Global Prevalence of Non-Attendance at Scheduled Antenatal Care Visits and Associated Factors: A Systematic Review, Meta-Analysis, and GRADE Certainty Assessment
Year: 2026
Type: other
Abstract: Description Antenatal care (ANC) is an essential component of maternal and newborn healthcare, providing opportunities to monitor pregnancy progression, identify maternal and fetal complications, deliver preventive interventions, and promote positive pregnancy outcomes. However, attendance at scheduled ANC appointments remains inconsistent in many settings worldwide. Missing planned appointments may interrupt continuity of care, delay the recognition and management of pregnancy-related complications, and reduce opportunities for timely preventive and therapeutic interventions. Understanding the magnitude and determinants of this problem is important for developing effective strategies to improve antenatal care utilization and maternal health outcomes. This systematic review and meta-analysis aims to estimate the global prevalence of non-attendance at scheduled antenatal care visits and identify factors associated with this outcome. The review will examine evidence from observational studies conducted across different geographical regions, healthcare systems, and socioeconomic settings. Particular attention will be given to distinguishing missed scheduled appointments from related but conceptually different outcomes, including failure to initiate antenatal care, discontinuation of care after an initial visit, and failure to complete the recommended number of antenatal care contacts. These outcomes will not be considered interchangeable, and studies will be synthesized according to the definitions and measures they report. The review will include eligible primary observational studies that provide extractable data on non-attendance at scheduled ANC appointments or its associated factors. Relevant information will be collected on study characteristics, population characteristics, geographical setting, operational definitions of non-attendance, measurement methods, prevalence estimates, and reported associations. Potential determinants will include maternal sociodemographic characteristics, educational attainment, economic circumstances, obstetric and pregnancy-related factors, geographical distance, transportation barriers, healthcare costs, waiting times, perceived quality of care, social support, and health-system characteristics. Adjusted association estimates will be prioritized when sufficiently comparable data are available. Where at least three independent studies provide sufficiently comparable data, random-effects meta-analysis will be used to estimate pooled prevalence or synthesize associations. Heterogeneity will be assessed using appropriate statistical measures, and subgroup analyses will explore differences by geographical region, country-income classification, study population, and measurement definition when the available evidence supports meaningful comparisons. Where quantitative synthesis is inappropriate because of substantial differences in definitions, populations, or reported outcomes, findings will be presented through structured narrative synthesis rather than combining incompatible estimates. The methodological quality and risk of bias of included studies will be assessed using an appropriate validated tool. The certainty of evidence for the principal outcomes will be evaluated using the GRADE framework where appropriate, considering risk of bias, inconsistency, indirectness, imprecision, and publication bias when assessable. The review will follow established systematic-review reporting principles, including the PRISMA 2020 guidelines, and will transparently document the literature search, study selection, data extraction, risk-of-bias assessment, and synthesis procedures. The expected outcomes are a comprehensive assessment of the available evidence on missed scheduled ANC appointments, pooled prevalence estimates where justified, and an evidence-based synthesis of factors associated with non-attendance. The findings are expected to identify important evidence gaps, highlight potentially modifiable barriers to appointment attendance, and inform the development of context-sensitive interventions such as appointment reminders, improved scheduling systems, transport support, reduced financial barriers, and strengthened communication between healthcare providers and pregnant women. These interventions will be discussed in light of the available evidence rather than assumed to be effective solely because an associated factor has been identified. By distinguishing appointment non-attendance from broader measures of inadequate antenatal care utilization, this review seeks to provide a more precise and clinically relevant understanding of continuity of antenatal care. The results may support maternal-health policymakers, healthcare administrators, clinicians, and researchers in prioritizing strategies to improve appointment adherence, strengthen continuity of pregnancy care, and guide future research. The conclusions will be limited to the populations, settings, and outcomes represented in the eligible evidence, and the certainty of each principal finding will be considered when formulating recommendations.
Source: Open Science Framework
Author: Habtamu Fekadu Andeta
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7224081908