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Cited by 5Global Maternal and Child HealthMigration, Health and TraumaMaternal and Neonatal Healthcare

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Navigating challenges in access to antenatal and intrapartum care: Afghan refugee women’s experiences amidst the COVID-19 pandemic in Pakistan

Open access
Shafiq, Yasir, Muhammad, Ameer, Suhag, Zamir Hussain, Tahir, Rehman, Jan, Abdullah, Atiq, Huba, Khakwani, Shayan, Ahmed, Muhammad, Eva, Dua, Ragazzoni, Luca, Barone-Adesi, Francesco, Valente, Martina·2025·Women's Health
DOI 10.1177/17455057251347081PMC PMC12188067
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Abstract

Background: Balochistan, Pakistan’s most economically and health system-deprived province, hosts a significant portion of the Afghan refugee population. The province’s already fragile healthcare infrastructure faces additional strain due to the refugees. Objective: This study aimed to investigate the barriers to antenatal and intrapartum care seeking among Afghan refugee women in Balochistan during the Coronavirus disease 2019 (COVID-19) pandemic. Design: This study employed a cross-sectional survey approach to assess antenatal and intrapartum care-seeking behavior among Afghan refugee women residing in Balochistan, Pakistan. The study focused on refugee women living in Kharotabad Union Council in Quetta city to understand their barriers to accessing maternal healthcare services. Methods: The survey focused on antenatal and childbirth care-seeking behaviors among married women of reproductive age (MWRA) with at least one child aged 12–23 months born during the first four waves of COVID-19 in Pakistan. Results: Of 480 MWRAs, only 36.9% sought antenatal care (ANC); only 13.1% received at least four ANC visits. Furthermore, only 38.8% of MWRA had skilled birth attendance. Only 32.9% of MWRAs received at least one ANC and had skilled birth attendance (i.e., comprehensive care). Accessing comprehensive care was associated with maternal age less than 25 years (adjusted odds ratio (OR): 0.40; 95% confidence interval (CI): 0.21, 0.78), Tajik ethnicity (adjusted OR: 0.40; 95% CI: 0.23, 0.70) and large family size (adjusted OR: 0.58; 95% CI: 0.37, 0.93). Predictors of poor access were concern related to documentation of the refugee women they faced (adjusted OR: 1.52; 95% CI: 1.00, 2.34), women with no one at household to accompany them at health facility (adjusted OR: 1.75; 95% CI: 1.13, 2.70), myths and misconceptions related to available care (adjusted OR: 1.89; 95% CI: 1.18, 3.02), and the transport availability (adjusted OR: 1.76; 95% CI: 1.12, 2.77). Concerns related to COVID-19 had no association. Conclusion: The study highlights the barriers to maternal, neonatal and child health service utilization among Afghan refugee women in Balochistan. Tailoring healthcare services to consider age, ethnicity, cultural dynamics, and system constraints is crucial for improving access.

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Figure 1. The study flow diagram.
Figure 1. The study flow diagram.CC BY-NC · PubMed Central
Figure 2. The level of satisfaction with services during pregnancy and childbirth.
Figure 2. The level of satisfaction with services during pregnancy and childbirth.CC BY-NC · PubMed Central

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Metadata

Authors
Shafiq, Y., Muhammad, A., Suhag, Z. H., Tahir, R., Jan, A., Atiq, H., Khakwani, S., Ahmed, M., Eva, D., Ragazzoni, L., Barone-Adesi, F., & Valente, M.
Affiliations
  • Aga Khan University (PK)
  • Vital Pakistan Trust (PK)
  • Trust for Vaccines & Immunization (PK)
  • Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT)
  • CRIMEDIM–Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy
Corresponding author
Shafiq, Yasir
ORCID
Venue
Women's Health
Publisher
SAGE Publications
Published
2025-06-24
Volume
21
Pages
17455057251347081-17455057251347081
ISSN
  • 1745-5057 (ISSN-L)
  • 1745-5065
DOI
10.1177/17455057251347081
PMC
PMC12188067
OpenAlex
W4411597475
Cited by
5
References
4
Citations by year
2026: 3 · 2025: 2
FWCI
7.61
Type
journal article
Language
en
Open access
Licence
Locations
  • Women s Health (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • eCommons - AKU (Aga Khan University) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
Keywords
prenatal care, intrapartum care, access to maternal health services, COVID-19 pandemic, skilled birth attendance, barriers to care, refugee documentation, myths and misconceptions, maternal age, family size, Balochistan, Quetta, obstetric care
MeSH terms
COVID-19, SARS-CoV-2, Adolescent, Adult, Afghanistan, Cross-Sectional Studies, Female, Health Services Accessibility, Humans, Maternal Health Services, Pakistan, Patient Acceptance of Health Care, Pregnancy, Prenatal Care, Refugees, Young Adult, Pandemics

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