Barriers to Antenatal Care Uptake Among Migrant Populations in Urban Sub-Saharan Africa

Abstract

Rural-to-urban and cross-border migration in Sub-Saharan Africa has produced growing populations of migrant women whose access to antenatal care remains poorly characterized in routine health system data. This study explores the structural, financial, and social barriers that shape antenatal care uptake among migrant women residing in informal urban settlements. Using a qualitative design combining focus group discussions with migrant mothers and key informant interviews with clinic staff and community health workers, we trace how documentation requirements, unpredictable work schedules, language differences, and perceived discrimination interact to delay first antenatal visits and reduce visit frequency. Findings indicate that informal referral networks among migrant women often substitute for formal health information channels, sometimes reinforcing avoidance of facilities perceived as unwelcoming. Clinic-level factors, including inconsistent enforcement of identification requirements and limited interpreter availability, compound these barriers even where antenatal services are nominally free. We identify feasible facility-level adaptations, such as flexible walk-in scheduling and community health worker outreach embedded within migrant social networks, that participants perceived as most likely to improve engagement. The study contributes context-specific evidence to inform maternal health programming in rapidly urbanizing settings with substantial internal and cross-border migration.