Rural Women’s Experiences in Accessing Prenatal and Postnatal Health Services: A Qualitative Study

Rural Women’s Experiences in Accessing Prenatal and Postnatal Health Services: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (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],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Rural Women’s Experiences in Accessing Prenatal and Postnatal Health Services: A Qualitative Study iffet güler kaya, hilal başak çakır, Nazire Bahar, Bahar Bayram, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8373535/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Rural women in Turkey continue to face significant challenges in accessing quality maternal healthcare despite improvements in service coverage. Persistent inequalities in healthcare quality, geographic isolation, transportation difficulties, and limited financial resources contribute to reduced prenatal and postnatal care utilization. These barriers may increase the risk of preventable maternal and neonatal complications. Hypothesis: It was hypothesized that women living in rural areas experience interrelated geographical, economic, cultural, and systemic barriers that limit access to maternal healthcare. Conversely, strong family ties, midwife involvement, and community solidarity may act as supportive factors enhancing care access. Methods: A hermeneutic phenomenological approach was employed to explore women’s lived experiences. Data were collected between February and May 2025 through semi-structured interviews with 15 pregnant or postpartum women (≤42 days). Thematic content analysis was conducted using MAXQDA Analytics Pro 2024, and descriptive statistics were analyzed in SPSS Version 28. Results: Findings confirmed multidimensional barriers including transportation problems, lack of awareness, economic hardship, and limited healthcare infrastructure. Facilitators included family support, midwife counseling, and private vehicle ownership. Participants recommended mobile health services, home visits, and educational programs. Conclusion: Structural, social, and cultural factors collectively restrict rural women’s access to maternal care. Strengthening community-based health systems, implementing mHealth initiatives, and empowering midwives through outreach programs are vital for ensuring equitable maternal healthcare. Rural women maternal health prenatal care postnatal care qualitative research healthcare access Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Maternal and neonatal mortality continue to be major indicators of global public health. Despite the considerable progress made in recent years, maternal and infant mortality continues to represent a significant public health problem, particularly in low- and middle-income countries (Boerma et al., 2023; Souza et al., 2023). Sustainable Development Goal 3 (SDG-3) aims to "ensure healthy lives and promote well-being for all at all ages" (UN, 2023). It assesses the performance of countries' health systems using indicators such as maternal mortality rate, neonatal mortality rate, and access to skilled health personnel during childbirth (Boerma et al., 2023; Roder-DeWan et al., 2020). These indicators not only reflect progress in health services but also reveal global and regional inequalities (Izulla et al., 2023). Although significant declines in maternal and neonatal mortality have been observed worldwide, these gains are not evenly distributed. While there has been a decline in mortality rates in high-income countries, the burden remains high in low- and middle-income regions, including sub-Saharan Africa and South Asia. According to data from the World Health Organization (WHO), in 2020, the maternal mortality ratio was 351 per 100,000 live births in Sub-Saharan Africa and 336 in South Asia, while the neonatal mortality rate was reported to be 20 and 43 per 1,000 live births, respectively (Boerma et al., 2023; Nabila et al., 2024). Furthermore, the fact that approximately 40–45% of these deaths occur during delivery or within the first 24 hours highlights the critical importance of the perinatal period (Lawn et al., 2014). The main risk factors associated with maternal mortality are defined as pregnancy at a young age ( 35 years), maternal anemia, abnormal body mass index, history of neonatal loss, and pregnancy complications (Bauserman et al., 2020; Bauserman et al., 2015; Thornton et al., 2023). Conversely, neonatal mortality is strongly associated with premature birth, low birth weight, perinatal asphyxia, and infections (Izulla et al., 2023; Nabila et al., 2024). However, it is acknowledged that these deaths are associated with biological factors, deficiencies in healthcare systems, and socioeconomic barriers. Several factors have been identified as the key determinants of high mortality rates. These include shortages of trained health personnel, low institutional delivery rates, transportation and infrastructure problems, and financial barriers (Boerma et al., 2023; Roder-DeWan et al., 2020). In recent years, the rate of access to prenatal care services in Turkey has exceeded 90%; however, the maternal mortality rate has been reported to be 14.7 per 100,000 live births (Ministry of Health, 2018; TNSA, 2019). This situation indicates that despite quantitative improvements in access, structural gaps persist in terms of quality of care and women's experiences. In addition, an examination of the international literature reveals that millions of women lack access to adequate prenatal and postnatal care, a deficiency that is closely associated with complications and preventable deaths (Durfee et al., 2024; Rodrigues et al., 2023). Research indicates that evidence-based practices can substantially reduce maternal and neonatal mortalities. The expansion of the scope of emergency obstetric and neonatal care, prevention of maternal anemia, and promotion of early breastfeeding after birth are among the most effective strategies in this area (Melesse et al., 2024; Boerma et al., 2023; Amsalu et al., 2022). However, there is a paucity of qualitative studies examining the experiences of women living in rural areas accessing these services from their own perspectives (Faulks et al., 2024; Mayangitan et al., 2022; Meyer et al., 2016). This study aimed to comprehensively examine the experiences of women residing in rural areas when accessing prenatal and postnatal health services. This study identifies the social, cultural, and structural barriers encountered by these women, and reveals their strategies for coping with these barriers. The findings of this study are expected to contribute to the development of accessible, culturally sensitive, and sustainable healthcare service models aimed at improving maternal and neonatal health. Purpose and Design of the Study The primary purpose of this study was to examine the experiences of women living in rural areas regarding access to health services during prenatal and postnatal periods. This study used a hermeneutic-phenomenological, qualitative research design. Hermeneutic phenomenology focuses on understanding the essence of individuals' experiences to reveal how experiences are perceived, interpreted, and structured at the level of consciousness (Korstjens & Moser, 2017; Errasti Ibarrondo et al., 2018; Korstjens & Moser, 2021). This approach was deemed appropriate for revealing how the social, cultural, and structural barriers encountered in accessing healthcare services are reflected in women's lives. Place and Time of Study The study was conducted in a rural area between February 2025 and May 2025. This region was selected because of the prevalence of geographical and infrastructural barriers to accessing healthcare services, and the direct impact of this situation on women's experiences. Participants and Sampling The study sample consisted of 15 women in the prenatal or postnatal period. The number of participants was determined based on the criteria of data saturation in qualitative research. Data saturation was achieved when information obtained from new participants did not add anything to existing data. Snowball sampling was used to select the participants. The first participants were healthcare workers in the region, and the other women were recruited through referrals from these participants (Noy, 2008; Patton, 2015). Inclusion criteria: • Living in a rural area for at least one year • Being in the prenatal period or having given birth within the previous year. Agreement to voluntarily participate in the study Exclusion criteria: • Having cognitive or serious health problems that prevent communication. Data Collection Tools Data were collected using a semi-structured interview form developed based on the literature and supported by expert opinion. Interviews were conducted in two sections. 1. Twelve closed-ended questions inquired about the participants' sociodemographic and obstetric characteristics such as age, education, income, marital status, gravida-parity-abortion, and number of living children. 2. 8 open-ended questions aimed at understanding their experiences of accessing health services. Sample questions include: • Can you describe your experience accessing health services during pregnancy? What difficulties did you encounter when accessing postpartum health services? • How would you rate your interactions with the healthcare workers? What are your suggestions for improving health services? The form was evaluated by four academics and was confirmed to be clear and understandable following pilot interviews with three women. The semi-structured interview guide was developed specifically for this study based on a comprehensive review of the literature and expert opinions and was pilot tested prior to data collection. The final English version of the interview guide is provided as Supplementary File 1. Data Collection Process Interviews were conducted in private rooms set aside in health centers or home settings, according to the participants' preferences. All interviews were conducted in accordance with the principles of confidentiality. The interviews lasted approximately 40–50 minutes, were audio-recorded with the participants' consent, and were transcribed on the same day. All interviews were conducted by the principal investigator (H.B.Ç), who is pursuing a doctorate in women's health and has prior experience in qualitative research. The data collection process continued until no new information emerged and no further repetition was observed. Ethical Principles Approval was obtained from the Ethics Committee of the relevant university for the research, and the necessary permissions were obtained from the institution where the study was to be conducted. Written and verbal informed consent was obtained from all the participants. Participants' identity information was kept confidential and codes (K1, K2, ..., K15) were used to report the data. The participants were given the right to withdraw from the study at any time. Validity and Reliability To ensure the reliability of the research, triangulation (data, researcher, and literature triangulation), independent coder support, and expert opinion were used. The inter-coder agreement was high (Cohen’s κ=0.92), supporting the analytical rigor of the study (Bakeman, 2022). To increase the traceability of the process, all steps were documented in detail and made available for external review (Cypress, 2017). Data Analysis The qualitative data were evaluated using content analysis. First, the interviews were read line-by-line, and open codes were extracted. The codes were then categorized according to their common characteristics and themes were created in the final stage (Corbin & Strauss, 1990). The coding process was performed independently by two researchers, and differences were resolved through discussion. The themes were finalized based on expert opinions. The MAXQDA Analytics Pro 2024 software (VERBI Software, Berlin, Germany) was used for data management. Participants' sociodemographic characteristics were evaluated using descriptive statistics (mean, standard deviation, minimum-maximum values), and IBM SPSS Statistics Version 28 was used for these analyses. Ethical Review This study was approved by the Non-Interventional Clinical Research Ethics Committee of the Istanbul Medipol University (Decision No: 199; date: 02/20/2025). Written permission to conduct the study was obtained from the relevant institutions. This study was conducted in accordance with the principles of the Declaration of Helsinki, the national ethical standards, and relevant legislation. Participants were provided with detailed information about the purpose, scope, and procedures of the study, and written and verbal informed consent was obtained from each participant prior to their participation in the study. Participants’ identity information was kept confidential, and the data were used solely for research purposes. All the participants were granted the right to withdraw from the study at any given time. Sociodemographic and Obstetric Findings The study included 15 women living in rural areas from the prenatal period to the 42nd day postnatal. The age range of participants was 23–39 years, with an average age of 31.06. In terms of educational status, 53.3% of the women were elementary school graduates and 46.7% were high school graduates; none of the women had university education or were illiterate. Only 6.7% of the participants were employed and the vast majority (93.3%) were housewives. In terms of family structure, 73.3% lived in nuclear families, and 26.7% lived in extended families. These sociodemographic characteristics are closely related to women's experiences with health care services. In particular, participants with low levels of education experienced risks related to a lack of information more frequently, whereas women living in extended families found that their elders’ decisions limited their use of healthcare services. Not employed increases economic dependence, reinforces transportation difficulties, and increases access to services. Results Women’s experiences of prenatal and postnatal healthcare services in rural areas were analyzed under four main themes: challenges in meeting healthcare needs, experiences in accessing healthcare services, factors facilitating access, and recommendations for improving services. The distribution of themes, subthemes, and code frequencies is presented in Table 1 , and the hierarchical thematic structure is illustrated in Figure 1 . Challenges in Meeting Prenatal and Postnatal Healthcare Needs in Rural Areas Participants described multiple overlapping challenges that constrained their ability to access prenatal and postnatal healthcare services. Analysis of the interview data revealed that these challenges were not isolated but frequently co-occurred within the same narratives. As shown in Table 1 , the most frequently reported barriers were physical difficulties (n = 14), geographical difficulties (n = 12), and lack of knowledge and awareness (n = 12), followed by economic hardships (n = 2) and health system–related barriers (n = 2). The hierarchical structure of these challenges is shown in Figure 2 . Challenges in Meeting Prenatal and Postnatal Healthcare Needs in Rural Areas Participants described multiple, overlapping, and interrelated challenges that constrained their ability to access prenatal and postnatal healthcare. Analysis of the interview data showed that these challenges were rarely experienced in isolation ; instead, several barriers often co-occurred within the same narratives, reinforcing one another over time. As shown in Table 1 , the most frequently reported barriers were physical difficulties (n = 14), geographical difficulties (n = 12), and lack of knowledge and awareness (n = 12), followed by economic hardships (n = 2) and health system–related barriers (n = 2). The hierarchical structure of these challenges is shown in Figure 2 . Geographical Difficulties Geographical difficulties emerged as a dominant and cross-cutting barrier , particularly among women living in villages located far from health care facilities. Participants repeatedly described transportation as irregular, unavailable, or dependent on others , which limited their ability to attend routine antenatal follow-ups and respond promptly to pregnancy-related concerns. These accounts were frequently accompanied by descriptions of seasonal and weather-related disruptions , further compromising continuity of care. “Access was very difficult. I live in a village, and there are no cars available when you need them.” (K11) “When it snowed, the roads were closed, so I couldn’t go to my pregnancy check-ups.” (K7) “Even if you want to go, you can’t always find someone to take you to the hospital.” (K1) These narratives indicate that transportation barriers functioned as persistent constraints , shaping both routine follow-ups and emergency access. Lack of Knowledge and Awareness Lack of knowledge and awareness were frequently identified in narratives describing delayed care-seeking and missed opportunities for early intervention . Participants reported limited information on pregnancy warning signs, referral timing, and the importance of regular follow-up. These accounts were particularly common among women with lower educational levels and first-time mothers , where uncertainty and inexperience intersected. Insufficient information often results in waiting at home despite concerning symptoms : “My water broke, but I waited. If I had known what that meant, I wouldn’t have given birth early.” (K15) “I was inexperienced with my first pregnancy and didn’t think follow-up visits were necessary.” (K9) “No one explained to us what we should pay attention to during pregnancy.” (K8) Across narratives, limited knowledge appeared alongside family influence and communication gaps , further shaping women’s care-seeking behavior. Physical Difficulties Physical difficulties were another frequently reported barrier, and were most pronounced during the later stages of pregnancy . Women described reduced mobility, fatigue, and pain as factors that made traveling to healthcare facilities physically demanding and exhausting . For mothers with young children, these difficulties were compounded by caregiving responsibilities , further restricting access. “When your belly gets bigger, walking becomes very difficult, and going to check-ups is exhausting.” (K10) “It was very hard to go to the hospital while taking care of my child.” (K1) “After a certain point in pregnancy, even standing for a long time was difficult.” (K6) These accounts suggest that physical limitations are closely associated with geographical and social barriers. Economic Hardships Although mentioned less frequently, economic hardships were present in some narratives and often intersected with transportation barriers to care. Participants described the inability to afford travel costs or access services due to a lack of insurance: “I didn’t have money for transportation, so I could only go once.” (K4) “We didn’t have insurance, so I couldn’t go to the doctor regularly.” (K11) Economic barriers appeared to play a restrictive but indirect role in amplifying other access limitations. Health System–Related Barriers Health system–related barriers reflect structural limitations within rural healthcare services . Participants described inadequate equipment, limited availability of healthcare professionals, and insufficient follow-up mechanisms, which reduced their confidence in local health facilities. “Health centers need improvement; women are not followed up properly.” (K15) “Sometimes there was no doctor or equipment, so we had to look for private care.” (K7) Together, these findings indicate that women’s access to healthcare in rural areas is shaped by a complex interaction of individual, structural, and environmental constraints . Experiences in Accessing Prenatal and Postnatal Healthcare Services Participants’ experiences of accessing healthcare services varied widely and reflected differences in service quality, communication, and provider support quality. As presented in Table 1 , the experiences were grouped into inadequate care and communication (n = 3), midwife support and education (n = 3), and delay in medical intervention (n = 1). These experiential patterns were integrated into the thematic model shown in Figure 1 . Inadequate Care and Communication Reports of inadequate care and communication were characterized by limited interaction, insufficient explanations, and perceived indifference from the healthcare professionals. These experiences were not described as isolated events but as encounters that gradually reduced women’s engagement with services : “I chose not to go anymore because they didn’t care before birth.” (K4) “They didn’t explain things in a way we could understand.” (K8) “I felt ignored when I went for follow-up.” (K9) Midwife Support and Education In contrast, midwife support and education were consistently described as positive, reassuring, and informative experiences , particularly in the postpartum period. Women emphasized the role of midwives in providing practical guidance, emotional reassurance, and continuity , especially for first-time mothers. “During my first birth, the midwives explained everything to us.” (K5) “They showed me how to breastfeed and take care of my baby.” (K6) “Their support after birth made me feel more confident.” (K3) Delay in Medical Intervention Although reported by a single participant, delays in medical intervention were associated with severe and irreversible outcomes , highlighting critical gaps in emergency response capacity. “The doctor came late; my baby suffocated because he was breech.” (K1) Facilitating Factors for Accessing Prenatal and Postnatal Health Services Despite these challenges, participants identified several factors that facilitated access to healthcare services. As shown in Table 1 , family and social support systems (n = 7) were the most frequently reported facilitators, followed by primary healthcare support (n = 4), transportation and private vehicle ownership (n = 4), and private physician support (n = 2). The hierarchical organization of these facilitators is illustrated in Figures 3 and 4 . Family and social support emerged as a key compensatory mechanism , particularly in overcoming transportation and caregiving barriers. “My family was always with me during pregnancy and after birth.” (K6) “They helped me with transportation and childcare.” (K10) “Without my family, I couldn’t have gone to my check-ups.” (K1) Primary healthcare providers were described as accessible and reliable sources of information . “My family doctor’s nurse always informed me.” (K5) “I could easily ask questions at the health center.” (K8) Participants with access to transportation or private vehicles reported greater continuity of care . “I had a car, so I didn’t have any problems going to my appointments.” (K3) “Having a vehicle made everything easier.” (K11) Support from private physicians provided an alternative and responsive pathway to care . “I could reach my doctor anytime by phone.” (K13) “He was very attentive, which made me feel safe.” (K2) Recommendations and Expectations for Improving Prenatal and Postnatal Services in Rural Areas Participants articulated several recommendations for improving prenatal and postnatal healthcare services in rural areas. As shown in Table 1 , the most frequently expressed expectations were mobile health services and transportation support (n = 7), followed by health education programs (n = 4), home visits and regular follow-up (n = 4), active rural health centers (n = 2), and strengthening primary healthcare services (n = 2). These recommendations are shown in Figure 5 . Women emphasized the importance of outreach-based, continuous, and family oriented services . “Health workers should come to the villages.” (K4) “Transportation support is essential.” (K7) “Families should also be educated, not only women.” (K8) “There should be regular home visits during pregnancy.” (K13) Thematic Overview The thematic word cloud ( Figure 6 ) provides a visual summary of the most frequently occurring concepts in the participants’ narratives, highlighting transportation barriers, economic challenges, family support systems, and midwife education as central elements shaping rural prenatal and postnatal healthcare experiences. Discussion This study examined the experiences of women in rural Turkey regarding access to health services during the prenatal and postnatal periods using a hermeneutic-phenomenological approach, filling the gap left by quantitative research with in-depth qualitative data. The findings revealed that multidimensional barriers, such as geographic isolation, transportation difficulties, low health literacy, economic inadequacies, and limited primary care capacity, significantly affected women’s health service utilization rates. This picture reflects not only physical access limitations but also the weakness of social support mechanisms in rural communities and the determinacy of gender roles. In line with data from the Turkish Statistical Institute (TÜİK, 2023), the fact that most women have low levels of education and low labor force participation rates increases their dependency on health behaviors, deepening structural inequalities in service access. These findings are consistent with those of similar studies conducted in Africa. Research conducted in Zambia, Ethiopia, and Tanzania has shown that the main reasons women living in rural areas do not have sufficient access to health services are socioeconomic deficiencies, transportation difficulties, and a shortage of health personnel (Sialubanje et al., 2023; Amsalu et al., 2022). Similarly, in this study, women faced serious barriers to accessing health services, particularly because of long distances, inadequate transportation options, and restrictive attitudes within the family decision-making mechanisms. In extended family structures, the influence of older family members on decision-making limits women's ability to act in accordance with their own health needs. This situation points to a complex network of interactions that shapes women's health in rural contexts, not only at the systemic level but also at the cultural and social levels. This situation demonstrates that rural women's health is shaped not only at the systemic level but also at the cultural and social levels. Cultural norms and a lack of health literacy are other significant factors shaping women's health-seeking behaviors. Hashim et al. (2025) noted that women experiencing hypertensive disorders during pregnancy delayed seeking healthcare because of cultural beliefs and low health literacy levels. Wong Shee et al. (2021) showed that women experiencing pregnancy during adolescence avoided care services because of fear of stigmatization, lack of information, and distrust of healthcare workers. Our study also found that participants missed prenatal checkups due to a lack of information, communication difficulties, and family pressure. These similarities clearly show that health behaviors in rural settings do not develop individually but are intertwined with social norms and values. Therefore, culturally sensitive education and awareness programs should be viewed as complementary to structural reforms. Women's experiences also indicate inequalities in the quality-of-service delivery. Some participants complained about the indifference of health workers, inadequate information sharing, and delays in emergency interventions. This demonstrates that health services in rural areas are inadequate, not only in terms of access but also in terms of their quality. Similarly, the literature indicates that the inability to ensure continuity of care in rural areas and inadequate communication by healthcare workers undermine women's trust (Khatun Nisha et al., 2021; Dawson et al., 2021). In contrast, some women had positive experiences with the guidance of midwives and nurses at the family health centers. This finding clearly demonstrates the critical role of primary healthcare workers who provide informative, empathetic, and continuous counselling in the rural healthcare system (Bala & Roets, 2022). These findings are directly related to global maternal and neonatal health policies. The World Health Organization (WHO, 2017) recommends strengthening the accessibility, continuity, and monitoring capacity of primary care services to reduce maternal and infant mortality rates in rural and disadvantaged areas. Perry et al. (2021) emphasized the impact of income inequality and spatial isolation on maternal mortality. In our study, some women experienced adverse birth outcomes due to a lack of transportation or delayed intervention, demonstrating that systemic deficiencies in service delivery directly impact the health outcomes. Therefore, it is vital to develop active monitoring systems in rural areas and expand monitoring programs for at-risk groups. However, some women's experiences have revealed protective factors that facilitate access. Opportunities such as spousal and family support, private vehicle ownership, and access to private physicians have made it easier to regularly use health services. The fact that social support systems are decisive shows that rural health policies should focus not only on service provision but also on community solidarity mechanisms. Research conducted by Mbuthia et al. (2019) indicated that mobile health (mHealth) applications and digital information systems increase awareness and facilitate access in rural communities. This finding highlights the importance of integrating primary care models with home visits, mobile teams and digital monitoring systems. The suggestions put forward by women demonstrate that rural women can be active participants in the solution and are not merely recipients of services. Women have called for the expansion of mobile health services, strengthening of home-based care systems, increased health education for the community, and restoration of village health centres to full functionality. These suggestions are largely consistent with the literature advocating the strengthening of community-based health systems (Bala & Roets, 2023; Bala & Roets, 2022). These field-based suggestions from women offer policymakers a sustainable roadmap grounded in local realities. Finally, a lack of services in rural areas has both physical and psychosocial consequences. A case reported in Australia, in which a mother experiencing postnatal depression faced difficulties due to social isolation, highlighted the effects of rural life on mental health (Trethewey, 2022). This suggests that a similar lack of social support in rural Turkey may weaken women's psychological well-being. Therefore, primary healthcare services need to be restructured to include not only physical care but also psychosocial counselling components. In general, this study revealed multidimensional barriers to accessing prenatal and postnatal health services for women living in rural areas. These barriers intersect at the geographical, economic, cultural, and systemic levels, directly shaping women's access to health services. Protective factors, such as family support, social solidarity networks, and guidance from primary healthcare workers, provide an important buffer mechanism for mitigating the impact of these barriers. The findings indicate that rural women's health policies need to be restructured using multilevel strategies that focus not only on access, but also on equity, continuity, and service quality. Conclusions and Recommendations This study revealed that women living in rural areas face multidimensional barriers to accessing prenatal and postnatal health services. Geographical distance, transportation constraints, low health literacy, economic inadequacies, and limited capacity of primary care services significantly reduce service utilization. The findings show that access problems stem not only from infrastructure deficiencies but also from sociocultural factors arising from intrafamily decision-making mechanisms and inadequate social support. Strengthening the primary healthcare system and supporting midwives and nurses in their advisory and home-visit roles are priorities. Mobile health (mHealth) solutions can be considered effective tools for reducing access inequalities in information and follow-up processes. Additionally, health literacy programs that include families can strengthen women's early referral and help-seeking behavior. At the policy level, transportation support in rural areas, expansion of mobile teams, and the functionalization of equipped health houses are recommended. The adoption of inclusive, culturally sensitive, community-based health models will support equal and sustainable access to prenatal and postnatal care services for women in rural areas. Limitations This study has several limitations that should be considered when interpreting the findings. First, the study was conducted with a relatively small sample of women living in a specific rural region, which may limit the transferability of the findings to other rural settings with different cultural or healthcare contexts. However, the aim of hermeneutic phenomenological research is depth of understanding rather than generalizability. Second, data were based on self-reported experiences, which may be influenced by recall bias or social desirability. Nevertheless, in-depth interviews conducted in familiar environments allowed participants to express their experiences openly. Finally, the perspectives of healthcare providers were not included in this study. Future research incorporating multiple stakeholder perspectives may provide a more comprehensive understanding of barriers and facilitators to accessing prenatal and postnatal healthcare services in rural areas. Abbreviations WHO: World Health Organization SDG: Sustainable Development Goals mHealth: Mobile health TÜİK: Turkish Statistical Institute MAXQDA: Qualitative Data Analysis Software SPSS: Statistical Package for the Social Sciences Declarations Ethics Approval and Consent to Participate This study was approved by the Non-Interventional Clinical Research Ethics Committee of Istanbul Medipol University (Decision No: 199; Date: February 20, 2025). Written permission to conduct the study was obtained from the relevant institutions. All procedures were carried out in accordance with the principles of the Declaration of Helsinki and national ethical regulations. Written and verbal informed consent was obtained from all participants prior to data collection. Consent for Publication Written informed consent for publication was obtained from all participants. All data were anonymized, and no identifying information was included in the manuscript. Availability of Data and Materials The datasets generated and/or analyzed during the current study are not publicly available due to ethical and confidentiality considerations but are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ Contributions Iffet Guler Kaya contributed to conceptualization, methodology, formal analysis, validation, supervision, and writing—original draft and review & editing. Hilal Basak Cakir contributed to conceptualization, methodology, validation, and writing—original draft and review & editing. Nazire Bahar , Bahar Bayram , and Ayse Kose contributed to data collection, investigation, resources, and writing—review & editing. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank all women who participated in this study for sharing their experiences. We also acknowledge the support of healthcare professionals who facilitated access to the study field. Funding Statement This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The study was conducted independently by the authors as part of an academic project at Istanbul Medipol University. Data Access Statement The data supporting the findings of this study are available from the corresponding author upon reasonable request. Due to privacy and ethical considerations, raw interview transcripts are not publicly available. Conflict of Interest Declaration The authors declare that they have no known competing financial interests or personal relationships that could influence the work reported in this study. Author Contributions (CRediT Statement) Iffet Güler Kaya: Conceptualization, Methodology, Supervision, Writing, Review & Editing. Hilal Başak Çakır: Formal Analysis, Writing – Original Draft, Data Curation. Nazire Bahar: Investigation, Data Collection, Validation. Bahar Bayram: Data Curation, Visualization, and Writing – Original Draft. Ayşe Köse: Project Administration, Literature Review, Writing, Review & Editing References Amsalu, G., Talie, A., Gezimu, W., & Duguma, A. (2022). Non-utilization of postnatal care and its associated factors among women who gave birth in rural districts of Northern Ethiopia: A community-based mixed-method study. Women’s Health, 18 , 1–12. https://doi.org/10.1177/17455057221125091 Bala, H., & Roets, L. (2022). The role of midwives in improving rural maternal health outcomes: a qualitative exploration. African Journal of Primary Health Care & Family Medicine, 14 (1), 1–8. https://doi.org/10.4102/phcfm.v14i1.3265 Bauserman, M., Lokangaka, A., Thorsten, V., Tshefu, A., Goudar, S., Goldenberg, R., Wallace, D., McClure, E., & Bose, C. (2015). Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: a prospective longitudinal cohort analysis. Reproductive Health, 12 (S2), S5–S5. https://doi.org/10.1186/1742-4755-12-s2-s5 Bauserman, M., Thorsten, V., Nolen, T., Patterson, J., Lokangaka, A., Tshefu, A., Patel, A., Hibberd, P., Garcés, A., Figueroa, L., Krebs, N., Esamai, F., Nyongesa, P., Liechty, E., Carlo, W., Chomba, E., Goudar, S., Kavi, A., Derman, R., Saleem, S., Jessani, S., Billah, S., Koso-Thomas, M., McClure, E., Goldenberg, R., & Bose, C. (2020). Maternal mortality in six low- and lower-middle-income countries from 2010 to 2018: Risk factors and trends. Reproductive Health, 17 , 1–12. https://doi.org/10.1186/s12978-020-00990-z Boerma, T., Campbell, O., Amouzou, A., Blumenberg, C., Blencowe, H., Moran, A., Lawn, J., & Ikilezi, G. (2023). Maternal mortality, stillbirths, and neonatal mortality: A transition model based on analyses of 151 countries. The Lancet Global Health, 11 , e1024–e1031. https://doi.org/10.1016/S2214-109X(23)00195-X Campbell, O., Graham, W., & Bustreo, F. (2024). Addressing global inequity in maternal and newborn health through system redesign. BMJ Global Health, 9 , e012345. Dawson, A., Nkowane, A., & Muriuki, P. (2021). Midwives' experiences in providing maternal care in rural contexts: A qualitative systematic review. Midwifery, 97 , 102987. https://doi.org/10.1016/j.midw.2021.102987 Durfee, S., Nazarenko, D., & Agbemenu, K. (2024). Perceptions of rural access to prenatal care in the United States by patients, nurses, midwives, and physicians. MCN: The American Journal of Maternal/Child Nursing, 50 , 30–38. https://doi.org/10.1097/nmc.0000000000001062 Faulks, F., Edvardsson, K., & Shafiei, T. (2024). Barriers and enablers to access perinatal health services for rural Australian women: A qualitative exploration of rural healthcare providers' perspectives. The Australian Journal of Rural Health, 32 (4), 267–278. https://doi.org/10.1111/ajr.13147 Hashim, R., Mohamed, A., & Ibrahim, N. (2025). Cultural beliefs, health literacy, and maternal care seeking among women with hypertensive disorders during pregnancy: A qualitative study. BMC Pregnancy and Childbirth, 25 (1), 112–120. https://doi.org/10.1186/s12884-025-07018-6 Izulla, P., Muriuki, A., Kiragu, M., Yahner, M., Fonner, V., Nitu, S., Osir, B., Bello, F., & De Graft-Johnson, J. (2023). Proximate and distant determinants of maternal and neonatal mortality in the postnatal period: A scoping review of data from low- and middle-income countries. PLOS ONE, 18 (11), e0293479. https://doi.org/10.1371/journal.pone.0293479 Khatun Nisha, M., Islam, R., & Begum, H. (2021). Communication gaps and trust issues in maternal health services in rural Bangladesh: a qualitative study. International Journal of Women’s Health, 13 , 893–903. https://doi.org/10.2147/IJWH.S314902 Lawn, J., Blencowe, H., Oza, S., You, D., Lee, A., Waiswa, P., Lalli, M., Bhutta, Z., Barros, A., Christian, P., Mathers, C., & Cousens, S. (2014). Every Newborn: Progress, priorities, and potential beyond survival. The Lancet, 384 (9938), 189–205. https://doi.org/10.1016/S0140-6736(14)60496-7 Mayangitan, J., Poudel, B., Gulliver, H., Stephenson, C. (2022). Community perceptions of facilitators and barriers to postnatal care access in rural Laos. The European Journal of Public Health, 32 (Suppl. 3). https://doi.org/10.1093/eurpub/ckac130.238 Mbuthia, G., Reid, M., & Fichardt, A. (2019). mHealth in maternal and newborn health care: review of the role of mobile technology in improving health outcomes in rural settings. BMC Public Health, 19 , 117–125. https://doi.org/10.1186/s12889-019-6422-5 Melesse, D., Tadele, A., Mulu, S., Spicer, N., Tadelle, T., Wado, Y., Gajaa, M., Arja, A., Blumenberg, C., Manaye, T., Gonfa, G., Du Plessis, E., Hamilton, E., Mihretu, A., Usamael, A., Mengesha, M., Gelaw, S., Worku, A., Woldie, M., Abate, B., Getachew, T., Wondirad, N., Zelalem, M., Tollera, G., Boerma, T. (2024). Learning from Ethiopia’s success in reducing maternal and neonatal mortality through a health system perspective BMJ Global Health, 9 (5), e011911. https://doi.org/10.1136/bmjgh-2023-011911 Meyer, E., Hennink, M., Rochat, R., Julian, Z., Pinto, M., Zertuche, A., Spelke, B., Dott, A., & Cota, P. (2016). Working towards safe motherhood: Delays and barriers to prenatal care for women in rural and peri-urban areas of Georgia. Maternal and Child Health Journal, 20 (7), 1358–1365. https://doi.org/10.1007/s10995-016-1997-x Nabila, M., Baidani, A., Mourajid, Y., Chebabe, M., Abderraouf, H. (2024). Analysis of risk determinants of neonatal mortality in the last decade: A systematic literature review (2013–2023). Pediatric Reports, 16 , 696–716. https://doi.org/10.3390/pediatric16030059 Perry, L., Singh, R., & Khan, M. (2021). Socioeconomic inequalities and spatial barriers in maternal mortality: a global systematic analysis. Global Public Health, 16 (12), 1823–1838. https://doi.org/10.1080/17441692.2021.1945117 Roder-DeWan, S., Nimako, K., Twum-Danso, N., Amatya, A., Langer, A., Kruk, M. (2020). Health system redesign for maternal and newborn survival: Rethinking care models to close the global equity gap. BMJ Global Health, 5 (10), e002539. https://doi.org/10.1136/bmjgh-2020-002539 Rodrigues, C., Thomaz, É., Batista, R., Riggirozzi, P., De Oliveira Moreira, D., Gonçalves, L., & Lamy, Z. (2023). Prenatal care and human rights: addressing the gap between medical and legal frameworks and the experience of women in Brazil. PLOS ONE, 18 , e0281581. https://doi.org/10.1371/journal.pone.0281581 Sialubanje, C., Massar, K., Hamer, D., Ruiter, R. (2023). Why do women in rural Zambia give birth at home? A qualitative study of barriers to institutional delivery. BMC Pregnancy and Childbirth, 23 (1), 210–225. https://doi.org/10.1186/s12884-023-05312-7 Souza, J., Day, L., Rezende-Gomes, A., Zhang, J., Mori, R., Baguiya, A., Jayaratne, K., Osoti, A., Vogel, J., Campbell, O., Mugerwa, K., Lumbiganon, P., Tunçalp, Ö., Cresswell, J., Say, L., Moran, A., & Oladapo, O. (2023). A global analysis of the determinants of maternal health and transitions in maternal mortality. The Lancet Global Health, 11 , e1452–e1468. https://doi.org/10.1016/S2214-109X(23)00468-0 Trethewey, A. (2022). Postnatal depression and social isolation in rural communities: An Australian case study. Australian Journal of Rural Health, 30 (5), 684–692. https://doi.org/10.1111/ajr.12884 Wong Shee, A., Wilson, K., & McKay, K. (2021). Barriers to adolescent pregnancy care in rural communities: Stigma, knowledge gaps, and healthcare access. Women and Birth, 34 (6), e540–e548. https://doi.org/10.1016/j.wombi.2020.12.004 Table Table.1 Themes and Sub-Themes Representing the Experiences of Women Living in Rural Areas Regarding Prenatal and Postnatal Health Services Theme Sub-theme Code Count Challenges in Meeting Prenatal and Postnatal Healthcare Needs in Rural Areas Geographical difficulties 12 Lack of knowledge and awareness 12 Physical difficulties 14 Economic hardships 2 Health system–related barriers 2 Experiences in Accessing Prenatal and Postnatal Health Services Inadequate care and communication 3 Midwife support and education 3 Delay in medical intervention 1 Facilitating Factors for Accessing Prenatal and Postnatal Health Services Family and social support systems 7 Primary healthcare service support 4 Transportation and private vehicle ownership 4 Support from private physicians 2 Recommendations and Expectations for Improving Prenatal and Postnatal Services in Rural Areas Mobile health services and transportation support 7 Health education programs for women and families 4 Home visits and regular follow-up 4 Active and well-equipped rural health centers 2 Enhancing the functionality of primary healthcare institutions 2 Note. Number of participants = 15. Total code count = 85. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 23 Mar, 2026 Reviews received at journal 19 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviews received at journal 04 Feb, 2026 Reviewers agreed at journal 28 Jan, 2026 Reviewers invited by journal 28 Jan, 2026 Editor invited by journal 13 Jan, 2026 Editor assigned by journal 30 Dec, 2025 Submission checks completed at journal 29 Dec, 2025 First submitted to journal 29 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8373535","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":582652365,"identity":"46efef56-0a43-4820-b5b9-184c17349827","order_by":0,"name":"iffet güler 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08:08:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8373535/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8373535/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101498346,"identity":"adedf872-8fdb-492f-acfe-f8bf6689b90c","added_by":"auto","created_at":"2026-01-30 13:05:55","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":250871,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrenatal and Postnatal Service Experiences in Rural Areas Theme Hierarchical Code Subcode Model\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8373535/v1/999062d0fa4119ecd9021b2f.jpeg"},{"id":101498347,"identity":"b451f323-22fc-4219-9bef-fb64448f7768","added_by":"auto","created_at":"2026-01-30 13:05:55","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":96641,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrenatal and Postnatal Service Challenges in Rural Area Hierarchical Code Subcode Model\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8373535/v1/7ed921562c145259b9d36c74.jpeg"},{"id":101752290,"identity":"88852b0e-1549-4f35-b68d-344e6a194d5b","added_by":"auto","created_at":"2026-02-03 10:26:35","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":95102,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFactors Facilitating Access to Prenatal and Postnatal Healthcare Services Hierarchical Code Subcode Model\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8373535/v1/89bdc3175106cd1d53ede37e.jpeg"},{"id":101752112,"identity":"d0b24093-a27b-4dd8-979e-6b8bec7799b5","added_by":"auto","created_at":"2026-02-03 10:25:29","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":101223,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFactors Facilitating Access to Prenatal and Postnatal Healthcare Services Hierarchical Code Subcode Model\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8373535/v1/c75994f4571c2b894fbf7c61.jpeg"},{"id":101751774,"identity":"e252fbd2-f735-40a1-ae11-b01fa7b7949c","added_by":"auto","created_at":"2026-02-03 10:23:20","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":101179,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRecommendations and Expectations for Improving Prenatal and Postnatal Services in Rural Areas Hierarchical Code Subcode Model\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8373535/v1/82fb7f6ec2959d2759267d86.jpeg"},{"id":101751781,"identity":"cb656671-67d0-40b3-a85c-ce02dfcfc7a7","added_by":"auto","created_at":"2026-02-03 10:23:22","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":2348084,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRural maternal and postnatal healthcare experiences: Thematic word cloud.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe word cloud illustrates key concepts derived from qualitative analysis of rural women’s prenatal and postnatal healthcare experiences. Prominent themes such as “Transportation Limitations,” “Economic Challenges,” “Family and Social Support Systems,” and “Midwife Support and Education” highlight the multifactorial barriers and facilitators influencing maternal health service utilization.\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-8373535/v1/440438a272b97b78d113b7b6.png"},{"id":101755222,"identity":"9d6f90f1-a787-4cb1-bb74-a0a2937e72ef","added_by":"auto","created_at":"2026-02-03 10:49:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5410175,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8373535/v1/87da2163-6b82-4cb2-8158-cc2973874d58.pdf"},{"id":101751710,"identity":"3dfbac0f-9b5a-4682-8adc-faca73a3f962","added_by":"auto","created_at":"2026-02-03 10:22:48","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29967,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8373535/v1/b6da79af0a2593c80b55d4be.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eRural Women’s Experiences in Accessing Prenatal and Postnatal Health Services: A Qualitative Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMaternal and neonatal mortality continue to be major indicators of global public health. Despite the considerable progress made in recent years, maternal and infant mortality continues to represent a significant public health problem, particularly in low- and middle-income countries (Boerma et al., 2023; Souza et al., 2023). Sustainable Development Goal 3 (SDG-3) aims to \"ensure healthy lives and promote well-being for all at all ages\" (UN, 2023). It assesses the performance of countries' health systems using indicators such as maternal mortality rate, neonatal mortality rate, and access to skilled health personnel during childbirth (Boerma et al., 2023; Roder-DeWan et al., 2020). These indicators not only reflect progress in health services but also reveal global and regional inequalities (Izulla et al., 2023). Although significant declines in maternal and neonatal mortality have been observed worldwide, these gains are not evenly distributed. While there has been a decline in mortality rates in high-income countries, the burden remains high in low- and middle-income regions, including sub-Saharan Africa and South Asia. According to data from the World Health Organization (WHO), in 2020, the maternal mortality ratio was 351 per 100,000 live births in Sub-Saharan Africa and 336 in South Asia, while the neonatal mortality rate was reported to be 20 and 43 per 1,000 live births, respectively (Boerma et al., 2023; Nabila et al., 2024). Furthermore, the fact that approximately 40\u0026ndash;45% of these deaths occur during delivery or within the first 24 hours highlights the critical importance of the perinatal period (Lawn et al., 2014). The main risk factors associated with maternal mortality are defined as pregnancy at a young age (\u0026lt;\u0026thinsp;20 years) or advanced age (\u0026gt;\u0026thinsp;35 years), maternal anemia, abnormal body mass index, history of neonatal loss, and pregnancy complications (Bauserman et al., 2020; Bauserman et al., 2015; Thornton et al., 2023).\u003c/p\u003e \u003cp\u003eConversely, neonatal mortality is strongly associated with premature birth, low birth weight, perinatal asphyxia, and infections (Izulla et al., 2023; Nabila et al., 2024). However, it is acknowledged that these deaths are associated with biological factors, deficiencies in healthcare systems, and socioeconomic barriers. Several factors have been identified as the key determinants of high mortality rates. These include shortages of trained health personnel, low institutional delivery rates, transportation and infrastructure problems, and financial barriers (Boerma et al., 2023; Roder-DeWan et al., 2020). In recent years, the rate of access to prenatal care services in Turkey has exceeded 90%; however, the maternal mortality rate has been reported to be 14.7 per 100,000 live births (Ministry of Health, 2018; TNSA, 2019). This situation indicates that despite quantitative improvements in access, structural gaps persist in terms of quality of care and women's experiences. In addition, an examination of the international literature reveals that millions of women lack access to adequate prenatal and postnatal care, a deficiency that is closely associated with complications and preventable deaths (Durfee et al., 2024; Rodrigues et al., 2023). Research indicates that evidence-based practices can substantially reduce maternal and neonatal mortalities. The expansion of the scope of emergency obstetric and neonatal care, prevention of maternal anemia, and promotion of early breastfeeding after birth are among the most effective strategies in this area (Melesse et al., 2024; Boerma et al., 2023; Amsalu et al., 2022). However, there is a paucity of qualitative studies examining the experiences of women living in rural areas accessing these services from their own perspectives (Faulks et al., 2024; Mayangitan et al., 2022; Meyer et al., 2016).\u003c/p\u003e \u003cp\u003eThis study aimed to comprehensively examine the experiences of women residing in rural areas when accessing prenatal and postnatal health services. This study identifies the social, cultural, and structural barriers encountered by these women, and reveals their strategies for coping with these barriers. The findings of this study are expected to contribute to the development of accessible, culturally sensitive, and sustainable healthcare service models aimed at improving maternal and neonatal health.\u003c/p\u003e"},{"header":"Purpose and Design of the Study","content":"\u003cp\u003eThe primary purpose of this study was to examine the experiences of women living in rural areas regarding access to health services during prenatal and postnatal periods. This study used a hermeneutic-phenomenological, qualitative research design. Hermeneutic phenomenology focuses on understanding the essence of individuals\u0026apos; experiences to reveal how experiences are perceived, interpreted, and structured at the level of consciousness (Korstjens \u0026amp; Moser, 2017; Errasti Ibarrondo et al., 2018; Korstjens \u0026amp; Moser, 2021). This approach was deemed appropriate for revealing how the social, cultural, and structural barriers encountered in accessing healthcare services are reflected in women\u0026apos;s lives.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePlace and Time of Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in a rural area between February 2025 and May 2025. This region was selected because of the prevalence of geographical and infrastructural barriers to accessing healthcare services, and the direct impact of this situation on women\u0026apos;s experiences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study sample consisted of 15 women in the prenatal or postnatal period. The number of participants was determined based on the criteria of data saturation in qualitative research. Data saturation was achieved when information obtained from new participants did not add anything to existing data. Snowball sampling was used to select the participants. The first participants were healthcare workers in the region, and the other women were recruited through referrals from these participants (Noy, 2008; Patton, 2015).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; Living in a rural area for at least one year\u003c/p\u003e\n\u003cp\u003e\u0026bull; Being in the prenatal period or having given birth within the previous year.\u003c/p\u003e\n\u003cp\u003eAgreement to voluntarily participate in the study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026bull; Having cognitive or serious health problems that prevent communication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using a semi-structured interview form developed based on the literature and supported by expert opinion. Interviews were conducted in two sections.\u003c/p\u003e\n\u003cp\u003e1. Twelve closed-ended questions inquired about the participants\u0026apos; sociodemographic and obstetric characteristics such as age, education, income, marital status, gravida-parity-abortion, and number of living children.\u003c/p\u003e\n\u003cp\u003e2. 8 open-ended questions aimed at understanding their experiences of accessing health services.\u003c/p\u003e\n\u003cp\u003eSample questions include:\u003c/p\u003e\n\u003cp\u003e\u0026bull; Can you describe your experience accessing health services during pregnancy?\u003c/p\u003e\n\u003cp\u003eWhat difficulties did you encounter when accessing postpartum health services?\u003c/p\u003e\n\u003cp\u003e\u0026bull; How would you rate your interactions with the healthcare workers?\u003c/p\u003e\n\u003cp\u003eWhat are your suggestions for improving health services?\u003c/p\u003e\n\u003cp\u003eThe form was evaluated by four academics and was confirmed to be clear and understandable following pilot interviews with three women.\u003c/p\u003e\n\u003cp\u003eThe semi-structured interview guide was developed specifically for this study based on a comprehensive review of the literature and expert opinions and was pilot tested prior to data collection. The final English version of the interview guide is provided as Supplementary File 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInterviews were conducted in private rooms set aside in health centers or home settings, according to the participants\u0026apos; preferences. All interviews were conducted in accordance with the principles of confidentiality. The interviews lasted approximately 40\u0026ndash;50 minutes, were audio-recorded with the participants\u0026apos; consent, and were transcribed on the same day. All interviews were conducted by the principal investigator (H.B.\u0026Ccedil;), who is pursuing a doctorate in women\u0026apos;s health and has prior experience in qualitative research. The data collection process continued until no new information emerged and no further repetition was observed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Principles\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval was obtained from the Ethics Committee of the relevant university for the research, and the necessary permissions were obtained from the institution where the study was to be conducted. Written and verbal informed consent was obtained from all the participants. Participants\u0026apos; identity information was kept confidential and codes (K1, K2, ..., K15) were used to report the data. The participants were given the right to withdraw from the study at any time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eValidity and Reliability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure the reliability of the research, triangulation (data, researcher, and literature triangulation), independent coder support, and expert opinion were used. The inter-coder agreement was high (Cohen\u0026rsquo;s \u0026kappa;=0.92), supporting the analytical rigor of the study (Bakeman, 2022). To increase the traceability of the process, all steps were documented in detail and made available for external review (Cypress, 2017).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative data were evaluated using content analysis. First, the interviews were read line-by-line, and open codes were extracted. The codes were then categorized according to their common characteristics and themes were created in the final stage (Corbin \u0026amp; Strauss, 1990). The coding process was performed independently by two researchers, and differences were resolved through discussion. The themes were finalized based on expert opinions.\u003c/p\u003e\n\u003cp\u003eThe MAXQDA Analytics Pro 2024 software (VERBI Software, Berlin, Germany) was used for data management. Participants\u0026apos; sociodemographic characteristics were evaluated using descriptive statistics (mean, standard deviation, minimum-maximum values), and IBM SPSS Statistics Version 28 was used for these analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Review\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Non-Interventional Clinical Research Ethics Committee of the Istanbul Medipol University (Decision No: 199; date: 02/20/2025). Written permission to conduct the study was obtained from the relevant institutions. This study was conducted in accordance with the principles of the Declaration of Helsinki, the national ethical standards, and relevant legislation.\u003c/p\u003e\n\u003cp\u003eParticipants were provided with detailed information about the purpose, scope, and procedures of the study, and written and verbal informed consent was obtained from each participant prior to their participation in the study. Participants\u0026rsquo; identity information was kept confidential, and the data were used solely for research purposes. All the participants were granted the right to withdraw from the study at any given time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic and Obstetric Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study included 15 women living in rural areas from the prenatal period to the 42nd day postnatal. The age range of participants was 23\u0026ndash;39 years, with an average age of 31.06. In terms of educational status, 53.3% of the women were elementary school graduates and 46.7% were high school graduates; none of the women had university education or were illiterate. Only 6.7% of the participants were employed and the vast majority (93.3%) were housewives. In terms of family structure, 73.3% lived in nuclear families, and 26.7% lived in extended families.\u003c/p\u003e\n\u003cp\u003eThese sociodemographic characteristics are closely related to women\u0026apos;s experiences with health care services. In particular, participants with low levels of education experienced risks related to a lack of information more frequently, whereas women living in extended families found that their elders\u0026rsquo; decisions limited their use of healthcare services. Not employed increases economic dependence, reinforces transportation difficulties, and increases access to services.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWomen\u0026rsquo;s experiences of prenatal and postnatal healthcare services in rural areas were analyzed under four main themes: challenges in meeting healthcare needs, experiences in accessing healthcare services, factors facilitating access, and recommendations for improving services. The distribution of themes, subthemes, and code frequencies is presented in \u003cstrong\u003eTable 1\u003c/strong\u003e, and the hierarchical thematic structure is illustrated in \u003cstrong\u003eFigure 1\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003eChallenges in Meeting Prenatal and Postnatal Healthcare Needs in Rural Areas\u003c/h3\u003e\n\u003cp\u003eParticipants described multiple overlapping challenges that constrained their ability to access prenatal and postnatal healthcare services. Analysis of the interview data revealed that these challenges were not isolated but frequently co-occurred within the same narratives. As shown in \u003cstrong\u003eTable 1\u003c/strong\u003e, the most frequently reported barriers were physical difficulties (n = 14), geographical difficulties (n = 12), and lack of knowledge and awareness (n = 12), followed by economic hardships (n = 2) and health system\u0026ndash;related barriers (n = 2). The hierarchical structure of these challenges is shown in \u003cstrong\u003eFigure 2\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eChallenges in Meeting Prenatal and Postnatal Healthcare Needs in Rural Areas\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eParticipants described \u003cstrong\u003emultiple, overlapping, and interrelated challenges\u003c/strong\u003e that constrained their ability to access prenatal and postnatal healthcare. Analysis of the interview data showed that these challenges were \u003cstrong\u003erarely experienced in isolation\u003c/strong\u003e; instead, several barriers often co-occurred within the same narratives, reinforcing one another over time. As shown in \u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e the most frequently reported barriers were \u003cstrong\u003ephysical difficulties\u003c/strong\u003e (n = 14), \u003cstrong\u003egeographical difficulties\u003c/strong\u003e (n = 12), and \u003cstrong\u003elack of knowledge and awareness\u003c/strong\u003e (n = 12), followed by \u003cstrong\u003eeconomic hardships\u003c/strong\u003e (n = 2) and \u003cstrong\u003ehealth system\u0026ndash;related barriers\u003c/strong\u003e (n = 2). The hierarchical structure of these challenges is shown in \u003cstrong\u003eFigure 2\u003c/strong\u003e.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eGeographical Difficulties\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eGeographical difficulties emerged as a \u003cstrong\u003edominant and cross-cutting barrier\u003c/strong\u003e, particularly among women living in villages located far from health care facilities. Participants repeatedly described transportation as \u003cstrong\u003eirregular, unavailable, or dependent on others\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e which limited their ability to attend routine antenatal follow-ups and respond promptly to pregnancy-related concerns. These accounts were frequently accompanied by descriptions of \u003cstrong\u003eseasonal and weather-related disruptions\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003efurther compromising continuity of care.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Access was very difficult. I live in a village, and there are no cars available when you need them.\u0026rdquo;\u003c/em\u003e (K11)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When it snowed, the roads were closed, so I couldn\u0026rsquo;t go to my pregnancy check-ups.\u0026rdquo;\u003c/em\u003e (K7)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Even if you want to go, you can\u0026rsquo;t always find someone to take you to the hospital.\u0026rdquo;\u003c/em\u003e (K1)\u003c/p\u003e\n\u003cp\u003eThese narratives indicate that transportation barriers functioned as \u003cstrong\u003epersistent constraints\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e shaping both routine follow-ups and emergency access.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eLack of Knowledge and Awareness\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eLack of knowledge and awareness were frequently identified in narratives describing \u003cstrong\u003edelayed care-seeking and missed opportunities for early intervention\u003c/strong\u003e. Participants reported limited information on pregnancy warning signs, referral timing, and the importance of regular follow-up. These accounts were particularly common among \u003cstrong\u003ewomen with lower educational levels and first-time mothers\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003ewhere uncertainty and inexperience intersected. Insufficient information often results in \u003cstrong\u003ewaiting at home despite concerning symptoms\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My water broke, but I waited. If I had known what that meant, I wouldn\u0026rsquo;t have given birth early.\u0026rdquo;\u003c/em\u003e (K15)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was inexperienced with my first pregnancy and didn\u0026rsquo;t think follow-up visits were necessary.\u0026rdquo;\u003c/em\u003e (K9)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;No one explained to us what we should pay attention to during pregnancy.\u0026rdquo;\u003c/em\u003e (K8)\u003c/p\u003e\n\u003cp\u003eAcross narratives, limited knowledge appeared alongside \u003cstrong\u003efamily influence and communication gaps\u003c/strong\u003e, further shaping women\u0026rsquo;s care-seeking behavior.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003ePhysical Difficulties\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003ePhysical difficulties were another frequently reported barrier, and were \u003cstrong\u003emost pronounced during the later stages of pregnancy\u003c/strong\u003e. Women described reduced mobility, fatigue, and pain as factors that made traveling to healthcare facilities \u003cstrong\u003ephysically demanding and exhausting\u003c/strong\u003e. For mothers with young children, these difficulties were \u003cstrong\u003ecompounded by caregiving responsibilities\u003c/strong\u003e, further restricting access.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When your belly gets bigger, walking becomes very difficult, and going to check-ups is exhausting.\u0026rdquo;\u003c/em\u003e (K10)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It was very hard to go to the hospital while taking care of my child.\u0026rdquo;\u003c/em\u003e (K1)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;After a certain point in pregnancy, even standing for a long time was difficult.\u0026rdquo;\u003c/em\u003e (K6)\u003c/p\u003e\n\u003cp\u003eThese accounts suggest that physical limitations are closely associated with geographical and social barriers.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eEconomic Hardships\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eAlthough mentioned less frequently, economic hardships were present in some narratives and often \u003cstrong\u003eintersected with transportation barriers\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;to care.\u003c/strong\u003e Participants described the inability to afford travel costs or access services due to a lack of insurance:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I didn\u0026rsquo;t have money for transportation, so I could only go once.\u0026rdquo;\u003c/em\u003e (K4)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;We didn\u0026rsquo;t have insurance, so I couldn\u0026rsquo;t go to the doctor regularly.\u0026rdquo;\u003c/em\u003e (K11)\u003c/p\u003e\n\u003cp\u003eEconomic barriers appeared to play a \u003cstrong\u003erestrictive but indirect role\u003c/strong\u003e in amplifying other access limitations.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eHealth System\u0026ndash;Related Barriers\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eHealth system\u0026ndash;related barriers reflect \u003cstrong\u003estructural limitations within rural healthcare services\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eParticipants described inadequate equipment, limited availability of healthcare professionals, and insufficient follow-up mechanisms, which reduced their confidence in local health facilities.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Health centers need improvement; women are not followed up properly.\u0026rdquo;\u003c/em\u003e (K15)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Sometimes there was no doctor or equipment, so we had to look for private care.\u0026rdquo;\u003c/em\u003e (K7)\u003c/p\u003e\n\u003cp\u003eTogether, these findings indicate that women\u0026rsquo;s access to healthcare in rural areas is shaped by a \u003cstrong\u003ecomplex interaction of individual, structural, and environmental constraints\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eExperiences in Accessing Prenatal and Postnatal Healthcare Services\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eParticipants\u0026rsquo; experiences of accessing healthcare services varied widely and reflected differences in \u003cstrong\u003eservice quality, communication, and provider support\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;quality.\u003c/strong\u003e As presented in \u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e the experiences were grouped into \u003cstrong\u003einadequate care and communication\u003c/strong\u003e (n = 3), \u003cstrong\u003emidwife support and education\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(n = 3), and \u003cstrong\u003edelay in medical intervention\u003c/strong\u003e (n = 1). These experiential patterns were integrated into the thematic model shown in\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003eFigure 1\u003c/strong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eInadequate Care and Communication\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eReports of inadequate care and communication were characterized by \u003cstrong\u003elimited interaction, insufficient explanations, and perceived indifference\u003c/strong\u003e from the healthcare professionals. These experiences were not described as isolated events but as encounters that \u003cstrong\u003egradually reduced women\u0026rsquo;s engagement with services\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I chose not to go anymore because they didn\u0026rsquo;t care before birth.\u0026rdquo;\u003c/em\u003e (K4)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;They didn\u0026rsquo;t explain things in a way we could understand.\u0026rdquo;\u003c/em\u003e (K8)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I felt ignored when I went for follow-up.\u0026rdquo;\u003c/em\u003e (K9)\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eMidwife Support and Education\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eIn contrast, midwife support and education were consistently described as \u003cstrong\u003epositive, reassuring, and informative experiences\u003c/strong\u003e, particularly in the postpartum period. Women emphasized the role of midwives in providing \u003cstrong\u003epractical guidance, emotional reassurance, and continuity\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e especially for first-time mothers.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;During my first birth, the midwives explained everything to us.\u0026rdquo;\u003c/em\u003e (K5)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;They showed me how to breastfeed and take care of my baby.\u0026rdquo;\u003c/em\u003e (K6)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Their support after birth made me feel more confident.\u0026rdquo;\u003c/em\u003e (K3)\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eDelay in Medical Intervention\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eAlthough reported by a single participant, delays in medical intervention were associated with \u003cstrong\u003esevere and irreversible outcomes\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e highlighting critical gaps in emergency response capacity.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The doctor came late; my baby suffocated because he was breech.\u0026rdquo;\u003c/em\u003e (K1)\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFacilitating Factors for Accessing Prenatal and Postnatal Health Services\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eDespite these challenges, participants identified several factors that \u003cstrong\u003efacilitated access\u003c/strong\u003e to healthcare services. As shown in \u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e, \u003cstrong\u003efamily and social support systems\u003c/strong\u003e\u003c/strong\u003e (n = 7) were the most frequently reported facilitators, followed by \u003cstrong\u003eprimary healthcare support\u003c/strong\u003e (n = 4), \u003cstrong\u003etransportation and private vehicle ownership\u003c/strong\u003e (n = 4), and \u003cstrong\u003eprivate physician support\u003c/strong\u003e (n = 2). The hierarchical organization of these facilitators is illustrated in \u003cstrong\u003eFigures 3 and 4\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFamily and social support emerged as a \u003cstrong\u003ekey compensatory mechanism\u003c/strong\u003e, particularly in overcoming transportation and caregiving barriers.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My family was always with me during pregnancy and after birth.\u0026rdquo;\u003c/em\u003e (K6)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;They helped me with transportation and childcare.\u0026rdquo;\u003c/em\u003e (K10)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Without my family, I couldn\u0026rsquo;t have gone to my check-ups.\u0026rdquo;\u003c/em\u003e (K1)\u003c/p\u003e\n\u003cp\u003ePrimary healthcare providers were described as \u003cstrong\u003eaccessible and reliable sources of information\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My family doctor\u0026rsquo;s nurse always informed me.\u0026rdquo;\u003c/em\u003e (K5)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I could easily ask questions at the health center.\u0026rdquo;\u003c/em\u003e (K8)\u003c/p\u003e\n\u003cp\u003eParticipants with access to transportation or private vehicles reported \u003cstrong\u003egreater continuity of care\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I had a car, so I didn\u0026rsquo;t have any problems going to my appointments.\u0026rdquo;\u003c/em\u003e (K3)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Having a vehicle made everything easier.\u0026rdquo;\u003c/em\u003e (K11)\u003c/p\u003e\n\u003cp\u003eSupport from private physicians provided an \u003cstrong\u003ealternative and responsive pathway to care\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I could reach my doctor anytime by phone.\u0026rdquo;\u003c/em\u003e (K13)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;He was very attentive, which made me feel safe.\u0026rdquo;\u003c/em\u003e (K2)\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eRecommendations and Expectations for Improving Prenatal and Postnatal Services in Rural Areas\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eParticipants articulated several recommendations for improving prenatal and postnatal healthcare services in rural areas. As shown in \u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e the most frequently expressed expectations were \u003cstrong\u003emobile health services and transportation support\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(n = 7), followed by\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003ehealth education programs\u003c/strong\u003e\u003c/strong\u003e (n = 4), \u003cstrong\u003ehome visits and regular follow-up\u003c/strong\u003e (n = 4), \u003cstrong\u003eactive rural health centers\u003c/strong\u003e (n = 2), and \u003cstrong\u003estrengthening primary healthcare services\u003c/strong\u003e (n = 2). These recommendations are shown in \u003cstrong\u003eFigure 5\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eWomen emphasized the importance of \u003cstrong\u003eoutreach-based, continuous, and family oriented services\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Health workers should come to the villages.\u0026rdquo;\u003c/em\u003e (K4)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Transportation support is essential.\u0026rdquo;\u003c/em\u003e (K7)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Families should also be educated, not only women.\u0026rdquo;\u003c/em\u003e (K8)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There should be regular home visits during pregnancy.\u0026rdquo;\u003c/em\u003e (K13)\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eThematic Overview\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe thematic word cloud (\u003cstrong\u003eFigure 6\u003c/strong\u003e) provides a visual summary of the most frequently occurring concepts in the participants\u0026rsquo; narratives, highlighting \u003cstrong\u003etransportation barriers, economic challenges, family support systems, and midwife education\u003c/strong\u003e as central elements shaping rural prenatal and postnatal healthcare experiences.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the experiences of women in rural Turkey regarding access to health services during the prenatal and postnatal periods using a hermeneutic-phenomenological approach, filling the gap left by quantitative research with in-depth qualitative data. The findings revealed that multidimensional barriers, such as geographic isolation, transportation difficulties, low health literacy, economic inadequacies, and limited primary care capacity, significantly affected women\u0026rsquo;s health service utilization rates. This picture reflects not only physical access limitations but also the weakness of social support mechanisms in rural communities and the determinacy of gender roles. In line with data from the Turkish Statistical Institute (T\u0026Uuml;İK, 2023), the fact that most women have low levels of education and low labor force participation rates increases their dependency on health behaviors, deepening structural inequalities in service access.\u003c/p\u003e \u003cp\u003eThese findings are consistent with those of similar studies conducted in Africa. Research conducted in Zambia, Ethiopia, and Tanzania has shown that the main reasons women living in rural areas do not have sufficient access to health services are socioeconomic deficiencies, transportation difficulties, and a shortage of health personnel (Sialubanje et al., 2023; Amsalu et al., 2022). Similarly, in this study, women faced serious barriers to accessing health services, particularly because of long distances, inadequate transportation options, and restrictive attitudes within the family decision-making mechanisms. In extended family structures, the influence of older family members on decision-making limits women's ability to act in accordance with their own health needs. This situation points to a complex network of interactions that shapes women's health in rural contexts, not only at the systemic level but also at the cultural and social levels. This situation demonstrates that rural women's health is shaped not only at the systemic level but also at the cultural and social levels.\u003c/p\u003e \u003cp\u003eCultural norms and a lack of health literacy are other significant factors shaping women's health-seeking behaviors. Hashim et al. (2025) noted that women experiencing hypertensive disorders during pregnancy delayed seeking healthcare because of cultural beliefs and low health literacy levels. Wong Shee et al. (2021) showed that women experiencing pregnancy during adolescence avoided care services because of fear of stigmatization, lack of information, and distrust of healthcare workers. Our study also found that participants missed prenatal checkups due to a lack of information, communication difficulties, and family pressure. These similarities clearly show that health behaviors in rural settings do not develop individually but are intertwined with social norms and values. Therefore, culturally sensitive education and awareness programs should be viewed as complementary to structural reforms.\u003c/p\u003e \u003cp\u003eWomen's experiences also indicate inequalities in the quality-of-service delivery. Some participants complained about the indifference of health workers, inadequate information sharing, and delays in emergency interventions. This demonstrates that health services in rural areas are inadequate, not only in terms of access but also in terms of their quality. Similarly, the literature indicates that the inability to ensure continuity of care in rural areas and inadequate communication by healthcare workers undermine women's trust (Khatun Nisha et al., 2021; Dawson et al., 2021). In contrast, some women had positive experiences with the guidance of midwives and nurses at the family health centers. This finding clearly demonstrates the critical role of primary healthcare workers who provide informative, empathetic, and continuous counselling in the rural healthcare system (Bala \u0026amp; Roets, 2022).\u003c/p\u003e \u003cp\u003eThese findings are directly related to global maternal and neonatal health policies. The World Health Organization (WHO, 2017) recommends strengthening the accessibility, continuity, and monitoring capacity of primary care services to reduce maternal and infant mortality rates in rural and disadvantaged areas. Perry et al. (2021) emphasized the impact of income inequality and spatial isolation on maternal mortality. In our study, some women experienced adverse birth outcomes due to a lack of transportation or delayed intervention, demonstrating that systemic deficiencies in service delivery directly impact the health outcomes. Therefore, it is vital to develop active monitoring systems in rural areas and expand monitoring programs for at-risk groups.\u003c/p\u003e \u003cp\u003eHowever, some women's experiences have revealed protective factors that facilitate access. Opportunities such as spousal and family support, private vehicle ownership, and access to private physicians have made it easier to regularly use health services. The fact that social support systems are decisive shows that rural health policies should focus not only on service provision but also on community solidarity mechanisms. Research conducted by Mbuthia et al. (2019) indicated that mobile health (mHealth) applications and digital information systems increase awareness and facilitate access in rural communities. This finding highlights the importance of integrating primary care models with home visits, mobile teams and digital monitoring systems.\u003c/p\u003e \u003cp\u003eThe suggestions put forward by women demonstrate that rural women can be active participants in the solution and are not merely recipients of services. Women have called for the expansion of mobile health services, strengthening of home-based care systems, increased health education for the community, and restoration of village health centres to full functionality. These suggestions are largely consistent with the literature advocating the strengthening of community-based health systems (Bala \u0026amp; Roets, 2023; Bala \u0026amp; Roets, 2022). These field-based suggestions from women offer policymakers a sustainable roadmap grounded in local realities.\u003c/p\u003e \u003cp\u003eFinally, a lack of services in rural areas has both physical and psychosocial consequences. A case reported in Australia, in which a mother experiencing postnatal depression faced difficulties due to social isolation, highlighted the effects of rural life on mental health (Trethewey, 2022). This suggests that a similar lack of social support in rural Turkey may weaken women's psychological well-being. Therefore, primary healthcare services need to be restructured to include not only physical care but also psychosocial counselling components.\u003c/p\u003e \u003cp\u003eIn general, this study revealed multidimensional barriers to accessing prenatal and postnatal health services for women living in rural areas. These barriers intersect at the geographical, economic, cultural, and systemic levels, directly shaping women's access to health services. Protective factors, such as family support, social solidarity networks, and guidance from primary healthcare workers, provide an important buffer mechanism for mitigating the impact of these barriers. The findings indicate that rural women's health policies need to be restructured using multilevel strategies that focus not only on access, but also on equity, continuity, and service quality.\u003c/p\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eConclusions and Recommendations\u003c/h2\u003e \u003cp\u003eThis study revealed that women living in rural areas face multidimensional barriers to accessing prenatal and postnatal health services. Geographical distance, transportation constraints, low health literacy, economic inadequacies, and limited capacity of primary care services significantly reduce service utilization. The findings show that access problems stem not only from infrastructure deficiencies but also from sociocultural factors arising from intrafamily decision-making mechanisms and inadequate social support.\u003c/p\u003e \u003cp\u003eStrengthening the primary healthcare system and supporting midwives and nurses in their advisory and home-visit roles are priorities. Mobile health (mHealth) solutions can be considered effective tools for reducing access inequalities in information and follow-up processes. Additionally, health literacy programs that include families can strengthen women's early referral and help-seeking behavior.\u003c/p\u003e \u003cp\u003eAt the policy level, transportation support in rural areas, expansion of mobile teams, and the functionalization of equipped health houses are recommended. The adoption of inclusive, culturally sensitive, community-based health models will support equal and sustainable access to prenatal and postnatal care services for women in rural areas.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations that should be considered when interpreting the findings. First, the study was conducted with a relatively small sample of women living in a specific rural region, which may limit the transferability of the findings to other rural settings with different cultural or healthcare contexts. However, the aim of hermeneutic phenomenological research is depth of understanding rather than generalizability.\u003c/p\u003e \u003cp\u003eSecond, data were based on self-reported experiences, which may be influenced by recall bias or social desirability. Nevertheless, in-depth interviews conducted in familiar environments allowed participants to express their experiences openly.\u003c/p\u003e \u003cp\u003eFinally, the perspectives of healthcare providers were not included in this study. Future research incorporating multiple stakeholder perspectives may provide a more comprehensive understanding of barriers and facilitators to accessing prenatal and postnatal healthcare services in rural areas.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWHO: World Health Organization\u003c/p\u003e\n\u003cp\u003eSDG: Sustainable Development Goals\u003c/p\u003e\n\u003cp\u003emHealth: Mobile health\u003c/p\u003e\n\u003cp\u003eT\u0026Uuml;İK: Turkish Statistical Institute\u003c/p\u003e\n\u003cp\u003eMAXQDA: Qualitative Data Analysis Software\u003c/p\u003e\n\u003cp\u003eSPSS: Statistical Package for the Social Sciences\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Non-Interventional Clinical Research Ethics Committee of Istanbul Medipol University (Decision No: 199; Date: February 20, 2025). Written permission to conduct the study was obtained from the relevant institutions. All procedures were carried out in accordance with the principles of the Declaration of Helsinki and national ethical regulations. Written and verbal informed consent was obtained from all participants prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication was obtained from all participants. All data were anonymized, and no identifying information was included in the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to ethical and confidentiality considerations but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIffet Guler Kaya\u003c/strong\u003e contributed to conceptualization, methodology, formal analysis, validation, supervision, and writing\u0026mdash;original draft and review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHilal Basak Cakir\u003c/strong\u003e contributed to conceptualization, methodology, validation, and writing\u0026mdash;original draft and review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNazire Bahar\u003c/strong\u003e, \u003cstrong\u003eBahar Bayram\u003c/strong\u003e, and \u003cstrong\u003eAyse Kose\u003c/strong\u003e contributed to data collection, investigation, resources, and writing\u0026mdash;review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all women who participated in this study for sharing their experiences. We also acknowledge the support of healthcare professionals who facilitated access to the study field.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The study was conducted independently by the authors as part of an academic project at Istanbul Medipol University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Access Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available from the corresponding author upon reasonable request. Due to privacy and ethical considerations, raw interview transcripts are not publicly available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could influence the work reported in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions (CRediT Statement)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIffet G\u0026uuml;ler Kaya:\u003c/strong\u003e Conceptualization, Methodology, Supervision, Writing, Review \u0026amp; Editing.\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eHilal Başak \u0026Ccedil;akır:\u003c/strong\u003e Formal Analysis, Writing \u0026ndash; Original Draft, Data Curation.\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eNazire Bahar:\u003c/strong\u003e Investigation, Data Collection, Validation.\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eBahar Bayram:\u003c/strong\u003e Data Curation, Visualization, and Writing \u0026ndash; Original Draft.\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eAyşe K\u0026ouml;se:\u003c/strong\u003e Project Administration, Literature Review, Writing, Review \u0026amp; Editing\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmsalu, G., Talie, A., Gezimu, W., \u0026amp; Duguma, A. 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Prenatal care and human rights: addressing the gap between medical and legal frameworks and the experience of women in Brazil. \u003cem\u003ePLOS ONE, 18\u003c/em\u003e, e0281581. https://doi.org/10.1371/journal.pone.0281581\u003c/li\u003e\n\u003cli\u003eSialubanje, C., Massar, K., Hamer, D., Ruiter, R. (2023). Why do women in rural Zambia give birth at home? A qualitative study of barriers to institutional delivery. \u003cem\u003eBMC Pregnancy and Childbirth, 23\u003c/em\u003e(1), 210\u0026ndash;225. https://doi.org/10.1186/s12884-023-05312-7\u003c/li\u003e\n\u003cli\u003eSouza, J., Day, L., Rezende-Gomes, A., Zhang, J., Mori, R., Baguiya, A., Jayaratne, K., Osoti, A., Vogel, J., Campbell, O., Mugerwa, K., Lumbiganon, P., Tun\u0026ccedil;alp, \u0026Ouml;., Cresswell, J., Say, L., Moran, A., \u0026amp; Oladapo, O. (2023). A global analysis of the determinants of maternal health and transitions in maternal mortality. \u003cem\u003eThe Lancet Global Health, 11\u003c/em\u003e, e1452\u0026ndash;e1468. https://doi.org/10.1016/S2214-109X(23)00468-0\u003c/li\u003e\n\u003cli\u003eTrethewey, A. (2022). Postnatal depression and social isolation in rural communities: An Australian case study. \u003cem\u003eAustralian Journal of Rural Health, 30\u003c/em\u003e(5), 684\u0026ndash;692. https://doi.org/10.1111/ajr.12884\u003c/li\u003e\n\u003cli\u003eWong Shee, A., Wilson, K., \u0026amp; McKay, K. (2021). Barriers to adolescent pregnancy care in rural communities: Stigma, knowledge gaps, and healthcare access. \u003cem\u003eWomen and Birth, 34\u003c/em\u003e(6), e540\u0026ndash;e548. https://doi.org/10.1016/j.wombi.2020.12.004\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable.1 Themes and Sub-Themes Representing the Experiences of Women Living in Rural Areas Regarding Prenatal and Postnatal Health Services\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003eTheme\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003eSub-theme\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003eCode Count\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003eChallenges in Meeting Prenatal and Postnatal Healthcare Needs in Rural Areas\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eGeographical difficulties\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e12\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eLack of knowledge and awareness\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e12\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003ePhysical difficulties\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e14\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eEconomic hardships\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eHealth system\u0026ndash;related barriers\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003eExperiences in Accessing Prenatal and Postnatal Health Services\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eInadequate care and communication\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eMidwife support and education\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e3\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eDelay in medical intervention\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e1\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003eFacilitating Factors for Accessing Prenatal and Postnatal Health Services\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eFamily and social support systems\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003ePrimary healthcare service support\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eTransportation and private vehicle ownership\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eSupport from private physicians\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003eRecommendations and Expectations for Improving Prenatal and Postnatal Services in Rural Areas\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eMobile health services and transportation support\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e7\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eHealth education programs for women and families\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eHome visits and regular follow-up\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eActive and well-equipped rural health centers\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003eEnhancing the functionality of primary healthcare institutions\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote. Number of participants = 15.\u003cbr\u003eTotal code count = 85.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Rural women, maternal health, prenatal care, postnatal care, qualitative research, healthcare access","lastPublishedDoi":"10.21203/rs.3.rs-8373535/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8373535/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003cbr\u003e\nRural women in Turkey continue to face significant challenges in accessing quality maternal healthcare despite improvements in service coverage. Persistent inequalities in healthcare quality, geographic isolation, transportation difficulties, and limited financial resources contribute to reduced prenatal and postnatal care utilization. These barriers may increase the risk of preventable maternal and neonatal complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypothesis:\u003c/strong\u003e\u003cbr\u003e\nIt was hypothesized that women living in rural areas experience interrelated geographical, economic, cultural, and systemic barriers that limit access to maternal healthcare. Conversely, strong family ties, midwife involvement, and community solidarity may act as supportive factors enhancing care access.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003cbr\u003e\nA hermeneutic phenomenological approach was employed to explore women’s lived experiences. Data were collected between February and May 2025 through semi-structured interviews with 15 pregnant or postpartum women (≤42 days). Thematic content analysis was conducted using MAXQDA Analytics Pro 2024, and descriptive statistics were analyzed in SPSS Version 28.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003cbr\u003e\nFindings confirmed multidimensional barriers including transportation problems, lack of awareness, economic hardship, and limited healthcare infrastructure. Facilitators included family support, midwife counseling, and private vehicle ownership. Participants recommended mobile health services, home visits, and educational programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003cbr\u003e\nStructural, social, and cultural factors collectively restrict rural women’s access to maternal care. Strengthening community-based health systems, implementing mHealth initiatives, and empowering midwives through outreach programs are vital for ensuring equitable maternal healthcare.\u003c/p\u003e","manuscriptTitle":"Rural Women’s Experiences in Accessing Prenatal and Postnatal Health Services: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-30 13:05:50","doi":"10.21203/rs.3.rs-8373535/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-23T05:46:41+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T19:26:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138045534171609285432807489548764879902","date":"2026-03-18T16:39:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-04T05:16:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5755685618607844450213601481503119087","date":"2026-01-28T11:55:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-28T08:00:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-13T11:34:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-30T05:27:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T21:11:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-12-29T21:06:22+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2a52947b-a0f0-42e2-8c7f-b0d4b60a6eea","owner":[],"postedDate":"January 30th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T06:39:43+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-30 13:05:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8373535","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8373535","identity":"rs-8373535","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}