BACKGROUND:
Timely initiation of antenatal care is critical to maximising positive maternal and infant health outcomes. Women from ethnic minority backgrounds in high income countries are likely to initiate antenatal care later than the recommended 10 weeks. These women often experience poor maternal and infant outcomes.

OBJECTIVES:
To explore experiences and perspectives of mothers in an ethnically diverse neighbourhood who started antenatal care late (>10 weeks' gestation) on facilitators and barriers to antenatal care access in the United Kingdom.

METHODS:
We conducted a midwife-led qualitative study using semi-structured interviews with 20 mothers from ethnically diverse backgrounds who initiated ANC late (>10 weeks' gestation) in the East of England region in the United Kingdom. Mothers were recruited through purposive and snowball sampling. Interviews were conducted between October 2024 and January 2025, in-person, online, or via telephone, and were transcribed and analysed using a framework approach.

RESULTS:
Interviews reflected four main themes: perceptions about antenatal care, facilitators and barriers to access, information needs, and strategies to improve antenatal care access. All participants recognised importance of antenatal care, but described lack of awareness about when and how to start care. Differences between maternity care systems in home countries and the UK caused uncertainty for migrant mothers, compounded by fragmented antenatal care pathways, long waiting times, rushed appointments, and language and logistical barriers. Women viewed awareness of antenatal care pathways, presence of friendly and respectful healthcare professionals, midwife-led continuity of carer and support from family and friends as key facilitators for timely access and uptake.

CONCLUSIONS:
Findings highlight the need for co-produced easy-to-navigate antenatal care pathways along with midwife-led continuity of carer, to facilitate equitable antenatal care provision for all mothers.

KEY MESSAGE:
Fragmented care pathways, rushed appointments, and practical challenges create inequalities in timely and adequate access to antenatal care, which need to be addressed through redesigning integrated care pathways. Marginalized - minorities