Individual factors had limited ability to explain antenatal care access

What the study found: Individual-level socioeconomic and demographic variables alone had limited ability to explain antenatal care (ANC, prenatal care during pregnancy) completion among disadvantaged pregnant women. The authors also found that broader social vulnerability was associated with inadequate or delayed prenatal care in the studies they reviewed.
Why the authors say this matters: The authors conclude that the findings suggest broader structural and health system-level factors may be important for access to antenatal care, not just individual socioeconomic status.
What the researchers tested: The study combined secondary data from 2,019 women in the Institute for Health Metrics and Evaluation dataset with a systematic review and meta-analysis following PRISMA 2020 guidelines. It used multivariable logistic regression and exploratory machine learning methods (K-Nearest Neighbors and XGBoost) to assess how well individual-level variables predicted ANC completion, and a random-effects meta-analysis to pool adjusted odds ratios from observational studies.
What worked and what didn't: In the IHME dataset, socioeconomic status was not significantly associated with ANC completion after adjustment (aOR = 0.97; 95% CI: 0.78–1.21), and the predictive models performed poorly (AUC range: 0.49–0.50). In contrast, a meta-analysis of six studies found that socioeconomic disadvantage was significantly associated with inadequate or delayed prenatal care (pooled aOR = 1.96; 95% CI: 1.26–3.07), with substantial heterogeneity across studies. The review also combined indicators such as migrant status and neighborhood risk as proxies for broader social vulnerability.
What to keep in mind: The meta-analysis included only six studies and showed substantial heterogeneity. The abstract does not describe other limitations beyond the use of proxy indicators for social vulnerability.

Key points

• Individual-level socioeconomic status was not significantly linked to ANC completion in the IHME dataset after adjustment.
• The prediction models for ANC completion performed poorly, with AUC values from 0.49 to 0.50.
• Across six studies, socioeconomic disadvantage was associated with inadequate or delayed prenatal care.
• The pooled estimate for the meta-analysis was aOR 1.96, with substantial heterogeneity.
• The authors suggest broader structural and health system-level factors may matter for ANC access.