Exploring prenatal care experiences in Ontario, Canada: An equity-oriented qualitative study

Introduction: The extent to which prenatal care is equity-oriented significantly influences patient satisfaction, care-seeking decisions, and health outcomes for both parent and newborn. The social determinants of health shape care experiences, disproportionately affecting marginalized populations (e.g., low-income, rural, racial minorities). This study explores prenatal patients’ care experiences and examines the impact of health inequities on these experiences. Methods: This patient-partner-oriented, cross-sectional, qualitative study was guided by Cochrane’s PROGRESS-Plus equity framework and carried out using a pragmatist paradigm. Purposeful, maximum variation sampling recruited individuals in Ontario, Canada who had been pregnant or experienced pregnancy loss within the last 12 months. Participants completed a 5-minute sociodemographic survey and a 1-hour semi-structured interview on their prenatal care experiences and equity impacts. Analysis included descriptive statistics, and inductive and deductive content analysis. Results: This study included 18 participants, half identifying as racial minorities. All participants interacted with a healthcare professional during pregnancy; most were followed by a primary care physician (n = 16), half by an obstetrician (n = 9), half by a nurse (n = 9), and/or eight by a midwife. Qualitative findings included experiences in accessing care ranging from feelings of powerlessness to continuity of care challenges, influenced by geographical and financial barriers. In addition, experiences of patient-centered care encompassed empathetic practitioners, validation of concerns, and power dynamics, influenced by discrimination and advocacy for personalized support. Conclusions: This study offers an in depth understanding of experiences that have the potential to improve pregnancy care including targeted access to health services in remote areas, diminishing patient-provider hierarchies, culturally-sensitive care approaches for trust-building, and community engagement. Findings can inform healthcare professionals and policymakers about patients’ expectations of equity-oriented prenatal care.