Barriers to Antenatal Care Attendance in Developing Countries: A Systematic Review

Attendance of antenatal care (ANC) is very crucial in enhancing the health of mothers and fetuses, and many barriers deny women in developing nations the opportunity to receive this important service. This systematic review aimed to identify the major obstacles and facilitators of ANC attendance and explore the determinants of healthcare use in pregnant women. A comprehensive search of PubMed, Google Scholar, and Web of Science was conducted for studies published between 2015 and 2025. Ten studies met the inclusion criteria. These cross-country studies (in Ethiopia, Nigeria, Tanzania, Bangladesh, and Malawi) revealed information on the socioeconomic, cultural, and healthcare system barriers that women are challenged by. The review identified financial constraints, transportation issues, and cultural beliefs as the primary barriers to attending antenatal care. Facilitators associated with this were community-based health programs, male participation, and enhanced healthcare facilities. Specifically, Tanzanian and Ethiopian studies have highlighted the role of health education and community health workers (CHWs) in facilitating ANC attendance. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for non-randomized studies, and the majority of studies demonstrated a low to moderate risk. The results indicate that overcoming economic and cultural barriers, along with improving healthcare access, is crucial for increasing ANC attendance. The interventions that can improve maternal health outcomes include empowerment initiatives, community-based programs, and strategies to enhance transportation access. Future studies should be guided by longitudinal designs and randomized experiments to determine the long-term effects of these interventions on ANC attendance and maternal health.