Exploring the barriers to accessing antenatal care at the primary health care center level of a tertiary hospital in Lebanon: a qualitative study

BACKGROUND: Access to antenatal care (ANC) is vital for improving maternal and neonatal outcomes. However, barriers to ANC remain a challenge, particularly in resource-limited settings such as Lebanon. This study examines the barriers pregnant women in Lebanon face when accessing ANC at a primary healthcare center (PHCC) in a public tertiary hospital located in Beirut, Lebanon. METHODS: This qualitative study explored the perspectives of 17 pregnant women receiving ANC at the Rafic Hariri University Hospital (RHUH) PHCC. Semi-structured interviews were conducted to gather in-depth insights into their experiences with ANC services. Verbatim transcripts of the interviews were analyzed using an inductive-deductive thematic approach, identifying several barriers to ANC at the PHCC level. Levesque's framework was used to identify key barriers to antenatal care across five dimensions of access, providing a structured approach to understanding challenges in service utilization at the study site. RESULTS: The key barriers to accessing ANC services identified in the study include cultural influences, inadequate health literacy, and financial constraints, which delayed care-seeking and fostered mistrust between pregnant women and healthcare providers. Systemic inefficiencies such as long wait times, overcrowding, and poorly organized appointment processes further limited accessibility, while discrimination and communication barriers reduced engagement in care. Additionally, logistical challenges like time constraints, transportation issues, and staff shortages exacerbated by employee strikes, along with the ongoing economic crisis, affected both the affordability and quality of ANC services at RHUH. CONCLUSION: Improving health literacy, streamlining service delivery, and enhancing patient-provider communication are key recommendations. Future efforts should focus on strengthening financial support, addressing logistical barriers, and regularly updating strategies to adapt to evolving challenges, ensuring equitable access to maternal care.