Exploration of facilitators and barriers to the implementation of the eight-contact antenatal care model in healthcare facilities in Nigeria

OBJECTIVES: This study explored the facilitators and barriers influencing the implementation of the eight-contact ANC model in selected healthcare facilities in Nigeria. DESIGN: A qualitative study using semi structured interviews. The data were analysed via thematic analysis. A qualitative descriptive design was employed, involving key informant interviews with antenatal care providers and focus group discussions with pregnant women. The interviews were audio recorded and transcribed. SETTING: Antenatal care clinic in selected health facilities. PARTICIPANTS: A purposive sample of 8 antenatal care providers (doctors, nurses, and allied health professionals) who are heads of their departments between November and April 2025 were eligible to participate. Four focus group discussions with pregnant women were held, each group consist of 8 pregnant women, with an age range of 16–38 years, and data saturation was reached. RESULTS: Four themes were identified: (1) implementation status, (2) facilitators of implementation, (3) barriers to implementation, and (4) opinions of pregnant women. Major barriers identified by antenatal care providers include inadequate awareness and training Pregnant women also reported low health literacy, long travel distances, delayed initiation of ANC, and negative provider attitudes as challenges (The way she attended to me was rude”). Providers reported a key finding, willingness to adopt innovations (Training healthcare workers on the latest guidelines in antenatal services will help in implementing any policy that is being introduced”), availability of health education materials, and If there is availability of supplies, we will be able to implement the model. It’s been a while since we got supplies from the government to facilitate ANC services”). CONCLUSIONS: This study offers valuable insight into the experiences of some frontline health professionals working in antenatal clinics. This study concludes that the eight-contact ANC model has not been effectively implemented due to systemic challenges such as insufficient provider training, weak institutional support, and socioeconomic limitations among pregnant women. Although women value ANC services, gaps in awareness, structural constraints, and negative care experiences hinder their full utilization. A disconnect remains between WHO guidelines and real-world clinical practice in these settings.