Antenatal care in Nepal: a qualitative study into missed opportunities in the first trimester

Felicity Greenfield, Mary Lynch, Nashna Maharjan, Miriam Toolan, Katie Barnard, Tina Lavender, Michael Larkin, Nisha Rai, Meena Thapa, Deborah M. Caldwell, Christy Burden, Dharma S. Manandhar, Abi Merriel*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


BACKGROUND Use of timely antenatal care has been identified as key to facilitating healthy pregnancies worldwide. Although considerable investment has been made to enhance maternal health services in Nepal, approximately one-third of women do not attend antenatal care until after the first trimester (late). These women miss out on the benefits of screening and interventions that are most effective in the first trimester. OBJECTIVE This study aimed to identify the missed opportunities of women who do not attend antenatal care in the first trimester, and to explore some of the factors underlying late attendance and consider potential solutions for minimizing these missed opportunities in the future. STUDY DESIGN This study was conducted in 3 hospitals in Nepal. Focus groups (n=18) with a total of 48 postnatal women and 49 staff members, and 10 individual interviews with stakeholders were conducted. Purposive sampling facilitated the obtainment of a full range of maternity experiences, staff categories, and stakeholder positions. Data were qualitative and analyzed using a thematic approach. RESULTS Limited awareness among women of the importance of early antenatal care was reported as a key factor behind attendance only after the first trimester. The family and community were described as significant influencers in women's decision-making regarding the timing of antenatal care. The benefits of early ultrasound scanning and effective supplementation in pregnancy were the major missed opportunities. Increasing awareness, reducing cost, and enhancing interprofessional collaboration were suggested as potential methods for improving timely initiation of antenatal care. CONCLUSION Limited awareness continues to drive late attendance to antenatal care after the first trimester. Investment in services in the first trimester and community health education campaigns are needed to improve this issue and enhance maternal and neonatal outcomes.
Original languageEnglish
Article number100127
JournalAJOG Global Reports
Issue number4
Early online date4 Nov 2022
Publication statusPublished - 30 Nov 2022

Bibliographical note

© 2022 The Authors. This is an open access article under the CC BY license (


  • focus groups
  • folic acid
  • low-income countries
  • pregnancy care
  • South Asia
  • ultrasound scanning


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