Exploring barriers and facilitators to achieving quality antenatal care in Ethiopia: a qualitative study

Quality antenatal care (ANC) is vital for reducing maternal and neonatal mortality and promoting long-term health; however, despite substantial gains in ANC coverage in Ethiopia over the past two decades, the quality of care remains low. This study aimed to explore barriers and facilitators of quality ANC provision and utilisation in Addis Ababa, Ethiopia.

We conducted exploratory in depth individual and focus group interviews with thirty-five purposively selected pregnant women and midwives from three healthcare facilities between December 2, 2024, and January 30, 2025. We interviewed pregnant women who received ANC and midwives who provided ANC at the facilities during the data collection period. We conducted interviews using an Amharic-based interview guide, audio-recorded, transcribed verbatim, translated into English, and analysed the data using NVivo 12 software. We employed thematic analysis to systematically identify and categorise the barriers and facilitators.

We identified barriers and facilitators related to facilities, midwives, and pregnant women that influence the provision and utilisation of quality ANC. Barriers included analogue medical records, limited ultrasound service days, unnecessary referrals and referral bias, deficits in physical and human resources, midwives' disengagement and unpunctuality, women's limited awareness and trust in ANC, emergency-driven care-seeking behaviour, and financial strain. Facilitators included pilot digitisation of medical records, affordability of available services, accessibility of facilities, midwives' collaborative learning, midwife-led services, and women's empowered voices during consultations.

Our study identified multiple barriers and facilitators influencing the provision and utilisation of quality ANC in Ethiopia, which warrant attention from policymakers. Equipping facilities with adequate physical and human resources, implementing efficient systems such as appropriate referral mechanisms and fully digitised medical records, acknowledging midwives' contributions, providing opportunities for continuous professional development, and promoting women's education and empowerment are crucial for improving both service provision and utilisation, thereby reducing maternal and neonatal mortality.