Factors contributing towards women booking late for antenatal care in the UK

Background: In order to improve outcomes for mothers and babies, and to fully utilise the antenatal screening programmes in the UK, women are advised to access antenatal care prior to 10 weeks gestation. This study aims to identify reasons as to why women may book late for antenatal care. Methods: A structured systematic literature search was undertaken using a PICO framework to identify research papers that focused upon barriers leading to late booking for antenatal care in the UK. Inclusion criteria were articles published in English between January 2001 and October 2020. Electronic databases (PubMed, CINAHL, Cochrane, NICE, internurse, Google Scholar, Scopus, ScienceDirect and OpenGrey) were searched using a combination of terms such as ‘antenatal’, ‘late booking’, ‘barriers’ and ‘UK’. Articles were critically assessed for inclusion and 10% of these were then independently screened by a second reviewer to ensure validity; Thematic analysis was then undertaken to identify the most commonly occurring themes. Ethical approval: Ethical approval was not required as all literature utilised was available in the public domain. Findings: The database search identified 1964 papers published between 2001– 2020. After removing duplicates, 1642 were of potential interest. Following screening of the title and abstract, 1624 were excluded because of lack of specificity to the study criteria. The full texts of 18 papers were assessed and a further 6 excluded, resulting in 12 papers for critical review. From these 12 papers with10 common themes were identified. These were Social/Lifestyle factors, Ethnicity, Awareness/acceptance of pregnancy, Unaware of importance/need to book early, Language barriers and Previous antenatal care experience. Other issues such as Maternal age, Religious/cultural beliefs, Service provider issues and Multiparity were also identified. Discussion and conclusions: Factors leading to late booking were complex, with many of the themes being intrinsically linked. Difficult social circumstances, lack of support, judgement by care providers and language barriers were strongly associated with women not being able to, or not choosing to, access care. Improved accessibility to services, provision of childcare, the use of interpreters and community engagement projects are recommended to improve early access to antenatal care.