• W Alanazy, J Rance, and A Brown.
• Department of Public Health, Policy and Social Sciences, Swansea University, Singleton Park, Sketty, Swansea SA2 8PP, UK.
• Midwifery. 2019 Sep 1; 76: 36-44.

ObjectiveEffective antenatal care is important for the health and wellbeing of pregnant women and infants. However, in Saudi Arabia, attendance rates are low, increasing the risk of negative birth outcomes. The aim of this research is to understand the beliefs of pregnant women and health professionals about the factors leading to these low attendance rates.MethodologyA qualitative exploratory study-using semi structured face-to-face interviews. Interviews were conducted exploring (a) attitudes to the use of antenatal care by pregnant Saudi women, (b) beliefs of women regarding the value of antenatal care and (c) perceived barriers to attendance.SettingData were collected from three hospitals in two regions of Saudi Arabia.ParticipantsWomen at any stage of their pregnancy attending for antenatal care or ultrasound, women attending postnatal clinic, and health professionals (obstetricians) who support women during pregnancy and birth.FindingsAlthough mothers viewed antenatal care as important for maternal and infant health, several barriers to attending care were identified by mothers and professionals. These factors were classified into three themes: physical barriers (e.g., lack of transport), low maternal education, and inadequate healthcare facilities (including negative staff attitudes and poor communication). These factors were exacerbated by the beliefs of partners and family. Notably, the theme of low maternal education was raised only by health professionals, whilst the theme of staff attitudes and communication was raised only by mothers.Key ConclusionsBarriers to antenatal care exist at the personal, social, socioeconomic and health services level. Some health professionals may be unaware of the importance of their communication style. Interventions to improve attendance must be multifaceted rather than focussing on individual women alone.Implications For PracticeBarriers for women attending antenatal healthcare must be addressed in order to increase attendance rates. Specific practice-based interventions may involve changing the time or location of services and exploring changes to staff communication with women.Copyright © 2019 Elsevier Ltd. All rights reserved.

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