Centering community voices in prenatal care engagement during the COVID-19 pandemic: lived experiences of non-acculturated Hispanic women in California

Conventional prenatal care models often neglect key socioecological influences as well as the cultural and structural needs of marginalized communities, reinforcing disparities and reflecting health systems’ limited recognition of the voices of those they serve. This study explored the lived experiences of non-acculturated Hispanic women in Los Angeles, California, during the COVID-19 pandemic. An Interpretive Phenomenological Approach (IPA) was used to gather the perspectives, lived experiences and context of fourteen foreign born, Spanish speaking women in a medically underserved geographic area in South Los Angeles who attended at least one prenatal appointment between April 2020 and March 2023. Semi-structured interviews facilitated an in-depth exploration of personal and shared experiences, analyzed using descriptive and thematic approaches. Study participants were originally from Mexico, El Salvador and Guatemala. Ninety three percent of the participants were married or with long term partners. The study’s findings revealed that decisions and behaviors related to prenatal care were strategic and adaptive, shaped by the interplay of social support, economic resources, trust in healthcare providers, political contexts, systemic barriers, and cultural/religious values. Women prioritized having family or close social support available during prenatal care and delivery. Theirengagement with prenatal care was also influenced by their perceptions ofqualitycare and trust in providers. Women made adaptive decisions to maintain care during the COVID-19 pandemic while balancing emotional, logistical, and safety considerations, often substituting healthcare staff or enabling services for absent family support. These behaviors highlight how external crises and migration intersect with socioecological determinants to shape prenatal care engagement in this population. The findings highlight critical yet often overlooked insights from the firsthand experiences of non-acculturated Hispanic pregnant women in underserved communities. They underscore an imperative for further research, and to reimagine prenatal care strategies, shifting from one size fits all approaches to more contextually responsive, community informed interventions that actively include the voices of ethnic populations into the delivery of equitable prenatal care.