Keywords
Pregnant women
Access to health services
How to Cite
Copyright © | All rights reserved.
The journal holds the exclusive copyright for the publication of this article under the terms of Brazilian law 9610/98.
Partial reproduction
The use of parts of the texts, figures and questionnaire of the article is free, being mandatory the citation of the authors and journal.
Total reproduction
It is expressly prohibited and must be authorized by the journal.
Abstract
Objective: To identify the scientific evidence regarding barriers to access and adherence to prenatal care among pregnant women. Methods: This is an integrative literature review, conducted through consultation of the databases Latin American and Caribbean Literature in Health Sciences (LILACS), Nursing Library (BDENF), and Medical Literature Analysis and Retrieval System Online (MEDLINE). Articles published between 2016 and 2026, in Portuguese, English, and Spanish, available in full text, were included. At the end of the selection, 27 studies were analyzed. Results: The evidence demonstrated that barriers to access and adherence to prenatal care are multifactorial, involving socioeconomic, geographic, organizational, and relational factors. Low income, low education, transportation difficulties, distance from health units, weaknesses in services, and dehumanized care were highlighted. Final considerations: Studies indicate that socioeconomic, geographic, organizational, cultural, and relational factors have a considerable influence on the use of health services during pregnancy. The research also showed that the COVID-19 pandemic exacerbated many of these issues, limiting access to services and worsening existing inequalities.
References
BLACKWELL TM, et al. Using text messaging to improve access to prenatal health information in urban African American and Afro-Caribbean immigrant pregnant women: mixed methods analysis of Text4baby usage. JMIR mHealth and uHealth, 2020; 8 (2): e14737.
BRASIL. Ministério da Saúde. 2016. Protocolos da atenção básica: saúde das mulheres. Disponível em: https://bvsms.saude.gov.br/protocolos-da-atencao-basica/. Acesso em: 07 maio 2026.
BRASIL. Ministério da Saúde. 2024. Painel de Monitoramento da Mortalidade Materna. Disponível em: https://plataforma.saude.gov.br/mortalidade/materna/. Acesso em: 07 maio 2026.
BRASIL. Ministério da Saúde. 2024. Relatório sobre mortalidade materna de mulheres negras é divulgado. Disponível em: https://www.gov.br/saude/pt-br/assuntos/noticias/2024/janeiro/relatorio-sobre-mortalidade-materna-de-mulheres-negras-e-divulgado. Acesso em: 07 maio 2026.
BULCHA G, et al. Maternal health service utilization in the Jimma Zone, Ethiopia: results from a baseline study for mobile phone messaging interventions. BMC Pregnancy and Childbirth, 2024; 24:485.
CHARNLEY M, et al. A qualitative exploration of the experiences of pregnant women living with obesity and accessing antenatal care. PLOS ONE, San Francisco, 2024; 9(5): e0302599.
DITZEL AN, et al. Manejo da Gravidez de Risco e Assistência ao Pré-natal. Brazilian Journal of Implantology and Health Sciences, 2024;6(2): 2393-2408.
FAGBAMIGBE AF, et al. Sub-national analysis and determinants of numbers of antenatal care contacts in Nigeria. BMC Pregnancy and Childbirth, 2021; 21:300.
HAILEMARIAM, S, et al. Exploring COVID-19 related factors influencing antenatal care services uptake: a qualitative study among women in a rural community in southwest Ethiopia. Journal of Primary Care & Community Health, 2021; 12(2150132721996892).
HENSE, TD et al. Ser gestante durante a pandemia de Covid-19. Arquivos de Ciências da Saúde da UNIPAR, 2025; 29(1): 191-207.
HESS SY, et al. Using formative research to promote antenatal care attendance and iron folic acid supplementation in Niger. Maternal & Child Nutrition, Hoboken, 2018;14(2): e12656.
INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTATÍSTICA. 2019. Tábua completa de mortalidade para o Brasil – 2018. Disponível em: https://www.ibge.gov.br/estatisticas/sociais/populacao/9126-tabuas-completas-de-mortalidade.html. Acessado em: 07 de maio de 2026.
KASSA ZY, et al. Women’s experiences of receiving antenatal and intrapartum care during COVID-19 at public hospitals in the Sidama region, Ethiopia: a qualitative study using the combination of three delay and social-ecological framework (hybrid framework). Women’s Health, London), 2024; 20:17455057241274898.
LECHTHALER F, et al. Bottlenecks in the provision of antenatal care: rural settled and mobile pastoralist communities in Chad. Tropical Medicine & International Health, 2018; 23(9): 1033-1044.
LOCKWOOD CS, et al. Chapter 2: Systematic reviews of qualitative evidence. In: Aromataris E, Munn Z (Editors). JBI Reviewer's Manual, 2017.
MAMBA KC, et al. Facility-imposed barriers to early utilization of focused antenatal care services in Mangochi District, Malawi: a mixed methods assessment. BMC Pregnancy and Childbirth, 2017; 17(1): 444.
MARTINELLI KG, et al. Access to prenatal care: inequalities in a region with high maternal mortality in southeastern Brazil. Ciência & Saúde Coletiva, 2016; 21(5):1647-1658.
MARZIALE MH. 2015. Instrumento para recolección de datos revisión integrativa. Disponível em:https://gruposdepesquisa.eerp.usp.br/sites/redenso/wpcontent/uploads/sites/9/2019/09/Instrumiento_revision_litetarura_RedENSO_2015.pdf. Acesso em: 16 out. 2025.
MATOS LS, et al. Recorte raça/cor dos indicadores materno-infantis em uma regional de saúde do estado de Goiás. Revista Científica da Escola Estadual de Saúde Pública de Goiás Cândido Santiago, Goiânia, 2023; 9(9g8):1-18.
MELNYK BM, FINEOUT-OVERHOLT H. Evidence-based practice in nursing and healthcare: a guide to best practice. Philadelphia: Lippincott Williams & Wilkins, 2005; 608p.
MOHER D, et al. Preferred Reporting Items for Systematic Reviews and MetaAnalyses: The PRISMA Statement. PLoS Med, 2009; 6(7): e.1000097.
NGUYEN PH, et al. Provision and utilisation of health and nutrition services during COVID-19 pandemic in urban Bangladesh. Maternal & Child Nutrition, 2021; 17(4): e13218, 2021.
OKONOFUA F, et al. Predictors of women’s utilization of primary health care for skilled pregnancy care in rural Nigeria. BMC Pregnancy and Childbirth, 2018; 18(1): 106.
OLIVEIRA GP, et al. Programa de Humanização no Pré-Natal e Nascimento: integração das políticas públicas na promoção da maternidade segura. Contribuciones a las Ciencias Sociales, 2024; 17(1): 5085-5094.
OLIVEIRA CMW, et al. Acompanhamento pré-natal na atenção primária à saúde: aspectos diagnósticos, preventivos e multiprofissionais. Periódicos Brasil. Pesquisa Científica, 2026; 5(2): 1096-1114.
PÅFS J, et al. Beyond the numbers of maternal near-miss in Rwanda: a qualitative study on women’s perspectives on access and experiences of care in early and late stage of pregnancy. BMC Pregnancy and Childbirth, 2016;16 (1): 257.
PAN K, et al. Effects of Hurricane Michael on access to care for pregnant women and associated pregnancy outcomes. International Journal of Environmental Research and Public Health, 2021;18(2): 390.
PAQUIER L, et al. Do recent immigrants have similar obstetrical care and perinatal complications as long-term residents? A retrospective exploratory cohort study in Brussels. BMJ Open, 2020;10(3): e029683.
REBOUÇAS RRM, et al. Assistência à saúde materna na perspectiva de usuárias e profissionais da Atenção Primária. Physis: Revista de Saúde Coletiva, 2024; 34: e34001, 2024.
ROSÁRIO EVN, et al. Determinants of maternal health care and birth outcome in the Dande Health and Demographic Surveillance System area, Angola. PLOS ONE, 2019;14(8): e0221280.
SAPIENZA C, FOTIA PERNICIARO L. Estudio cualitativo sobre la fragmentación y segmentación del sistema sanitario desde las experiencias de personas gestantes durante la pandemia por Covid-19 en La Plata. Ludovica Pediátrica, 2022;25(02): 27-36.
TAYLOR YJ, et al. Insurance differences in preventive care use and adverse birth outcomes among pregnant women in a Medicaid nonexpansion state: a retrospective cohort study. Journal of Women’s Health, 2020; 29(1): 29-37.
TIRUNEH GT, et al. Predictors of maternal and newborn health service utilization across the continuum of care in Ethiopia: a multilevel analysis. PLOS ONE, 2022; 17(2): e0264612.
TWUM P, et al. Effectiveness of a free maternal healthcare programme under the National Health Insurance Scheme on skilled care: evidence from a cross-sectional study in two districts in Ghana. BMJ Open, 2018; 8(11): e022614.
UNITED NATIONS. The Millennium Development Goals Report 2015. New York: United Nations; 2015.
VAN'T HOOG AH, et al. A study to better understand under-utilization of laboratory tests for antenatal care in Senegal. PLOS ONE, 2020; 15(1): e0225710.
WHITTEMORE R, KNAFL K. The integrative review: updated methodology. Journal of Advanced Nursing, Hoboken, 2005;52(5): 546-553.
WINN A, et al. Caring for pregnant refugee women in a turbulent policy landscape: perspectives of health care professionals in Calgary, Alberta. International Journal for Equity in Health, 2018; 17(1): 91.
WORLD HEALTH ORGANIZATION. Countries commit to recover lost progress in maternal, newborn & child survival. Geneva: WHO, 2024. Disponível em: https://www.who.int/news/item/30-05-2024-countries-commit-to-recover-lost-progress-in-maternal--newborn---child-survival. Acesso em: 07 maio 2026.
WORLD HEALTH ORGANIZATION. Maternal mortality. Geneva: WHO, 2025. Disponível em: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality. Acesso em: 07 maio 2026.
YASUOKA J, et al. Barriers for pregnant women living in rural, agricultural villages to accessing antenatal care in Cambodia: a community-based cross-sectional study combined with a geographic information system. PLOS ONE, 2018;13(3): e0194103.
YOU H et al. Comparing maternal services utilization and expense reimbursement before and after the adjustment of the New Rural Cooperative Medical Scheme policy in rural China. PLOS ONE, 2016; 11(7): e0158473, 2016.