Factors Influencing Maternal Healthcare Service Utilization Decisions among Homeless Women: A Qualitative Study

Background: Homeless women experience significant barriers to access maternal healthcare services. Understanding the factors that shape healthcare-seeking decisions of homeless women is essential for developing responsive services. This study examined factors influencing maternal healthcare service utilization decisions among homeless women in Sekondi-Takoradi Metropolis in Ghana. Methods: This qualitative study employed interpretative phenomenological analysis. Using purposive sampling method, 38 homeless women aged 18-42 years who were pregnant or within the postpartum period were recruited from various locations in Sekondi-Takoradi Metropolis between August and November 2023 for the study. Semi-structured face-to-face interviews were conducted using the Fante language, audio-recorded, transcribed verbatim, and analysed thematically. The study adhered to COREQ guidelines. Results: Four major themes emerged regarding motivations to seek care: pregnancy, illness severity, routine check-ups, and no motivation. When asked about the impact of living conditions on healthcare-seeking desires, 25 participants reported substantial negative effects related to financial constraints, physical exhaustion, and lack of time, while 13 reported no impact. Regarding provider preferences, participants chose doctors, nurses, midwives, pharmacists, while some expressed no preference. Homeless women valued professional qualifications and respectful treatment over provider type. Conclusions and global health implications: Maternal healthcare utilization decisions among homeless women are shaped by their immediate health needs, economic constraints, living conditions, and interpersonal experiences with healthcare providers. Pregnancy emerged as a primary motivator for formal care-seeking, while daily survival challenges often supersede preventive health behaviours. Healthcare systems need to adapt service delivery models to address the vulnerabilities of homeless pregnant women through flexible scheduling, reduced financial barriers, and sensitized provider interactions. These adaptations can improve maternal health outcomes and reduce disparities experienced by homeless women in urban low-resource contexts.