06049-w OpenUrl CrossRef 32. ↵ Britten N , Campbell R , Pope C , Donovan J , Morgan M , Pill R . Using meta ethnography to synthesise qualitative research: A worked example . J Health Serv Res Policy [Internet] . 2002 Oct [cited 2025 May 10 ]; 7 ( 4 ): 209 – 15 . Available from: /doi/pdf/10.1258/135581902320432732?download=true OpenUrl 33. ↵ Malpass A , Shaw A , Sharp D , Walter F , Feder G , Ridd M , et al. “Medication career” or “Moral career”? The two sides of managing antidepressants: A meta-ethnography of patients’ experience of antidepressants. Soc Sci Med [Internet] . 2009 Jan 1 [cited 2025 May 10 ]; 68 ( 1 ): 154 – 68 . Available from: https://www.sciencedirect.com/science/article/pii/S0277953608005133?via%3Dihub#sec2 OpenUrl 34. ↵ Barkensjö M , Greenbrook JTV , Rosenlundh J , Ascher H , Elden H . The need for trust and safety inducing encounters: A qualitative exploration of women’s experiences of seeking perinatal care when living as undocumented migrants in Sweden . BMC Pregnancy Childbirth [Internet] . 2018 Jun 7 [cited 2024 Jul 17 ]; 18 ( 1 ): 1 – 17 . Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1851-9 OpenUrl 35. ↵ Tesfalul MA , Feuer SK , Castillo E , Coleman-Phox K , O’Leary A , Kuppermann M . Patient and provider perspectives on preterm birth risk assessment and communication . Patient Educ Couns [Internet] . 2021 Nov 1 [cited 2024 Jul 17 ]; 104 ( 11 ): 2814 – 23 . Available from: https://pubmed.ncbi.nlm.nih.gov/33892976/ OpenUrl 36. ↵ Ayers BL , Purvis RS , Bing WI , Rubon-Chutaro J , Hawley NL , Delafield R , et al. Structural and Socio-cultural Barriers to Prenatal Care in a US Marshallese Community . Matern Child Health J [Internet] . 2018 Jul 1 [cited 2024 Jul 17 ]; 22 ( 7 ): 1067 – 76 . Available from: https://link.springer.com/article/10.1007/s10995-018-2490-5 OpenUrl 37. ↵ McLemore MR , Altman MR , Cooper N , Williams S , Rand L , Franck L . Health care experiences of pregnant, birthing and postnatal women of color at risk for preterm birth . Soc Sci Med . 2018 Mar 1 ; 201 : 127 – 35 . OpenUrl CrossRef PubMed 38. ↵ Vang ZM , Gagnon R , Lee T , Jimenez V , Navickas A , Pelletier J , et al. Interactions Between Indigenous Women Awaiting Childbirth Away From Home and Their Southern, Non-Indigenous Health Care Providers . doi: 10.1177/1049732318792500 [Internet] . 2018 Aug 10 [cited 2024 Jul 17 ]; 28 ( 12 ): 1858 – 70 . Available from: https://journals.sagepub.com/doi/10.1177/1049732318792500 OpenUrl CrossRef 39. ↵ Holten L , Hollander M , de Miranda E . When the Hospital Is No Longer an Option: A Multiple Case Study of Defining Moments for Women Choosing Home Birth in High-Risk Pregnancies in The Netherlands . Qual Health Res [Internet] . 2018 Oct 1 [cited 2024 Jul 17 ]; 28 ( 12 ): 1883 – 96 . Available from: https://journals.sagepub.com/doi/10.1177/1049732318791535 OpenUrl 40. ↵ Origlia Ikhilor P , Hasenberg G , Kurth E , Asefaw F , Pehlke-Milde J , Cignacco E . Communication barriers in maternity care of allophone migrants: Experiences of women, healthcare professionals, and intercultural interpreters . J Adv Nurs [Internet] . 2019 Oct 1 [cited 2024 Jul 17 ]; 75 ( 10 ): 2200 – 10 . Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jan.14093 OpenUrl 41. ↵ Sami J , Lötscher KCQ , Eperon I , Gonik L , De Tejada BM , Epiney M , et al. Giving birth in Switzerland: A qualitative study exploring migrant women’s experiences during pregnancy and childbirth in Geneva and Zurich using focus groups . Reprod Health [Internet] . 2019 Jul 22 [cited 2024 Jul 17 ]; 16 ( 1 ): 1 – 9 . Available from: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-019-0771-0 OpenUrl 42. ↵ Spangaro J , Koziol-McLain J , Rutherford A , Zwi AB . “Made Me Feel Connected”: A Qualitative Comparative Analysis of Intimate Partner Violence Routine Screening Pathways to Impact . doi: 10.1177/1077801219830250 [Internet] . 2019 Mar 14 [cited 2024 Jul 17 ]; 26 ( 3–4 ): 334 – 58 . Available from: https://journals.sagepub.com/doi/10.1177/1077801219830250 OpenUrl CrossRef 43. ↵ Holden G , Corter AL , Hatters-Friedman S , Soosay I. Brief Report. A qualitative study of maternal mental health services in New Zealand: Perspectives of Māori and Pacific mothers and midwives . Asia-Pacific Psychiatry [Internet] . 2019 Jun 1 [cited 2024 Jul 17 ]; 12 ( 2 ): e12369 . Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/appy.12369 OpenUrl 44. ↵ Johnsen H , Christensen U , Juhl M , Villadsen SF . Contextual Factors Influencing the MAMAACT Intervention: A Qualitative Study of Non-Western Immigrant Women’s Response to Potential Pregnancy Complications in Everyday Life . International Journal of Environmental Research and Public Health 2020, Vol 17, Page 1040 [Internet] . 2020 Feb 6 [cited 2024 Jul 17 ]; 17 ( 3 ): 1040 . Available from: https://www.mdpi.com/1660-4601/17/3/1040/htm OpenUrl 45. ↵ Decker MJ , Pineda N , Gutmann-Gonzalez A , Brindis CD . Youth-centered maternity care: a binational qualitative comparison of the experiences and perspectives of Latina adolescents and healthcare providers . BMC Pregnancy Childbirth [Internet] . 2021 Dec 1 [cited 2024 Jul 17 ]; 21 ( 1 ): 1 – 12 . Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03831-4 OpenUrl 46. ↵ Bains S , Skråning S , Sundby J , Vangen S , Sørbye IK , Lindskog B V . Challenges and barriers to optimal maternity care for recently migrated women - a mixed-method study in Norway . BMC Pregnancy Childbirth [Internet] . 2021 Dec 1 [cited 2024 Jul 17 ]; 21 ( 1 ): 1 – 14 . Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-04131-7 OpenUrl 47. ↵ Hjelm K , Bard K , Apelqvist J . A qualitative study of developing beliefs about health, illness and healthcare in migrant African women with gestational diabetes living in Sweden . BMC Womens Health [Internet] . 2018 Feb 5 [cited 2024 Jul 17 ]; 18 ( 1 ): 1 – 14 . Available from: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0518-z OpenUrl 48. ↵ Nottingham-Jones J , Simmonds JG , Snell TL . First-time mothers’ experiences of preparing for childbirth at advanced maternal age . Midwifery . 2020 Jul 1 ; 86 : 102558 . 49. ↵ Utne R , Antrobus-Johannessen CL , Aasheim V , Aaseskjær K , Vik ES . Somali women’s experiences of antenatal care: A qualitative interview study . Midwifery . 2020 Apr 1 ; 83 : 102656 . 50. ↵ Bitar D , Oscarsson M . Arabic-speaking women’s experiences of communication at antenatal care in Sweden using a tablet application—Part of development and feasibility study . Midwifery . 2020 May 1 ; 84 : 102660 . OpenUrl 51. ↵ Oza-Frank R , Conrey E , Bouchard J , Shellhaas C , Weber MB . Healthcare Experiences of Low-Income Women with Prior Gestational Diabetes . Matern Child Health J [Internet] . 2018 Jul 1 [cited 2024 Jul 17 ]; 22 ( 7 ): 1059 – 66 . Available from: https://link.springer.com/article/10.1007/s10995-018-2489-y OpenUrl 52. ↵ Byatt N , Straus J , Stopa A , Biebel K , Mittal L , Simas TAM . Massachusetts Child Psychiatry Access Program for Moms: Utilization and Quality Assessment . Obstetrics and Gynecology [Internet] . 2018 [cited 2024 Jul 17 ]; 132 ( 2 ): 345 – 53 . Available from: https://journals.lww.com/greenjournal/fulltext/2018/08000/massachusetts_child_psychiatry_access_program_for.11.aspx OpenUrl 53. ↵ Drago MJ , Guillén U , Schiaratura M , Batza J , Zygmunt A , Mowes A , et al. Constructing a Culturally Informed Spanish Decision-Aid to Counsel Latino Parents Facing Imminent Extreme Premature Delivery . Matern Child Health J [Internet] . 2018 Jul 1 [cited 2024 Jul 17 ]; 22 ( 7 ): 950 – 7 . Available from: https://link.springer.com/article/10.1007/s10995-018-2471-8 OpenUrl 54. ↵ Daoud N , Abu-Hamad S , Berger-Polsky A , Davidovitch N , Orshalimy S . Mechanisms for racial separation and inequitable maternal care in hospital maternity wards . Soc Sci Med . 2022 Jan 1 ; 292 : 114551 . OpenUrl 55. ↵ Wah YYE , McGill M , Wong J , Ross GP , Harding AJ , Krass I . Self-management of gestational diabetes among Chinese migrants: A qualitative study . Women and Birth . 2019 Feb 1 ; 32 ( 1 ): e17 – 23 . OpenUrl 56. ↵ Farewell C V. , Jewell J , Walls J , Leiferman JA. A Mixed-Methods Pilot Study of Perinatal Risk and Resilience During COVID-19 . J Prim Care Community Health [Internet] . 2020 Jul 16 [cited 2024 Jul 17 ]; 11 . Available from: https://journals.sagepub.com/doi/10.1177/2150132720944074 57. ↵ Savory NA , Hannigan B , Sanders J . Women’s experience of mild to moderate mental health problems during pregnancy, and barriers to receiving support . Midwifery . 2022 May 1 ; 108 : 103276 . OpenUrl 58. ↵ Alanazy W , Rance J , Brown A . Exploring maternal and health professional beliefs about the factors that affect whether women in Saudi Arabia attend antenatal care clinic appointments . Midwifery . 2019 Sep 1 ; 76 : 36 – 44 . OpenUrl 59. ↵ Henry J , Beruf C , Fischer T . Access to Health Care for Pregnant Arabic-Speaking Refugee Women and Mothers in Germany . Qualitatiive Health Research [Internet] . 2019 Sep 18 [cited 2024 Jul 17 ]; 30 ( 3 ): 437 – 47 . Available from: https://journals.sagepub.com/doi/10.1177/1049732319873620 OpenUrl 60. ↵ Barkin JL , Bloch JR , Smith KER , Telliard SN , McGreal A , Sikes C , et al. Knowledge of and Attitudes Toward Perinatal Home Visiting in Women with High-Risk Pregnancies . J Midwifery Womens Health [Internet] . 2021 Mar 1 [cited 2024 Jul 17 ]; 66 ( 2 ): 227 – 32 . Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jmwh.13204 OpenUrl 61. ↵ Frederiksen MS , Schmied V , Overgaard C . Living With Fear: Experiences of Danish Parents in Vulnerable Positions During Pregnancy and in the Postnatal Period . Qual Health Res [Internet] . 2021 Jan 10 [cited 2024 Jul 17 ]; 31 ( 3 ): 564 – 77 . Available from: https://journals.sagepub.com/doi/10.1177/1049732320978206 OpenUrl 62. ↵ Frederiksen MS , Schmied V , Overgaard C . Supportive encounters during pregnancy and the postnatal period: An ethnographic study of care experiences of parents in a vulnerable position . J Clin Nurs [Internet] . 2021 Aug 1 [cited 2024 Jul 17 ]; 30 ( 15–16 ): 2386 – 98 . Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.15778 OpenUrl 63. ↵ Reid CN , Fryer K , Cabral N , Marshall J . Health care system barriers and facilitators to early prenatal care among diverse women in Florida . Birth [Internet] . 2021 Sep 1 [cited 2024 Jul 17 ]; 48 ( 3 ): 416 – 27 . Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/birt.12551 OpenUrl 64. ↵ (Fontein)Kuipers YJ , Mestdagh E . The experiential knowledge of migrant women about vulnerability during pregnancy: A woman-centred mixed-methods study . Women and Birth . 2022 Feb 1 ; 35 ( 1 ): 70 – 9 . OpenUrl 65. ↵ Mule V , Reilly NM , Schmied V , Kingston D , Austin MP V . Why do some pregnant women not fully disclose at comprehensive psychosocial assessment with their midwife? Women and Birth . 2022 Feb 1 ; 35 ( 1 ): 80 – 6 . OpenUrl 66. ↵ McClellan C , Madler B . Lived Experiences of Mongolian Immigrant Women Seeking Perinatal Care in the United States . doi: 10.1177/10436596221091689 [Internet] . 2022 May 10 [cited 2024 Jul 17 ]; 33 ( 5 ): 594 – 602 . Available from: https://journals.sagepub.com/doi/10.1177/10436596221091689?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed OpenUrl CrossRef 67. ↵ Njenga A . Somali Refugee Women’s Experiences and Perceptions of Western Health Care . Journal of Transcultural Nursing [Internet] . 2022 Oct 5 [cited 2024 Jul 17 ]; 34 ( 1 ): 8 – 13 . Available from: https://journals.sagepub.com/doi/10.1177/10436596221125893 OpenUrl 68. ↵ Mehrara L , Olaug Gjernes TK , Young S . Immigrant women’s experiences with Norwegian maternal health services: implications for policy and practice . Int J Qual Stud Health Well-being [Internet] . 2022 Dec 31 [cited 2024 Jul 17 ]; 17 ( 1 ). Available from: https://www.tandfonline.com/doi/abs/10.1080/17482631.2022.2066256 69. ↵ Goodwin L , Hunter B , Jones A . The midwife–woman relationship in a South Wales community: Experiences of midwives and migrant Pakistani women in early pregnancy . Health Expect [Internet] . 2018 Feb 1 [cited 2024 Jul 17 ]; 21 ( 1 ): 347 . Available from: /pmc/articles/PMC5750740/ OpenUrl 70. ↵ Wilson R , Paterson P , Larson HJ . Strategies to improve maternal vaccination acceptance . BMC Public Health [Internet] . 2019 Mar 25 [cited 2024 Jul 17 ]; 19 ( 1 ). Available from: /pmc/articles/PMC6434850/ 71. ↵ Naylor Smith J , Taylor B , Shaw K , Hewison A , Kenyon S . “ I didn’t think you were allowed that, they didn’t mention that .” A qualitative study exploring women’s perceptions of home birth. BMC Pregnancy Childbirth [Internet] . 2018 Apr 18 [cited 2024 Jul 17 ]; 18 ( 1 ): 1 – 11 . Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1733-1 OpenUrl 72. ↵ Husain F , Powys VR , White E , Jones R , Goldsmith LP , Heath PT , et al. COVID-19 vaccination uptake in 441 socially and ethnically diverse pregnant women . PLoS One [Internet] . 2022 Aug 1 [cited 2024 Jul 17 ]; 17 ( 8 ). Available from: /pmc/articles/PMC9385003/ 73. ↵ Stacey T , Haith-Cooper M , Almas N , Kenyon C . An exploration of migrant women’s perceptions of public health messages to reduce stillbirth in the UK: a qualitative study . BMC Pregnancy Childbirth [Internet] . 2021 Dec 1 [cited 2024 Jul 17 ]; 21 ( 1 ): 1 – 9 . Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03879-2 OpenUrl 74. ↵ Gong Q (Sarah) S , Bharj K. A qualitative study of the utilisation of digital resources in pregnant Chinese migrant women’s maternity care in northern England . Midwifery . 2022 Dec 1 ; 115 : 103493 . OpenUrl 75. ↵ Balaam MC , Thomson G . Building capacity and wellbeing in vulnerable/marginalised mothers: A qualitative study . Women and Birth . 2018 Oct 1 ; 31 ( 5 ): e341 – 7 . OpenUrl 76. ↵ Hall J , Hundley V , Collins B , Ireland J . Dignity and respect during pregnancy and childbirth: A survey of the experience of disabled women . BMC Pregnancy Childbirth [Internet] . 2018 Aug 13 [cited 2024 Jul 17 ]; 18 ( 1 ): 1 – 13 . Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1950-7 OpenUrl 77. ↵ Gordon ACT , Burr J , Lehane D , Mitchell C . Influence of past trauma and health interactions on homeless women’s views of perinatal care: a qualitative study . The British Journal of General Practice [Internet] . 2019 [cited 2024 Jul 17 ]; 69 ( 688 ): e760 . Available from: /pmc/articles/PMC6733590/ OpenUrl 78. ↵ McLeish J , Redshaw M . Maternity experiences of mothers with multiple disadvantages in England: A qualitative study . Women and Birth . 2019 Apr 1 ; 32 ( 2 ): 178 – 84 . OpenUrl 79. ↵ George EK , Dominique S , Irie W , Edmonds JK . “It’s my Home away from Home:” A hermeneutic phenomenological study exploring decision-making experiences of choosing a freestanding birth centre for perinatal care . Midwifery [Internet] . 2024 Dec 1 [cited 2025 May 24 ]; 139 : 104164 . Available from: https://www.sciencedirect.com/science/article/pii/S026661382400247X?via%3Dihub OpenUrl 80. ↵ Parker G , Miller S , Ker A , Baddock S , Kerekere E , Veale J . “Let All Identities Bloom, Just Let Them Bloom”: Advancing Trans-Inclusive Perinatal Care Through Intersectional Analysis . Qual Health Res [Internet] . 2025 Apr 1 [cited 2025 May 24 ]; 35 ( 4–5 ): 403 – 17 . Available from: https://scholar.google.com/scholar_url?url= https://journals.sagepub.com/doi/pdf/10.1177/10497323241309590&hl=en&sa=T&oi=ucasa&ct=usl&ei=JQ8yaIXxHeW16rQPsqVy&scisig=AAZF9b_Twrdk22B-j7aJ0SceLajy OpenUrl 81. ↵ Faulks F , Shafiei T , Mogren I , Edvardsson K . “It’s just too far…”: A qualitative exploration of the barriers and enablers to accessing perinatal care for rural Australian women . Women and Birth [Internet] . 2024 Nov 1 [cited 2025 May 24 ]; 37 ( 6 ): 101809 . Available from: https://www.sciencedirect.com/science/article/pii/S1871519224002695?via%3Dihub OpenUrl 82. ↵ Nechaeva E , Kharkova O , Postoev V , Grjibovski AM , Darj E , Odland JØ . Awareness of postpartum depression among midwives and pregnant women in Arkhangelsk , Arctic Russia. Glob Health Action [Internet] . 2024 [cited 2025 May 24 ]; 17 ( 1 ): 2354008 . Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11149570/ OpenUrl 83. ↵ Pierce P , Whitten M , Hillman S . The impact of digital healthcare on vulnerable pregnant women: A review of the use of the MyCare app in the maternity department at a central London tertiary unit . Front Digit Health . 2023 Apr 21 ; 5 : 1155708 . OpenUrl 84. ↵ Yuill C , Sinesi A , Meades R , Williams LR , Delicate A , Cheyne H , et al. Women’s experiences and views of routine assessment for anxiety in pregnancy and after birth: A qualitative study . Br J Health Psychol [Internet] . 2024 Nov 1 [cited 2025 May 24 ]; 29 ( 4 ). Available from: https://pubmed.ncbi.nlm.nih.gov/38955505/ 85. ↵ Tuckett A . Rules, Paper, Status Migrants and Precarious Bureaucracy in Contemporary Italy . Stanford University Press ; 2018 . 86. ↵ Mackian S , Bedri N , Lovel H . Up the garden path and over the edge: where might health-seeking behaviour take us? Health Policy Plan [Internet] . 2004 May 1 [cited 2022 Jan 23 ]; 19 ( 3 ): 137 – 46 . Available from: https://academic.oup.com/heapol/article/19/3/137/774112 OpenUrl 87. ↵ Sharma E , Tseng PC , Harden A , Li L , Puthussery S . Ethnic minority women’s experiences of accessing antenatal care in high income European countries: a systematic review . BMC Health Serv Res . 2023 ; 23 : 612 . OpenUrl 88. ↵ Higginbottom G , Evans C , Morgan M , Bharj K , Eldridge J , Hussain B . Experience of and access to maternity care in the United Kingdom (UK) by immigrant women: a narrative synthesis systematic review . 2019 ; 89. ↵ Silverio SA , Varman N , Barry Z , Khazaezadeh N , Rajasingam D , Magee LA , et al. Inside the ‘imperfect mosaic’: Minority ethnic women’s qualitative experiences of race and ethnicity during pregnancy, childbirth, and maternity care in the United Kingdom . BMC Public Health . 2023 Dec 21 ; 23 ( 1 ): 2555 . OpenUrl 90. ↵ Puthussery S , Bayih WA , Brown H , Aborigo RA . Promoting a global culture of respectful maternity care . BMC Pregnancy Childbirth [Internet] . 2023 Dec 1 [cited 2024 Sep 9 ]; 23 ( 1 ): 1 – 3 . Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-06118-y OpenUrl 91. ↵ Bohren MA , Hunter EC , Munthe-Kaas HM , Souza JP , Vogel JP , Gülmezoglu AM . Facilitators and barriers to facility-based delivery in low- and middle-income countries: A qualitative evidence synthesis . Reprod Health [Internet] . 2014 Sep 19 [cited 2024 Sep 9 ]; 11 ( 1 ): 1 – 17 . Available from: https://link.springer.com/articles/10.1186/1742-4755-11-71 OpenUrl 92. ↵ Glover A , Holman C , Boise P . Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice . BMC Pregnancy Childbirth [Internet] . 2024 Dec 1 [cited 2024 Sep 9 ]; 24 ( 1 ): 1 – 13 . Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-024-06491-2 OpenUrl 93. ↵ Rayment-Jones H , Dalrymple K , Harris JM , Harden A , Parslow E , Georgi T , et al. Project20: maternity care mechanisms that improve access and engagement for women with social risk factors in the UK – a mixed-methods, realist evaluation . BMJ Open . 2023 Feb 7 ; 13 ( 2 ): e064291 . OpenUrl Abstract / FREE Full Text 94. ↵ Stanton ME , Higgs ES , Koblinsky M . Investigating Financial Incentives for Maternal Health: An Introduction . J Health Popul Nutr [Internet] . 2013 [cited 2024 Sep 9 ]; 31 ( 4 Suppl 2 ): S1 . Available from: /pmc/articles/PMC4021699/ OpenUrl 95. Whitaker KL , Macleod U , Winstanley K , Scott SE , Wardle J . Help seeking for cancer ‘alarm’ symptoms: a qualitative interview study of primary care patients in the UK . British Journal of General Practice [Internet] . 2015 Feb 1 [cited 2024 Sep 9 ]; 65 ( 631 ): e96 – 105 . Available from: https://bjgp.org/content/65/631/e96 OpenUrl 96. Richard L , Furler J , Densley K , Haggerty J , Russell G , Levesque JF , et al. Equity of access to primary healthcare for vulnerable populations: The IMPACT international online survey of innovations . Int J Equity Health [Internet] . 2016 Apr 12 [cited 2024 Sep 9 ]; 15 ( 1 ): 1 – 20 . Available from: https://link.springer.com/articles/10.1186/s12939-016-0351-7 OpenUrl 97. ↵ McKnight P , Goodwin L , Kenyon S . A systematic review of asylum-seeking women’s views and experiences of UK maternity care . Midwifery . 2019 Oct 1 ; 77 : 16 – 23 . OpenUrl 98. ↵ Brennan N , Barnes R , Calnan M , Corrigan O , Dieppe P , Entwistle V . Trust in the health-care provider–patient relationship: a systematic mapping review of the evidence base . International Journal for Quality in Health Care [Internet] . 2013 Dec 1 [cited 2024 Sep 9 ]; 25 ( 6 ): 682 – 8 . Available from : doi: 10.1093/intqhc/mzt063 OpenUrl CrossRef PubMed 99. ↵ Earnshaw VA , Quinn DM . The Impact of Stigma in Healthcare on People Living with Chronic Illnesses . doi: 10.1177/1359105311414952 [Internet] . 2011 Jul 28 [cited 2024 Sep 9 ]; 17 ( 2 ): 157 – 68 . Available from: https://journals.sagepub.com/doi/10.1177/1359105311414952 OpenUrl CrossRef PubMed Web of Science 100. ↵ Barry CA , Stevenson FA , Britten N , Barber N , Bradley CP . Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor–patient communication in general practice . Soc Sci Med . 2001 Aug 1 ; 53 ( 4 ): 487 – 505 . OpenUrl CrossRef PubMed Web of Science 101. ↵ Bridle L , Bassett S , Silverio SA . “We couldn’t talk to her”: a qualitative exploration of the experiences of UK midwives when navigating women’s care without language . Int J Hum Rights Healthc . 2021 Oct 25 ; 14 ( 4 ): 359 – 73 . OpenUrl 102. ↵ Rayment-Jones H , Harris J , Harden A , Silverio SA , Turienzo CF , Sandall J . Project20: interpreter services for pregnant women with social risk factors in England: what works, for whom, in what circumstances, and how? Int J Equity Health . 2021 Dec 24 ; 20 ( 1 ): 233 . OpenUrl 103. ↵ Khan Z , Vowles Z , Fernandez Turienzo C , Barry Z , Brigante L , Downe S , et al. Targeted health and social care interventions for women and infants who are disproportionately impacted by health inequalities in high-income countries: a systematic review . Int J Equity Health . 2023 Jul 11 ; 22 ( 1 ): 131 . OpenUrl 104. ↵ Wolynn M . It Didn’t Start With You: How inherited family trauma shapes who we are and how to end the cycle. reprint . Random House ; 2022 . 105. ↵ World Health Organization . Health Financing Progress Matrix [Internet] . [cited 2025 Jun 13 ]. Available from: https://www.who.int/teams/health-financing-and-economics/health-financing/diagnostics/health-financing-progress-matrix 106. ↵ Solano G , Huddleston T . Migrant Integration Policy Index . 2020 . 107. ↵ Vohra-Gupta S , Petruzzi L , Jones C , Cubbin C . An Intersectional Approach to Understanding Barriers to Healthcare for Women . J Community Health [Internet] . 2022 Feb 1 [cited 2025 Jun 13 ]; 48 ( 1 ): 89 . Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9589537/ OpenUrl View the discussion thread. Back to top Previous Next Posted July 24, 2025. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. You are going to email the following Understanding care-seeking of pregnant women from underserved groups: A systematic review and meta-ethnography Message Subject (Your Name) has forwarded a page to you from medRxiv Message Body (Your Name) thought you would like to see this page from the medRxiv website. Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Share Understanding care-seeking of pregnant women from underserved groups: A systematic review and meta-ethnography Tisha Dasgupta , Hannah Rayment-Jones , Gillian Horgan , Yesmin Begum , Michelle Peter , Sergio A. Silverio , Laura A Magee medRxiv 2025.07.24.25332124; doi: https://doi.org/10.1101/2025.07.24.25332124 Share This Article: Copy Citation Tools Understanding care-seeking of pregnant women from underserved groups: A systematic review and meta-ethnography Tisha Dasgupta , Hannah Rayment-Jones , Gillian Horgan , Yesmin Begum , Michelle Peter , Sergio A. Silverio , Laura A Magee medRxiv 2025.07.24.25332124; doi: https://doi.org/10.1101/2025.07.24.25332124 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Public and Global Health Subject Areas All Articles Addiction Medicine (568) Allergy and Immunology (863) Anesthesia (300) Cardiovascular Medicine (4435) Dentistry and Oral Medicine (444) Dermatology (382) Emergency Medicine (608) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1509) Epidemiology (15228) Forensic Medicine (30) Gastroenterology (1124) Genetic and Genomic Medicine (6598) Geriatric Medicine (668) Health Economics (997) Health Informatics (4536) Health Policy (1368) Health Systems and Quality Improvement (1613) Hematology (540) HIV/AIDS (1264) Infectious Diseases (except HIV/AIDS) (15916) Intensive Care and Critical Care Medicine (1103) Medical Education (623) Medical Ethics (146) Nephrology (667) Neurology (6599) Nursing (346) Nutrition (998) Obstetrics and Gynecology (1144) Occupational and Environmental Health (957) Oncology (3332) Ophthalmology (974) Orthopedics (369) Otolaryngology (420) Pain Medicine (436) Palliative Medicine (130) Pathology (663) Pediatrics (1693) Pharmacology and Therapeutics (691) Primary Care Research (711) Psychiatry and Clinical Psychology (5447) Public and Global Health (9230) Radiology and Imaging (2198) Rehabilitation Medicine and Physical Therapy (1370) Respiratory Medicine (1196) Rheumatology (593) Sexual and Reproductive Health (712) Sports Medicine (530) Surgery (712) Toxicology (99) Transplantation (289) Urology (265) (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a004c6c9cdd4300f',t:'MTc3OTU0NjgxNQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();