Barriers and Enablers to Supplying Low-Dose Aspirin in Pregnancy: A Qualitative Study of Pharmacists’ Perspectives

Background Low-dose aspirin (LDA) is recommended to reduce the risk of pre-eclampsia and other placental dysfunction disorders when initiated before 16 weeks’ gestation in women at increased risk. Despite strong evidence for benefit and international guidance recommending it, uptake and adherence remain suboptimal. Pharmacists are well placed to support access, counselling and adherence; however, pharmacists’ perspectives on facilitating LDA use in pregnancy have not previously been explored. Methods A qualitative study was conducted using semi-structured interviews with community and general practice-based pharmacists within a UK Integrated Care System (Bristol, North Somerset and South Gloucestershire). Participants were purposively sampled to capture variation in professional role and practice setting. Interviews were informed by the Theoretical Domains Framework (TDF), recorded, transcribed and analysed thematically using Braun and Clarke’s six-step approach. Results Twelve pharmacists participated. Four interrelated themes were identified: (1) Foundations of professional practice – variable knowledge of LDA in pregnancy and limited formal training reduced confidence and promoted risk-averse practice; (2) Barriers and enablers within the maternity care pathway – fragmented communication, incomplete documentation and off-label licensing status delayed initiation and constrained supply; (3) The Role of the Pharmacist and Professional Boundaries – pharmacists’ involvement was largely reactive, with governance mechanisms such as protocols and patient group directions viewed as necessary to enable practice; and (4) Communication as an enabler of patient understanding and adherence – inconsistent patient contact, lack of standardised patient information, and challenges related to health literacy and language limited effective counselling. Conclusion Pharmacists’ contribution to LDA use in pregnancy is constrained by limited pregnancy-specific training, fragmented care pathways and unclear professional responsibility. Addressing these capability and opportunity related barriers through targeted education and clearer prescribing and supply pathways may improve timely initiation and support women’s adherence to evidence-based prevention of placental dysfunction. Trial registration: Not applicable.