Women’s experiences of seeking and receiving childbirth care in low- and middle-income countries: A systematic review

Background : Reducing maternal mortality requires an in-depth understanding of its underlying determinants, including women’s experiences of care-seeking during pregnancy and childbirth. In many low- and middle-income countries (LMICs), delays in recognising complications, making decisions, and accessing emergency care contribute substantially to preventable maternal deaths. Cultural norms, family decision-making dynamics, and inadequate communication between women and healthcare providers (HCPs) further shape care-seeking trajectories. Objective : To synthesise qualitative evidence on women’s experiences of seeking care during childbirth in LMICs, focusing on barriers and facilitators that influence their decisions, interactions with providers, and perceptions of childbirth services. Design : Qualitative evidence synthesis. Data sources : EMBASE, MEDLINE, MIDIRS, CINAHL, PsycINFO, Web of Science, citation chaining, and reference list screening. Methods : Studies were screened by title, abstract and full text. The CASP qualitative checklist was used to appraise study quality, and findings were synthesised thematically. Results : Fourteen qualitative studies met the inclusion criteria. Five overarching themes were identified: 1) Birth attendant and place of birth preferences; 2) Sociocultural and family factors; 3) Communication and information provision; 4) Disrespect and abuse; 5) Barriers in seeking care during childbirth. Conclusion : Women’s childbirth experiences in LMICs are shaped by an interplay of structural, interpersonal, and sociocultural factors. Improving maternal health requires more than expanding facility access; it necessitates respectful, culturally sensitive, and person-centred care, alongside strengthened transport systems, financial protection, and community engagement. Integrated approaches that address both structural and relational barriers are essential to improve utilisation, quality and equity of childbirth care.