Barriers and opportunities in utilizing maternal healthcare services during antenatal period in urban slum settings in India: A systematic review

Background: In urban slums, pregnant women are a high-risk group with limited access to health facilities due to reported barriers to utilization of maternal health services linked with sociodemographic variations in a few studies. Objective: Our objective is to assess barriers and opportunities in the current utilization of maternal healthcare services during the antenatal period in urban slum settings followed by the development of a conceptual framework utilizing this information to promote the utilization of maternal services in urban slums. Methods: A search was conducted using PubMed with articles published from January 2011 to May 2022. The search terms used were a combination of 'maternal health services, 'antenatal care', 'urban slums', and 'India. Results: A total of eleven studies met inclusion criteria and was critically appraised by two independent reviewers to retrieve relevant information. Most of them were cross-sectional surveys and only one study was a randomized trial that was conducted in the slums of Delhi and Mumbai. The most common age group included in all studies was 15-49 years. The different barriers found in this review include poor access to healthcare, cost, prior experience, domestic responsibility, long distance to facility, long waiting time at the hospital, non-co-operative hospital staff, multiparity, lack of information, and low literacy. Conclusion: Accessibility to healthcare services in urban slums is poor and slum dwellers are still subjected to the hazards of unsafe home deliveries. It is imperative to address different barriers such as poor accessibility, cost, long waiting time, hospital staff behaviour, and efforts to improve maternal literacy. We also proposed a framework to develop an Artificial Intelligence guided tool that will help identify high-risk pregnancies so that they can be motivated to avail of maternal health services more efficiently.